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Stress Echo Procedure | Everything you need to know
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- เผยแพร่เมื่อ 31 ก.ค. 2024
- The stress echo procedure is a safe and painless diagnostic test that uses high-frequency sound waves called ultrasound to capture moving images of the heart. It is often called stress cardiac ultrasound or an echo with a stress component. Soundwaves are directed at the heart from a small handheld transducer which is placed on your chest using gel to improve soundwave transmission. This is a test that evaluates blood flow to the heart to check for “blockages” in the heart arteries. It can assess chest pain, shortness of breath, fainting spells, heart rhythm problems, and known heart disease. It gives information about diagnosis, prognosis, and treatment effects. It gives ECG data as well as the echo/ultrasound data. It has much better accuracy compared to a treadmill stress ECG test. Its accuracy is the same as a “Thallium or Cardiolyte” nuclear stress test but at 1/3 the cost and without radiation exposure. It is provides more information about the structure/function of the heart and is much faster. The risks are the same as any stress test. A heart attack or other serious life threatening complication occurs in 1 in 5,000 tests. We have the necessary equipment/medication if this occurs.
The test takes 60 minutes in total. Patients will typically exercise for 6-10 minutes. The majority of my stress tests I use the supine bike is a vast majority of patients prefer this form of exercise to treadmill exercise. Utilizing the bike allows us to image throughout exercise so that we can diagnose an abnormality when it first occurs which makes the test safer. The ability to image throughout exercise as well as immediately after exercise improves picking up abnormalities as opposed to treadmill stress echo where we only get images immediately after exercise. The stress echo procedure has accuracy rates on the order of 85% for the detection of coronary artery blockages. Many measurements are taking during the stress echo procedure to assess how well your heart is functioning. We are able to see the heart valves, the heart chambers and measure their size. The function of the heart can be assessed and pressures within each chamber can be measured by echo. 4 dimensional echo equipment which we have had in my laboratory for many years allows us to see the heart the way it should instead of two-dimensional slices of the heart. After taking all of the resting images patients are exercised either on the supine bike or the treadmill.
Patients prefer the supine bike as they can control the speed of the bike and they do not have to worry about their balance if they were to be on the treadmill. Images are taken during exercise as well as immediately post exercise. The resting, peak exercise and immediately post exercise images are compared side-by-side to make an interpretation as to whether there is any reduction in blood flow causing regional cardiac muscle dysfunction. In this video, Dr. Moran will take you through each step of the stress echo procedure explaining as we go showing examples of the images and measurements that we do.
DISCLAIMER : Thank you for watching my TH-cam video. The content of my video is not intended to be a substitute for professional medical advice, diagnosis or treatment. No doctor-patient relationship is formed by viewing this video. For further details, please click the following link below for my full disclaimer.
drive.google.com/file/d/1tQku...
Dr. Keith Moran MD, RCPSC, DABIM, RCS, NBE Biography:
I am a consultant in Internal Medicine with special medical interests in gastroenterology, cardiology, and echocardiography. I am a a full-time practising physician in these areas. I was an undergraduate at the University of Toronto, Trinity College where I received a number of scholarships including one for top student at Trinity College. I attended medical school at the University of Toronto graduating with a gold medal. My internship was completed at McMaster University in Hamilton followed by a residency in Internal Medicine at the University of Western Ontario in London. I then completed a fellowship in General Internal Medicine at the University of Western Ontario. I have active staff privileges and work as a consultant at my hospital managing the intensive care unit and providing consultative care in all hospital departments. I am a past clinical preceptor at the Northern Ontario School of Medicine. I am an active echocardiographer who has been certified and recertified by the National Board of Echocardiography. I am certified in cardiac sonography and have trained and completely educated a number of cardiac sonographers. I am the medical director of my cardiology laboratory which was established in 2001. My laboratory performs echocardiography and stress echocardiography amongst other tests. I maintain my certification in the American Board of Internal Medicine.
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Thank you for showing a picture of a guy with slightly more chest hair than me. I feel like people would mistake me for Bigfoot if I were shirtless outside.
I got value from this video because I am having the procedure next week.
Glad to be of help Charles.
Thank you very much.💕 Dr Moran. Very informative. 😷👧
Thank you Tina! I'm glad it was helpful!
does the patient need to move the feet up and down while lying on the
bed to assist the DSE test or while the test is in progress?
Hopefully sir answer my question thanks sir and have a niceday
Hi Dr. Moran i don't know if u are common with Myocardial bridge disease so my question is, it is a possible to detect at least 1% or 10% of bridge arteries on the heart with Coronary Flow Reserve Assessment (CFR ) i am talking about Echocardiogram stress test with CFR ? please i need your opinion.
It can be detected that way and can also be detected without CFR during stress. I have had a couple of cases detecting this with stress echo in my career. It is important to note that stress test with imaging are not 100% accurate as I am sure I would have said in the video. The sensitivity of picking up a problem is 80-85% and if an abnormality is found the likelihood of it being a true positive is on the order of 80-90%.
Very informative video thank you so much. I have a question. Your video did not mention Definity or any other contrast solution. I just had a stress echo scheduled and went in for my appointment. Nothing was mentioned about contrast until they said they were going to hook me to an IV. To make a long story short. I politely declined the contrast as it has inherent risks(death), and image quality is reasonable without it. Shockingly the doctor refused to do the test and gave me the option to return if I changed my mind. Does this sound normal? You can obviously get a quality test without the contrast solution.
Good question Kent. Contrast is needed if image quality is suboptimal and we cannot see 2 or more of the 16 segments of the left ventricle. In the majority of cases all 15 or 16 segments can be seen from 1 of our 3 main echo windows. We image people in different positions (on their back and varying positions on their side as well as imaging during different phases of the respiratory cycle) to accomplish this. Only in a minority of cases would contrast be needed. Unfortunately, perhaps suboptimal image quality was the situation in your case. Best regards.
@@MedicinewithDrMoran Thank you for your input. For clarification, I had a standard echocardiogram about 6 months prior to this at another clinic. There were no image quality issues. I then had a standard stress test on a treadmill and I "developed ST depressions in the inferolateral leads which were horizontal". I had no symptoms at the time. That doctor planed to send me to another clinic in a hospital originally for a nuclear stress test which I declined, so he changed it to the standard Echo stress test. When I went to the new clinic, it was my understanding at the time that there would be no contrast solution. So I was at a new Clinic. A nurse set out to hook me to an IV for the Definity contrast. I requested that they do the tests with no contrast, the nurse then brought the doctor into the room and we had a short discussion in which he said they used to do it without the contrast. I then said let's do it the old way then. He then refused to do anything and said he won't be able to see anything without the contrast. They did not even attempt to do any test. Then he told me to book another appointment if I change my mind. Your information makes it quite clear that you can generally get good images without contrast. My opinion is the doctor was in the wrong by refusing to give me the test without the contrast. I'm 57 years old, slim and a non smoker with no family history of heart disease. However I do have occasional chest pain.
Hi doctor,
Is it common or has anyone fainted during one of these test?
Sir good day I have stress thread mill but my result is equivocal what is the problem sir in my stress thread mill
If there is a concern after the treadmill ECG (results equivocal or symptoms highly suspicious but treadmill test is negative) then additional testing is typically done. Which might include stress echo, stress nuclear testing, CT coronary angiography or even invasive coronary angiography. This is something your doctor would discuss with you. If you have concerns speak to your doctor.
New subscriber here from Philippines. I just had thread mill stress test with mask and face shield because of the current situation, will these affect the result? I hope you will answer my query? Thanks.
Thanks for subbing! No it does not affect the test at all. I have done about 1500 stress test since the beginning of the pandemic and we do not see any significant oxygen desaturation. Patients obviously do not like breathing through a mask but it does not affect the test characteristics if you give your best effort.
Hi Dr. Moran! Because my thread test result is not normal, my doctor advised me to have an angiogram. What are the risks of this procedure and what are the preparations I should be wary about before and after? Thank you in advance. ❤
Come on lose the cat that is so lame to see her petting that big ass cat how unprofessional is this place? Enjoy your hair ball coffee 🤷🏻