There are 7 teaching cases in this section on ischaemia imaging using Myocardial Contrast Echocardiography: One normal and one abnormal example to begin, then there are five real clinical patient studies with accompanying explanation(s).
Rest: A 66year old lady with progressively increasing breathlessness. Resting study normal. Unable to perform exercise then referred for pharmacological stress echocardiography. Normal perfusion at rest in all territories (as expected given normal wall motion)Stress: Repeat imaging performed after dobutamine intravenous infusion. Heart rate 130-140bpm, so full replenishment expected in 3-4beats (see Chapter 2). Note rapid replenishment indicating normal perfusion in all walls.
Stress: 55yr old male smoker with hypertension referred for investigation of chest pain. Unable to perform exercise stress due to arthritis. Rest wall motion and perfusion normal. Pharmacological stress echocardiogram performed using dipyridamole.
Patient with an episode of chest pain, no significant Troponin increase at 12hours and no significant ECG abnormalities. Stress echocardiogram is requested.
Patient with recurrent episodes of atypical chest pain and no baseline ECG abnormalities. Treadmill ECG requested.
Patient with recurrent episodes of chest pain, no baseline ECG abnormalities, normal exercise-SPECT (few months before) but symptoms persist... Contrast stress echocardiogram requested.
Patient with recurrent episodes of chest pain, no baseline ECG abnormalities. Significant diffuse downsloping ST depression but no chest pain on treadmill.
80yr old patient with effort dyspnea, no chest pain. Hypertensive, type II diabetes. Normal resting ECG. Normal resting echocardiogram. Referred for stress echocardiography.
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