Stress Echocardiography Flashcards

Which wall motion scoring index (WMSI) value indicates significant ischemia during stress echocardiography?

Answer: WMSI > 1.5

A WMSI greater than 1.5 is considered significant, as scores above this threshold indicate extensive wall motion abnormalities suggestive of ischemia.

During dobutamine stress echo, which finding in a previously akinetic segment indicates myocardial viability?

Answer: Biphasic response with improvement at low dose and deterioration at peak dose

A biphasic response (improvement at low-dose dobutamine followed by worsening at peak dose) is the classic marker of viable but ischemic myocardium.

What is the recommended imaging protocol when using exercise stress echocardiography on a treadmill?

Answer: Images acquired at rest and immediately post-exercise within 60–90 seconds

Post-exercise images must be acquired within 60–90 seconds because wall motion abnormalities resolve rapidly after exercise cessation.

Which pharmacological agent is used to reverse the effects of dobutamine during stress echocardiography?

Answer: Metoprolol (esmolol)

Beta-blockers such as esmolol or metoprolol are used to reverse tachycardia and other adverse effects of dobutamine.

A new regional wall motion abnormality during stress echocardiography involves the anterior wall and apex. Which coronary artery territory does this most likely represent?

Answer: Left anterior descending artery (LAD)

The LAD supplies the anterior wall, apex, and anteroseptal segments, so ischemia in these regions implicates the LAD territory.

In stress echocardiography, what does 'ischemic cascade' refer to?

Answer: Sequence: perfusion defect → wall motion abnormality → ECG changes → symptoms

The ischemic cascade begins with perfusion abnormalities, followed by diastolic dysfunction, then wall motion abnormalities, then ECG changes, and finally symptoms.

What is the significance of an augmented ejection fraction (EF) during low-dose dobutamine stress echo in a patient with reduced resting EF?

Answer: Suggests viable myocardium with potential for functional recovery after revascularization

An EF augmentation with low-dose dobutamine indicates contractile reserve, suggesting viable myocardium that may recover function after revascularization.