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
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.
TEE Versus ECG
Regional wall motion abnormalities are the bomb when it comes to detecting ischemia.
So, to summarize, TEE is better than ECG to detect ischemia.
Of course, putting on an ECG ain’t no biggie and placing a TEE is.
TEE Versus Coronary Angiography
Angiography wins the “visualize the coronaries” contest all hollow.
Femoral artery sticks are invasive, and can lead to pseudoaneurysms, retroperitoneal bleeds, and all kinda unholy terror. TEE obviates that, though TEE has its own complications.
Questions
1. You are performing epicardial scanning on a 2-month-old and cannot obtain an image, reasons include:
A The focus of the beam is too distal to the heart
B You forgot a spacer to properly allow conduction of the beam
C The patient’s heart is too small
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: