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Ischaemia : Normal Example

Rest exam: A 66year old lady with progressively increasing breathlessness. Resting study normal. Unable to perform exercise, then patient was referred for pharmacological stress echocardiography. Normal perfusion at rest in all territories (as expected given normal wall motion)

Stress exam: Repeat imaging performed after dobutamine intravenous infusion. Heart rate 130-140bpm, so full replenishment expected in 3-4beats (see Chapter on practice).
Note the rapid replenishment indicating normal perfusion in all walls.


 

Normal Example - REST

 

Real-time low MI perfusion imaging

AP4C AP2C AP3C

 

Note:

  • Low MI imaging (0.10 L) in top right corner with a high MI (0.65 F) for the ‘flash’ to destroy microbubbles
  • Bright images (gain usually >60%, often almost 70%).
  • Normal replenishment within 5 cardiac cycles of bubble destruction by flash impulses.

 

Triggered low MI perfusion imaging

AP4C AP2C AP3C

Note:
  • Low MI imaging (0.10 L) in top right corner with high MI (0.65 F) ‘flash’
  • The red triangle on the ECG above each T wave, as there is end-systolic triggering of images
  • Normal replenishment within 5 cardiac cycles of bubble destruction

 

Normal Example - STRESS

 

Real-time perfusion assessment following dobutamine (HR 130-140bpm)

AP4C AP2C AP3C
Note:
  • Rapid replenishment of microbubbles in all walls within 2-3cycles of flash

 

Triggered imaging perfusion assessment following dobutamine (HR >130bpm)

AP4C AP2C AP3C
Note:
  • Rapid replenishment of microbubbles in all walls within 2-3cycles of flash