Related Diagnostic Modalities

Published on 06/02/2015 by admin

Filed under Anesthesiology

Last modified 22/04/2025

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Related Diagnostic Modalities

Steven Gill, John C. Sciarra and Christopher J. Gallagher

Stress Echocardiography

Stress TEE is the same deal as a transthoracic stress echo. You get a baseline reading, stress the heart with some dobutamine, kick up the heart rate to marathon levels and do another exam. Besides seeing a heart running like a race horse, you will also see the hyperdynamic heart and any new wall motion abnormalities compared to the baseline resting heart. When you crank up the dobutamine, new wall motion abnormalities might pop-up revealing at risk myocardium, right? Well, not always. Sometimes, low-dose dobutamine improves ventricular function, but othertimes, you might see a biphasic response which is improving response until reserve is exhausted. At which point you start to fall off the old Starling curve and ventricular function declines to the point of what we call scientifically—“Dead-as-a-doornail” myocardium. That is no response to redbull levels of whipping the heart.

Epicardial Scanning

You cannot do TEE on everybody because of things like esophageal pathology or the 2% of people you can’t get a probe into. So you can go with epicardial scanning. A probe is covered with a sterile sheath and goop and passed onto the surgical field, placed on a sound conductive spacer (remember: air does not transmit sound waves as efficiently as goop), and is then placed directly on the patient’s chest. As mentioned in another section, kiddie cardiac surgery often uses epicardial scanning. You are not hindered by bronchi getting in the way, so you can get a look all over the place.

The Gologorsky method of creating a spacer for epicardial scanning: just fill the tip with gel and place in a sheath. Another common method is to fill a sterile glove with gel or water and use that as a stand-off or spacer.

Questions

1. You are performing epicardial scanning on a 2-month-old and cannot obtain an image, reasons include:

2. Which modality allows for earliest detection of myocardial ischemia:

3. Dobutamine can cause all the following except:

4. TTE may allow for better visualization of parts of the:

5. TEE usually can remain in the esophagus up to:

Answers

Bibliography

Bagur R, Rodes-Cabau J, Doyle D, et al. Usefulness of TEE as the primary imaging technique to guide transcatheter transapical aortic valve implantation. J Am Coll Cardiol Img. 2011;4:115–124.

Memtsoudis SG, Rosenberger P, Loffler M, et al. The usefulness of transesophageal echocardiography during intraoperative cardiac arrest in noncardiac surgery. Anesthesia Analgesia. 2006;102:1653.

Öwall A, Ehrenberg J, Brodin L.-Å. Myocardial ischaemia as judged from transoesophageal echocardiography and ECG in the early phase after coronary artery bypass surgery. Acta Anaesthesiol Scand. 1993;37:92–96.

Shapiro SM, Young E, De Guzman S, et al. Transesophageal echocardiography in diagnosis of infective endocarditis. Chest. 1994;105:377–382.

Youn H.-J., Foster E. Transesophageal echocardiography (TEE) in the evaluation of the coronary arteries. Cardiology Clinics. 2000;18:833–848.

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