Normal Treadmill Stress Echocardiography

 

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The views below are videos from standard treadmill stress echocardiogram. The individual in question had no known preexisting coronary disease and achieved a heart rate beyond 85% of the maximum predicted heart rate. For each echocardiographic view below, videos are shown for the different time points where images where acquired: at rest (top right), during peak stress (top left), and post exercise at rest (bottom left). This arrangement allows for direct comparison of all views. The standard views obtained during stress are: 1) the parasternal long axis, 2) the parasternal short axis at the mid ventricle, 3) the apical 4 chamber, and 4) the apical 2 chamber. These views allow for complete assessment of the motion of all 17 LV wall segments.

Parasternal Long Axis

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The parasternal views shown above, as do all other views below, shows the heart synchronized over one cardiac cycle, despite the widely different heart rates. By convention the top right is rest, the top left is stress, the bottom right is post exercise when the heart rate has returned to normal. The lower left is a blank space (usually used for the additional view acquired during dobutamine stress echo studies or for additional images). We see here that during normal exercise, LV function augments very well and becomes hyperdynamic at peak stress in all visualized LV segments. No wall motion abnormalities are noted.

 

Parasternal Short Axis

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At the mid ventricular short axis level, hyperdynamic function is seen in all segments at peak stress without wall motion abnormality. Frequently due to heavy breathing with exercise there is more lateral motion of the heart.

Apical 4 Chamber

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The apical 4 chamber shows that the lateral wall, apex and septum are both hypercontractile with exercise. Again, no wall motion abnormalities are noted.

Apical 2 Chamber

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Finally the 2 chamber view shows the inferior and anterior wall both thicken normally with stress, completing the LV function assessment.

All 17 segments of the LV can then be graded on a standard scale from 1 to 4 (1 is normal, 2 is hypokinetic, 3 is akinetic, 4 is dyskinetic, and 0 is hyperkinetic) regarding their motion during stress echocardiography. A Wall Motion Score Index can then be calculated by summing the values and dividing by the number of segments visualized.