Ebook Dynamic echocardiography: Part 2
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Ebook Dynamic echocardiography: Part 2
Coronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2the leading cause of death in the United States and is the principal contributor to the nations morbidity and health care expenditures. Cigarette smoking, physical inactivity, obesity, hypertension, and metabolic syndrome also contribute to the high IHD incidence rates among both women and men. More Ebook Dynamic echocardiography: Part 2 than a quarter of a million women die each year in the United States from IHD and its related conditions, and current projections indicate that thisEbook Dynamic echocardiography: Part 2
number will continue to rise with our aging population.1The evaluation of 1HD in women presents a unique and sometimes difficult challenge for cliniciCoronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2en.1 There are gender differences in the type, frequency, and quality of symptoms of CAD.1In a patient with a chest pain syndrome, the history, including the presence or absence of conventional risk factors, the physical examination, and the electrocardiogram (ECG) arc important factors to consider. Ebook Dynamic echocardiography: Part 2 A noninvasive diagnostic stress test frequently is selected to evaluate for the presence of significant CAD, to discriminate between significant andEbook Dynamic echocardiography: Part 2
nonsignificant disease, and to predict prognosis.DiagnosticsExercise Electrocardiographic EvaluationThe evidence suggests that one should not rely on Coronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2specially in women. Even when exercise stress test risk scores such as the Duke treadmill score are incorporated into the diagnostic method, exercise electrocardiography remains inferior to diagnostic imaging tests, such as exercise echocardiography.'Exercise EchocardiographyExercise echocardiograph Ebook Dynamic echocardiography: Part 2y combines treadmill or bicycle exercise with ultrasound imaging of the heart with the goal of detecting stress-induced wall motion abnormalities.BefoEbook Dynamic echocardiography: Part 2
re exercise, the resting echocardiographic images arc obtained from the parasternal and apical windows.4 These standard images include parasternal lonCoronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2indow is suboptimal, the subcostal approach can be used. The apical short-axis view proves particularly useful for assessing the presence or absence of apical regional wall motion abnormalities because, in some patients, visualization of the apex can be incomplete or foreshortened in the standard ap Ebook Dynamic echocardiography: Part 2ical views. Inferior basal wall motion abnormalities may be difficult to interpret; an abnormality in this region should be documented in two differenEbook Dynamic echocardiography: Part 2
t views, including the basal short-axis view or assessment of the basal inferior septum, which usually has the same coronary vascular supply. Once theCoronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2eadmill) or during peak exercise (bicycle). Acquisition of the postexercise images is challenging because of lung and motion artifacts as well as a limited time window after exercise; however, with the current imaging equipment, the use of harmonics, and occasionally the use of contrast agents, feas Ebook Dynamic echocardiography: Part 2ibility is excellent.’' The digitized images are displayed side-by-side for comparison with the resting images. Continuous tape recording of all stresEbook Dynamic echocardiography: Part 2
s images is recommended as a backup. In our laboratory, this information is also reviewed.Analysis of the Exercise EchocardiogramIn addition to the glCoronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2red. The additional information obtained from the echocardiogram at rest and immediately after exercise increases the sensitivity and specificity of this diagnostic modality.The interpretation of the echocardiographic study should include semiquantitative scoring of each of the segments of the left Ebook Dynamic echocardiography: Part 2ventricle at rest and with stress, as previously described.' The left ventricle is divided into 16 segments (or 17 segments if the apical cap is incluEbook Dynamic echocardiography: Part 2
ded) (Fig. 41.1). Each segment is analyzed individually and scored on the basis of its motion and systolic thickening as follows: 1 = normal or hypercCoronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2ments analyzed, a global left ventricular wall motion score index, both at rest and at exercise, can be generated. Myocardial ischemia is diagnosed when the postexercise188https: //khoth u vien .comSection VI—Coronary Artery Disease 189Fig. 41.1 The model for semiqudn-tiutive segmental evaluation of Ebook Dynamic echocardiography: Part 2 regional wall motion of the left ventricle is represented. The basal interoseptum and inferior wall and mid-inferior wall are attributed to the rightEbook Dynamic echocardiography: Part 2
coronary artery, the anteroseptum and anterior wall to the left anterior descending ocro-Iidfy .11 Illy. life 4nlcioL1liv.1l Zi.111 111 the h'fl AHlcCoronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2nt) r. 4llritx>lrd Io llx1 Il’fl onlcritN (levttxkriz| rnroiwry arteryechocardiographic images document a new regional wall motion abnormality or when no hyperdynamic motion develops despite a good exercise work load.The cardiologist interpreting the results of the test must analyze the images in a Ebook Dynamic echocardiography: Part 2thorough and methodical fashion. In addition to assessing the segmental responses to stress, the global left ventricular response to stress also mustEbook Dynamic echocardiography: Part 2
be considered. Normally, the ejection fraction will increase and the left ventricular end systolic volume will decrease in a normal study/Types of ExeCoronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2r uncooperative or fatigued subjects to decrease their pedaling speed. Cycles are calibrated in kilopods or walls. Cycle ergonomelry is usually less expensive and requires less space than a treadmill (Fig. 41.2). Compared with tread mill exercise, upper body motion is usually reduced, making it easi Ebook Dynamic echocardiography: Part 2er to obtain blood pressure measurements and to record the ECG. When subjects with angina perform identical submaximum cycle work in the supine and upEbook Dynamic echocardiography: Part 2
right positions, heart rale is higher in the supine position, maximum work performance is lower, and angina develops at a lower double product. A majoCoronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2 warm-up (low load) and progressive uninterrupted exercise with increasing loads, an adequate duration in each level, and a recovery period. For cycle ergonometry, the initial power output is usually 10 or 25 watts, usually followed by increases of 25 watts every .3 to 5 minutes until end points arc Ebook Dynamic echocardiography: Part 2 reached.6TreadmillSubjects should not tightly grab the front or side rails because this action decreases the workload and increases the exercise timeEbook Dynamic echocardiography: Part 2
and muscle artifact. Several different treadmill protocolsFig. 41.2 Supine tácyde exeróse ecbocard^graphy is illustrated. The patient pedals a cycle Coronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2s the Bruce protocol. The patient of average height may be instructed that the first three stages involve walking and that the fourth stage involves cither running or walking. It is important to adjust or select the treadmill or cycle ergometer and protocol to the subject being tested. The optimal p Ebook Dynamic echocardiography: Part 2rotocol should last between 6 and 12 minutes, and the exercise capacity should be reported in meta bulk equivalents (METs) and minutes.6Accuracy of ExEbook Dynamic echocardiography: Part 2
ercise Stress Echocardiography in WomenExercise stress echocardiography has reached a stale of matu rity not only with data regarding its sensitivity Coronary Artery DiseaseVIChapter 41Stress Echocardiography in Chest Pain SyndromesHector R. Villarraga, MD, FASEIschemic heart disease (IHD) remains t Ebook Dynamic echocardiography: Part 2; in women the sensitivity ranges from 77% to 88% with a mean weighted specificity of 73%.'Multiple studies have evaluated outcome and prognosis with respect to cardiac death and cardiovascular events. In a190Section VI—Coronary Artery Disease Ebook Dynamic echocardiography: Part 2Gọi ngay
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