Download Treadmill Exercise Stress Echocardiography Procedure

Treadmill Exercise Stress Echocardiography Procedure
Purpose
To outline a standard process and provide information to ensure best practice is
followed.
Procedure
Pre-test:
 Prior to study date, patient will be notified by phone or mail with the date and
time of test, instructions to wear comfortable clothing and shoes, and a
reminder to have someone available to drive them home.
 On arrival, after introductions and patient identification confirmed, patient will
receive a full explanation of the test procedure and potential risks, with the
opportunity to ask questions.
 A verbal and/ written consent must be obtained to continue.
Test:
 Ensure patient is wearing comfortable shoes to walk in.
 Patient will be required to disrobe from the waist up and don a gown open in the
front.
 Documentation of patient height, weight, age, resting B/P and current
medications.
 A cardiac history is taken and recorded for the reading cardiologist.
 12-lead ECG is attached ensuring a good signal with appropriate prep to the skin.
 The technologist will take standing and supine ECGs at rest for baseline.
 Use tissue harmonics (reduces near field artifact, improves resolution, enhances
myocardium, and improves endocardial border definition).
 Decide early in the process the need for a contrast agent, used with each
acquisition.
 The sonographer acquires digital loops of the imaging views Apical 4ch, 2ch,
ALAX, PLAX and PSAX at rest. The machine preset should have a continuous
capture or stacking function.
 Choose either the Bruce or the Modified protocol.
 Reinforce instructions and explanation of treadmill format immediately prior to
starting the test.
 Remind patient to speak up if having any symptoms or concerns while on the
treadmill.
 Remind patient of increase in incline and speed about 10 seconds before it
occurs.
 Encourage patient to stay on treadmill to reach or surpass the target heart rate.






Check patient B/P at each stage and document.
Continually watch 12-lead ECG for arrhythmias and ST changes.
Stop treadmill when test end point has been reached.
Assist patient back onto bed in a left lateral position so the sonographer can
acquire peak images while heart rate is at its maximum.
Continue to monitor B/P and any symptoms.
Complete the test with post imaging when heart rate is below 100 beats/minute
and document.
Test End Points:
 Reached or surpassed target heart rate.
 Drop in systolic blood pressure from baseline despite an increase in workload.
 ST segment or QRS changes such as excessive ST depression (> 2 mm of
horizontal or down-sloping).
 ST elevation > 1 mm in leads without diagnostic Q waves (other than V1 or AVR).
 Arrhythmias: ventricular tachycardia, multifocal frequent PVCs, heart block.
 Severe symptoms: moderate to severe angina, presyncope, ataxia, pallor.
 Machine technical difficulties—patient safety is a priority.
 Patient refuses to continue.
Policy











Respect patient’s modesty and privacy by draping the patient throughout the
test.
Respect patient’s right to refuse test or stop upon request.
Ensure proper test supervision by physician, location and availability prior to
starting the test.
Patient’s ability to walk on treadmill should be assessed by staff as early as
possible. Need to change test type should be discussed and approved by the
supervising physician.
Ensure requisition filled out and appropriateness of test indication.
Confidentiality: test results are not to be given to patient by the sonographer in a
preliminary format.
Use contrast if unable to see any of the walls of the myocardium to ensure a
complete study.
Medications and equipment available to treat and monitor if patient has
symptoms.
Crash cart is in close proximity and staff aware of emergency response protocols.
Appropriate room size and current equipment, to ensure patient safety in an
emergency situation.
Preprinted order forms preferred for the use of contrast, oxygen, nitroglycerine
and written instructions for administration.
Treatment of Symptoms:
 Moderate or severe angina: stop test, return patient to the bed, do an
immediate blood pressure, apply oxygen—notify physician for assessment of 12
lead ECG and vitals, and give Nitroglycerine if ordered.
 ST depression of > 2 mm or elevation > 1 mm: stop test and return patient to
bed, perform immediate images, and monitor vitals and symptoms.
 Presyncope, dizziness, unwell feeling: stop test, return to bed and monitor vitals.