Download Bicycle Stress Echocardiography Protocol Equipment

Bicycle Stress Echocardiography Protocol
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Recumbent bicycle attached to an echo bed with cut outs for imaging
12-lead ECG monitoring unit that connects to an echo machine
Prep materials for skin – alcohol, gauze, razor and abrasive tap
Electrodes
Automatic blood pressure unit
IV and contrast supplies
Pre-printed bike stress worksheets
Staff:
1. Sonographer
2. ECG Technologist
3. Supervising Physician
Pre Test:
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Reminder notice sent to patient before the day of the procedure to wear comfortable
clothing and shoes
No eating or drinking 2 hours before the test
Personal medications are taken as prescribed unless otherwise instructed by
Physician
Day of - introductions, patient ID confirmed, test explanation and time for questions
to be answered
Written consent to proceed with test
If client is an inpatient, check ID band
If the staff determines the patient will not be able to pedal the bike on their side the
supervising Physician must assess and change the test accordingly
If the supervising Physician is not available, the test is postponed until the patient is
reassessed
Have patient undress from the waist up and put on a gown
Skin prep and application of 12-lead ECG electrodes ensuring a good ECG signal on
both machines
Baseline ECG supine and standing
Baseline blood pressure
Height, weight and BSA
Cardiac history, allergies and a list of current medications – if patient is taking beta
blocker patient may not reach a high enough maximum heart rate.
Harness patient to the bed comfortably, put on shoe covers and place feet in
footholds, then tilt bed for preliminary images
Ensure the patient’s legs are not over-extended or under-extended: important the
patient is comfortable while pedaling
Choose the continuous capture stress package
Store the resting images as required - example apical 4, then apical 2, then PLAX,
then PSAX - decide at this time whether contrast will be needed
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Do measurements and EF at rest
Return patient to a supine position - explain about the pedaling, the stages, the lights
and a quick practice pedal before starting
Exercise Test:
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Have patient pedal until green light comes on
Start ECG timer and bike timer at the same time
Do a blood pressure every 2 minutes and multiply the systolic blood pressure
number by the heart rate at each stage for the RPP (Rate Pressure Product)
A minimum RPP of 20,000 is required to make it a readable test
Monitor for symptoms and arrhythmias throughout test
If the patient is having symptoms or arrhythmias or any other problem - the
supervising Physician must be made aware and assess patient to determine if test
should continue
Each stage is 2 minutes long as preset into the ECG monitor and ultrasound
machine
Have patient continue pedaling each stage until they reach an end point
Tilt bed again for peak images - decrease workload by 2 stages; have patient
continue pedaling while peak images are being acquired
When images have been acquired, patient can stop pedaling
Start the recovery phase on the treadmill
Document length of time biked, watts, RPP, symptoms, vitals, and any arrhythmias
Post Test:
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When heart rate below 100 beats/ min Post images can be taken
Position patient back in a supine position, remove feet from pedal boots and remove
harness
Wash chest, help dress and assess patient
Sanitize the echo bed, harness, ECG leads, blood pressure cuff, transducer and
pillow after each patient
End Points:
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Moderate or severe angina
ST elevation > than 1 mm or depression > 2 mm
Nausea and other symptoms with an abrupt change in vital signs
Frequent serious arrhythmias - VT, heart block, rapid sustained SVT
Technical difficulties with equipment
Patient refuses to continue test
Regional wall motion seen
Contraindications:
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Acute cardiac events or ECG changes - uncontrolled arrhythmias at rest
Recent MI
Unstable angina
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Severe pathology found in pre images - aortic stenosis, intracardiac mass,
pericardial effusion - all pathology must be reviewed by the supervising Physician
Severe hypertension - systolic > 225 and diastolic > 110 mmhg
Patient refuses the test after explanation and questions have been completed
Bike Exercise Stress Worksheet:
Should include the following columns: Example
Bike Protocol
Watts
Heart Rate
Blood
Symptoms and comments
Pressure
Rest
Stage 1
Stage 2
( 0-2 min)
( 2-4 min )
xx
10
30
60
82
100
130/70
148/66
160/80
Stage 3
( 4-6 min )
60
121
186/90
Stage 4
( 6-8 min )
90
155
194/92
Mets
8.60
RPP 194 x
155 = 30,070
Recovery
Exercise time 7
min 12 sec
mild dyspnea
dyspnea
legs sore, burning in chest,
dyspnea
stopped chest pains oxygen and nitro given
Interpretation of Bicycle Stress Echocardiography
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Due to the limitations of the bike stress echo, this test is not indicated for everyone.
Patients should be assessed prior to performing the test.
Conditions such as fibromyalgia, rheumatoid arthritis, peripheral vascular disease
can affect the test RPP making it inconclusive for CAD.
Criteria for Reporting:
Negative test: all segments that were active and augmenting at baseline and remain
active with exercise, plus a decrease in overall cavity size and improvement in overall
contractility
Positive test: Two or more adjacent segments—which demonstrated normal thickening
at baseline but decreased or absent thickening with stress—in at least 2 imaging planes
Indeterminate test: All other responses, with an explanatory note
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