echocardiography : Messages : 9516-9545 of 13139

Hi,
It depends on if you are doing adult or pediatric.
The ICAEL has a very nice section on what views they consider to be very
important in both.
If doing the arch is in your protocol then it must be done.
From what I know the first time around they are more flexible and will let you
know the issues you need to resolve before the reaccreditation.
Also, you can contact their technical diredtor and ask any question you like.
They are very helpfull and did alot of hand holding when I first got our lab
accredited 2 yrs ago.
Good luck
Anne
>
> From: ms cs <mirasub@...>
> Date: 2007/03/05 Mon PM 06:51:14 EST
> To: echocardiography@yahoogroups.com
> Subject: [echocardiography] accreditation
>
> Is icael very strict with respect to following the icael standards when we
submit studies for accreditation? If the echo lab  protocol varies very
slightly, do they usually deny the application??I have been doing the aortic
arch view only when requested. Have been following the 2004 standards.
>   thanks
>
>
> ---------------------------------
> Looking for earth-friendly autos?
>  Browse Top Cars by "Green Rating" at Yahoo! Autos' Green Center.
>

#9544

From: "Sandy Katanick" <katanick@...>
Date: Wed Mar 7, 2007 8:50 pm
Subject: RE: accreditation

katanick@...

Thanks Jon for that excellent explanation of the requirement for "best work". You are right on target with that description. All of the required views and measurements can be located in the ICAEL standards at http://www.intersocietal.org/icael/pdfs/Standards/Adult_TTE.pdf and are in Section 3 of the transthoracic, TEE and stress standards. Please feel free to contact us with any questions as you complete the process. Thanks Sandy

PS: I am pasting the views required from the ICAEL standards in answer to the original question as we do require an aortic arch on all studies.

3.2.1 Components of the examination: A protocol must be in place that defines the

components of the standard examination. Indications for performance of a

complete and/or limited examination must be included.

A) Complete M-Mode and 2-dimensional examination - Includes standard

views from multiple planes including views of all cardiac structures and

selected extracardiac structures. These include, but are not limited to:

1) Left ventricle

2) Right ventricle

3) Left atrium

4) Right atrium

5) Aortic valve

6) Pulmonic valve

7) Mitral valve

8) Tricuspid valve

9) Proximal ascending aorta

10) Aortic arch

11) Main pulmonary artery and proximal branches

12) Inferior vena cava

13) Pericardium

B) Complete Doppler study - Includes spectral Doppler and/or color flow

interrogation of all normal and abnormal flows within the heart including the

valves, the great vessels and the atrial and ventricular septa.

Sandra L. Katanick, CAE
Chief Executive Officer
Intersocietal Accreditation Commission
8830 Stanford Boulevard, Suite 306
Columbia, Maryland 21045
Phone: 800-838-2110 or 410-872-0100 extension 226
Fax: 410-872-0030
Web Sites: www.icavl.org; www.icael.org; www.icanl.org; www.icamrl.org; www.icactl.org

PRIVILEGED AND CONFIDENTIAL
This message is intended only for the addressee(s) shown above, and may
contain information that is privileged, confidential or otherwise
protected from disclosure. Any review, dissemination or use of this
transmission or its contents by persons other than the addressee is
strictly prohibited.

-----Original Message-----
From: echocardiography@yahoogroups.com [mailto:echocardiography@yahoogroups.com]On Behalf Of Jon Tagliaferri
Sent: Wednesday, March 07, 2007 8:03 AM
To: echocardiography@yahoogroups.com
Subject: Re: [echocardiography] accreditation

They are strict with what you hand in, since it is supposed to be representative of your best work. Your protocol should be the same throughout all your studies, although it does not mean that when circumstances are presented, that you cannot alter or vary, as long as everything in your protocol is included. The ICAEL knows the reality of scanning, but when you are asked to submit your best work, they expect to see the protocols followed fairly consistantly throughout all the studies submitted. If the aortic arch is not part of your standard protocol, they would not expect to see it, although for the little time it normlly takes to show it, maybe your lab should consider adding it to your protocol.

ms cs <mirasub@...> wrote:

Is icael very strict with respect to followi ng the icael standards when we submit studies for accreditation? If the echo lab protocol varies very slightly, do they usually deny the application??I have been doing the aortic arch view only when requested. Have been following the 2004 standards.

thanks

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#9543

From: the rattler <rattler_thesnake@...>
Date: Wed Mar 7, 2007 9:47 pm
Subject: Are there any ultrasound/industry jobs.

rattler_thes...

Offline

Hi,

I am RDCS and looking to go back into industy with either an ultrasound company or a IT imaging company.

I have a work history of :

Cardiac ultrasound and I am RDCS

I have some history of what I would call Sales...will elaborate on this if you contact me.( cold call, sales plans ......etc). Although due to the sector I am in numbers for success are hard to quantify.

I have left industry and echo for about a year to pursue other interests not related to the health care fields.

I have worked for a major Medical Software/imaging company in the past.

I am looking to settle down and now I am now looking to get back into the industry side of things.

I have a BA in Public admin and Allied Health

AAS in Business admin, marketing , cardio vascular (ECHO).

A confidential resume can be sent out if interested.

Please email me back if interested with your contact info.

rattler_thesnake@...

Any interest or leads would be appreciated.

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with theYahoo! Search weather shortcut.

Reply | Forward | Messages in this Topic (1)

#9542

From: Jon Tagliaferri <hearttek68@...>
Date: Wed Mar 7, 2007 1:02 pm
Subject: Re: accreditation

hearttek68

Offline

They are strict with what you hand in, since it is supposed to be representative of your best work. Your protocol should be the same throughout all your studies, although it does not mean that when circumstances are presented, that you cannot alter or vary, as long as everything in your protocol is included. The ICAEL knows the reality of scanning, but when you are asked to submit your best work, they expect to see the protocols followed fairly consistantly throughout all the studies submitted. If the aortic arch is not part of your standard protocol, they would not expect to see it, although for the little time it normlly takes to show it, maybe your lab should consider adding it to your protocol.

ms cs <mirasub@...> wrote:

Is icael very strict with respect to following the icael standards when we submit studies for accreditation? If the echo lab protocol varies very slightly, do they usually deny the application??I have been doing the aortic arch view only when requested. Have been following the 2004 standards.

thanks

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#9541

From: Jon Tagliaferri <hearttek68@...>
Date: Wed Mar 7, 2007 1:15 pm
Subject: RE: Definity

hearttek68

Offline

Nothing has changed with Definity. Because it is being used more often an accepted more widely, we are seeing more cases of reaction to it. It is purely a numbers game. If we use it on 100 people and one person has a reaction, no one notices. If we use it on 1000 and 10 have a reaction we may notice it more, but it is still the same 1%. This does not mean that you should stop using it, but be more aware of what the reactions might be and how to treat it. Usually time will take care of moast of these reactions which can include headache, flushed feelings, lower back (kidney area) pain, and shortness of breath. These can be normal transient effects last usually 15-30 minutes. Getting the patient comfortable, adding oxygen, applying a cool wet cloth, and reassurance are the only things needed. Protocols should take this into account, and all normal precautions should be taken. Should a nurse or physician have to be present, or give the Definity is really done on a state or institutional level. Many states clasify it as a drug, and can only be given by an RN or higher. some institutions will position it that way anyway, and want it given only by an RN etc.. Some institutions are ok with the techs giving provided its ordered (standing or written), with the proper protocol, training and physician backing. Hope this helps.

Brenda King <bkbroiler40@...> wrote:

why are we questioning the use of definity?
my question is... does an MD have to be present/in the room for the
injection(from a nurse) of definity or is just a nurse doing the injection
ok or is it ok for a mid level to be present during the stress echo with the
use of contrast?
i look forward to your reply clifford. (confusion)
tks
brenda

>From: Clifford Thornton <cmt51597@yahoo.com>
>Reply-To: echocardiography@yahoogroups.com
>To: echocardiography@yahoogroups.com
>Subject: RE: [echocardiography] Definity
>Date: Thu, 1 Mar 2007 22:46:38 -0800 (PST)
>
>why have you stopped using Definity?
>
>"Hogan, Candy" <candy.hogan@tenethealth.com> wrote: Did they stop
>using contrast in Radiology too?
>
>-----Original Message-----
>From: echocardiography@yahoogroups.com on behalf of James Schrimsher
>Sent: Wed 2/28/2007 7:23 AM
>To: echocardiography@yahoogroups.com
>Cc:
>Subject: [echocardiography] Definity
>
>
>
>We,ve had our administration stop the use of definity.We've (staff)
>wondered what the rest of the world is doing about this and why.
>
>Confidentiality Note: http://www.huntsvillehospital.org/footer/disclaimer/
><http://www.huntsvillehospital.org/footer/disclaimer/>
>
>
>
>
>
>
>
>
>
>
>---------------------------------
>Food fight? Enjoy some healthy debate
>in the Yahoo! Answers Food & Drink Q&A.

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#9540

From: "Brenda King" <bkbroiler40@...>
Date: Tue Mar 6, 2007 9:27 pm
Subject: RE: Definity

bkboiler40

Offline

why are we questioning the use of definity?
my question is... does an MD have to be present/in the room for the
injection(from a nurse) of definity or is just a nurse doing the injection
ok or is it ok for a mid level to be present during the stress echo with the
use of contrast?
i look forward to your reply clifford. (confusion)
tks
brenda

>From: Clifford Thornton <cmt51597@...>
>Reply-To: echocardiography@yahoogroups.com
>To: echocardiography@yahoogroups.com
>Subject: RE: [echocardiography] Definity
>Date: Thu, 1 Mar 2007 22:46:38 -0800 (PST)
>
>why have you stopped using Definity?
>
>"Hogan, Candy" <candy.hogan@...> wrote:          Did they stop
>using contrast in Radiology too?
>
>-----Original Message-----
>From: echocardiography@yahoogroups.com on behalf of James Schrimsher
>Sent: Wed 2/28/2007 7:23 AM
>To: echocardiography@yahoogroups.com
>Cc:
>Subject: [echocardiography] Definity
>
>
>
>We,ve had our administration stop the use of definity.We've (staff)
>wondered what the rest of the world is doing about this and why.
>
>Confidentiality Note: http://www.huntsvillehospital.org/footer/disclaimer/
><http://www.huntsvillehospital.org/footer/disclaimer/>
>
>
>
>
>
>
>
>
>
>
>---------------------------------
>Food fight? Enjoy some healthy debate
>in the Yahoo! Answers Food & Drink Q&A.

_________________________________________________________________
Rates near 39yr lows!  $430K Loan for $1,399/mo - Paying Too Much? Calculate
new payment
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#9539

From: JOYCE <jfraser425@...>
Date: Tue Mar 6, 2007 8:23 pm
Subject: Re: accreditation

jfraser425@...

I would say do your aortic arch on your case studies and try it on anyone that has AI. You can sometimes get a better doppler from the suprasternal notch.

Joyce

-----Original Message-----
From: ms cs
Sent: Mar 5, 2007 6:51 PM
To: echocardiography@yahoogroups.com
Subject: [echocardiography] accreditation

Is icael very strict with respect to following the icael standards when we submit studies for accreditation? If the echo lab protocol varies very slightly, do they usually deny the application??I have been doing the aortic arch view only when requested. Have been following the 2004 standards.

thanks

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#9538

From: a b <ginalulubaby@...>
Date: Mon Mar 5, 2007 9:59 pm
Subject: Re: bubble studies

ginalulubaby

Offline

You said your cardiologists want you to do a bubble always - that's your standing order. I don't believe you need anything more. If I'm wrong, someone here let me know please.

Since you're busy getting and hanging onto your image, I don't think it's out of line to ask the patient's nurse to push the saline for you. I've done it alone myself, but it can be a handful. It doesn't have to be the patient's nurse - I'd think you could ask for any nurse to give you a hand.

mikespeaker2006 <mikespeaker2006@...> wrote:

i have a question regarding bubble study or saline studies. were i
work right now cardiologists wants us to do a bubble study always on
pts with atrial septal aneurysm, also they want us to do it when we see
any color flow going through the septal walls when we are doing routine
studies. Usually the techs do the bubble study themselves, since most
pts have a iv running, after asking the nurse to hold the medicine
going through the iv. what do you think about this.. should we have the
doctors or nurses do the bubble study, and have the cardiologist write
the order to do an bubble study on the chart.

The fish are biting.
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#9537

From: ms cs <mirasub@...>
Date: Mon Mar 5, 2007 11:51 pm
Subject: accreditation

mirasub

Offline

Is icael very strict with respect to following the icael standards when we submit studies for accreditation? If the echo lab protocol varies very slightly, do they usually deny the application??I have been doing the aortic arch view only when requested. Have been following the 2004 standards.

thanks

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#9536

From: "pdigrazi" <pdigrazi@...>
Date: Mon Mar 5, 2007 6:47 pm
Subject: Re: free echo cme's

pdigrazi

Offline

Take a look at SDMS.org


--- In echocardiography@yahoogroups.com, Kathy Cross <mrtraipi@...>
wrote:
>
> You can go to www.cardiovillage.com, it is out of the University
of Virginia. I believe there are over 200 free cme's available on
that site.
>
>   Kathy
>
> Ed Chait <edchait4@...> wrote:
>
> Does anyone know of any websites that offer free echo and/or
vascular CME's?
>
> thanks in advance,
>
> Ed Chait, RDCS, RVT
>
>
>
>
>
>
> ---------------------------------
> Everyone is raving about the all-new Yahoo! Mail beta.
>

Reply | Forward | Messages in this Topic (5)

#9535

From: "Hogan, Candy" <candy.hogan@...>
Date: Mon Mar 5, 2007 4:32 pm
Subject: RE: bubble studies

candy.hogan@...

We have it in our policy and procedure to automatically do it if there is
aneurysm,
TIA, CVA, colorflow evidence and loss of vision depending type of loss.  Not for
dizziness.  Syncope we assess.  If there is aneurysm then we do it.  If syncope
and no colorflow is seen or no aneurysm or no drop out, then we don't. 
Sonographers do it or we ask nurses or other techs to assist.  We do 2 without
valsalva and 2 with valsalva if needed.

C. Hogan, RDCS

	 -----Original Message-----
	 From: echocardiography@yahoogroups.com on behalf of mikespeaker2006
	 Sent: Fri 3/2/2007 7:38 PM
	 To: echocardiography@yahoogroups.com
	 Cc:
	 Subject: [echocardiography] bubble studies



	 i have a question regarding bubble study or saline studies. were i
	 work right now cardiologists wants us to do a bubble study always on
	 pts with atrial septal aneurysm, also they want us to do it when we see
	 any color flow going through the septal walls when we are doing routine
	 studies. Usually the techs do the bubble study themselves, since most
	 pts have a iv running, after asking the nurse to hold the medicine
	 going through the iv. what do you think about this.. should we have the
	 doctors or nurses do the bubble study, and have the cardiologist write
	 the order to do an bubble study on the chart.

#9534

From: <bclusetti@...>
Date: Mon Mar 5, 2007 5:27 pm
Subject: Re: bubble studies

bclusetti

Offline

You should have an order, unless your policey and procedure allows standing
orders for certain diagnoses.
-
--- mikespeaker2006 <mikespeaker2006@...> wrote:
> i have a question regarding bubble study or saline studies.  were i
> work right now cardiologists wants us to do a bubble study always on
> pts with atrial septal aneurysm, also they want us to do it when we see
> any color flow going through the septal walls when we are doing routine
> studies. Usually the techs do the bubble study themselves, since most
> pts have a iv running, after asking the nurse to hold the medicine
> going through the iv. what do you think about this.. should we have the
> doctors or nurses do the bubble study, and have the cardiologist write
> the order to do an bubble study on the chart.
>
>
>

#9533

From: "Teri" <teri@...>
Date: Mon Mar 5, 2007 4:43 pm
Subject: Re: Re: Definity

teri@...

Its on the BMS website as a PDF download.
Teri Dittrich, RDCS

-----Original Message-----
From: "Alejandro J. Forero" <drforero@...>
Date: Sat, 3 Mar 2007 23:30:37
To:<echocardiography@yahoogroups.com>
Subject: Re: [echocardiography] Re: Definity

�
If somebody has the letter or notification from� Bristol-Myers/Squibb (end of
November last year) concerning the �warnings of possible serious reactions when
using Definity, please E mail it to me . We are using definity in�dobutamine
stress echos when we do not have a good window.
Alejandro J Forero� MD�
-------Mensaje original-------
�

De: a b: <mailto:ginalulubaby@...>
Fecha: 03/02/07 21:01:05
Para: echocardiography@: <mailto:echocardiography@yahoogroups.com>
yahoogroups.com
Asunto: Re: [echocardiography] Re: Definity
�

Apparently, Bristol-Myers/Squibb sent out an updated notification at the end of
November last year warning of serious reactions when using Definity.� I
personally didn't receive the letter, and Brian in Oregon posted here recently,
concerned about the notice's contents and asking how other Echo Labs were
addressing it.

I called the company yesterday and spoke to a gentleman in the Adverse Reactions
department, who said they've had three customers notify them of an incident in
each of their labs within the past year, however each reaction occurred between
1-1.5 hours after administration (My understanding is that Definity is gone from
the system within, at most, a half hour); however, this needs to be reported -
the package insert is being changed, but takes up to two months to get out, and
in the meantime, the company sent out the notification for users to be made
aware.

The three reactions, all in a questionable time frame, coincide with the da ta
already being presented in the warnings of use.� I'll be on my toes, as usual,
but it doesn't sound to me like there's much more to be concerned about than
there was before.� Each lab has to address its own way of handling this.

I was faxed the letter that was sent out, if you'd like a copy.� Post your fax
number and I'll send it.

Jana <mbm219@...> wrote:

I have� missed� some� important information about� the use of Definity...please
recirculate� information� or� respond� with� the� latest news!! Thanks to
everyone!!!!

Bre <bmercer@...> wrote:

We have also had a policy change that has cut way back on our use of
Definity. Essentially, if we think that the use of Definity would be
diagnostically useful, then the patient has to be referred back to us
from the PCP. The patient gets some education about the possible side
effects caused by Definity and instructed that they will have to be
observed for 90 minutes after the study to make sure that there are no
adverse reactions.

--- In echocardiography@: <mailto:echocardiography%40yahoogroups.com>
yahoogroups.com, James Schrimsher
<jschrim102@...> wrote:
>
> We,ve had our administration stop the use of definity.We've (staff)
wondered what the rest of the world is doing about this and why.
>
> Confidentiality Note:
http://www.huntsvil: <http://www.huntsvillehospital.org/footer/disclaimer/>
lehospital.org/footer/disclaimer/
>

----------------
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>  Enjoy some healthy debate
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#9532

From: "Hogan, Candy" <candy.hogan@...>
Date: Sat Mar 3, 2007 1:29 am
Subject: RE: Definity

candy.hogan@...

No we haven't stopped using it.  We use it when we need it all the time.

chogan

	 -----Original Message-----
	 From: echocardiography@yahoogroups.com on behalf of Clifford Thornton
	 Sent: Fri 3/2/2007 12:46 AM
	 To: echocardiography@yahoogroups.com
	 Cc:
	 Subject: RE: [echocardiography] Definity



	 why have you stopped using Definity?

	 "Hogan, Candy" <candy.hogan@...> wrote:

		 Did they stop using contrast in Radiology too?

		 -----Original Message-----
		 From: echocardiography@yahoogroups.com
<mailto:echocardiography%40yahoogroups.com>  on behalf of James Schrimsher
		 Sent: Wed 2/28/2007 7:23 AM
		 To: echocardiography@yahoogroups.com
<mailto:echocardiography%40yahoogroups.com>
		 Cc:
		 Subject: [echocardiography] Definity



		 We,ve had our administration stop the use of definity.We've (staff) wondered
what the rest of the world is doing about this and why.

		 Confidentiality Note: http://www.huntsvillehospital.org/footer/disclaimer/
<http://www.huntsvillehospital.org/footer/disclaimer/> 
<http://www.huntsvillehospital.org/footer/disclaimer/
<http://www.huntsvillehospital.org/footer/disclaimer/> >









   _____

	 Food fight?
<http://answers.yahoo.com/dir/index;_ylc=X3oDMTFvbGNhMGE3BF9TAzM5NjU0NTEwOARfcwM\
zOTY1NDUxMDMEc2VjA21haWxfdGFnbGluZQRzbGsDbWFpbF90YWcx?link=ask&sid=396545367> 
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#9531

From: "Alejandro J. Forero" <drforero@...>
Date: Sun Mar 4, 2007 5:30 am
Subject: Re: Re: Definity

drforero@...

If somebody has the letter or notification from Bristol-Myers/Squibb (end of November last year) concerning the warnings of possible serious reactions when using Definity, please E mail it to me . We are using definity in dobutamine stress echos when we do not have a good window.

Alejandro J Forero MD

-------Mensaje original-------

De: a b

Fecha: 03/02/07 21:01:05

Para: echocardiography@yahoogroups.com

Asunto: Re: [echocardiography] Re: Definity

Apparently, Bristol-Myers/Squibb sent out an updated notification at the end of November last year warning of serious reactions when using Definity. I personally didn't receive the letter, and Brian in Oregon posted here recently, concerned about the notice's contents and asking how other Echo Labs were addressing it.

I called the company yesterday and spoke to a gentleman in the Adverse Reactions department, who said they've had three customers notify them of an incident in each of their labs within the past year, however each reaction occurred between 1-1.5 hours after administration (My understanding is that Definity is gone from the system within, at most, a half hour); however, this needs to be reported - the package insert is being changed, but takes up to two months to get out, and in the meantime, the company sent out the notification for users to be made aware.

The three reactions, all in a questionable time frame, coincide with the da ta already being presented in the warnings of use. I'll be on my toes, as usual, but it doesn't sound to me like there's much more to be concerned about than there was before. Each lab has to address its own way of handling this.

I was faxed the letter that was sent out, if you'd like a copy. Post your fax number and I'll send it.

Jana <mbm219@yahoo.com> wrote:

I have missed some important information about the use of Definity...please recirculate information or respond with the latest news!! Thanks to everyone!!!!

Bre <bmercer@ohvi.org> wrote:

We have also had a policy change that has cut way back on our use of
Definity. Essentially, if we think that the use of Definity would be
diagnostically useful, then the patient has to be referred back to us
from the PCP. The patient gets some education about the possible side
effects caused by Definity and instructed that they will have to be
observed for 90 minutes after the study to make sure that there are no
adverse reactions.

--- In echocardiography@yahoogroups.com, James Schrimsher
<jschrim102@...> wrote:
>
> We,ve had our administration stop the use of definity.We've (staff)
wondered what the rest of the world is doing about this and why.
>
> Confidentiality Note:
http://www.huntsvillehospital.org/footer/disclaimer/
>

Food fight? Enjoy some healthy debate
in the Yahoo! Answers Food Drink Q&A.

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#9530

From: "mikespeaker2006" <mikespeaker2006@...>
Date: Sat Mar 3, 2007 1:38 am
Subject: bubble studies

mikespeaker2006

Offline

i have a question regarding bubble study or saline studies.  were i
work right now cardiologists wants us to do a bubble study always on
pts with atrial septal aneurysm, also they want us to do it when we see
any color flow going through the septal walls when we are doing routine
studies. Usually the techs do the bubble study themselves, since most
pts have a iv running, after asking the nurse to hold the medicine
going through the iv. what do you think about this.. should we have the
doctors or nurses do the bubble study, and have the cardiologist write
the order to do an bubble study on the chart.

#9529

From: Kathy Cross <mrtraipi@...>
Date: Sun Mar 4, 2007 3:01 pm
Subject: Re: free echo cme's

mrtraipi

Offline

You can go to www.cardiovillage.com, it is out of the University of Virginia. I believe there are over 200 free cme's available on that site.

Kathy

Ed Chait <edchait4@...> wrote:

Does anyone know of any websites that offer free echo and/or vascular CME's?

thanks in advance,

Ed Chait, RDCS, RVT

Everyone is raving about the all-new Yahoo! Mail beta.

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#9528

From: Mark Harry <mharry@...>
Date: Sat Mar 3, 2007 3:02 am
Subject: Choice of lower heart rate for CRT ( Part I )

mjhcuc

Offline

Recently there have been a couple of articles in the ASE journal that
explore the importance of assessment of diastolic function in
patients with cardiomyopathy and heart failure.  In the first article
published in the November issue (The Systolic to Diastolic Ratio in
Children with Heart Failure Secondary to Restrictive Cardiomyopathy)
Mark Friedberg et al. found that the systolic to diastolic ratio was
highly correlated to heart rate.  As heart rate increased, systole
(duration of TR) increased and diastole (end of TR to beginning of
TR) decreased.  The authors did not measure IVRT as part of their
study.  If you consider IVRT as part of diastole then in fact systole
did not increase.  What really happened was as heart rate increased
total diastolic filling time decreased while IVRT stayed unchanged.

I have attached a couple of images of two different case that
illustrate this observation.  Both patients are heart failure
patients that are receiving CRT.  In the first image
(IVRT_Case01.jpg) the heart rate on left is 60.  At a heart rate of
60 the total filling time (closure of the aortic valve to closure of
the mitral valve) is 620 msec.  The IVRT (aortic Doppler superimposed
on mitral inflow Doppler) is 210 msec (normal is around 100 msec).
With an IVRT of 210 msec., the actual filling time is 410 msec.  At
this heart rate there is a complete E wave and A wave at an optimal
Paced AV delay of 170 msec.

When the heart rate was increased to 70 in the image on the right,
the total filling time dropped to 460 msec. but the IVRT (aortic
Doppler superimposed on mitral inflow Doppler.  The mitral inflow PW
Doppler sample volume was positioned to include the MR) was
unchanged.  This resulted in a filling time of only 230 msec. and
there was total loss of the early filling E wave.  When this
patient's pacemaker was implanted, the initial setting for the heart
rate was 70.  The patient was considered a non-responder to CRT due
to increased symptoms of fatigue and shortness of breath.  These
symptoms decreased significantly when the heart rate was lowered to 60.

I see about one to two patients a week with similar findings at what
seems like a reasonable heart rate (70+) that is actually too fast.

In the second article published in the February issue (Hemodynamic
Effects of Tachycardia in Patients with Relaxation Abnormality:
Abnormal Stroke Volume Response as an Overlooked Mechanism of Dyspnea
Associated with Tachycardia in Diastolic Heart Failure) Dae-Won Sohn
et al. found that there was an inadequate stroke volume response to
tachycardia in patients with relaxation abnormalities.  As heart rate
increased there was a greater increase in the IVRT/cardiac cycle
ratio (IVRT divided by R to R interval).  This resulted in lower
cardiac output due to drop in stroke volume.  Although the authors
did not discuss IVRT as the primary mechanism for this result, their
IVRT/cardiac cycle ratio does include this primary mechanism.  Both
the systolic/diastolic ratio and the IVRT/cardiac cycle ratio can be
useful tools to identify those patients that need to be kept at lower
heart rates to avoid diastolic failure at heart rates that are
typically considered normal.

My second case example (image IVRT_Case02.jpg) is similar to the
first.  I saw this patient as a non-responder to CRT.  The heart rate
was set at 70 and the paced AV delay was optimized at 150.  At these
setting (upper left hand panel) there is no early filling.  The IVRT
at this heart rate (middle panel) was 300 msec.  The patient's
underlying rate was 57 so the lower rate limit was decreased to 55
and the sensed AV delay was optimized at 100 msec.  At these setting
(upper right hand panel) early filling is restored.  The IVRT
remained unchanged (lower panel).  The middle and lower panels
illustrate how I like to measure IVRT.  I use the maximum sweep speed
on the ultrasound system and I make the aortic and mitral
measurements separately.  I saw this patient two weeks ago so I do
not have follow-up on how the patient has responded to these changes.

I hope everyone can see that diastole is just as important as systole
in these heart failure patients that have significant diastolic
dysfunction.  If you don't get it in you can't pump it out.  Next
week I hope to present part two which addresses CRT patients that
have been put in a low output state because too low of a lower heart
rate limit has been set on their pacemaker.

Thank you
Mark Harry
Cardiac Ultrasound Consulting

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#9527

From: a b <ginalulubaby@...>
Date: Fri Mar 2, 2007 2:59 pm
Subject: Re: Re: Definity

ginalulubaby

Offline

Apparently, Bristol-Myers/Squibb sent out an updated notification at the end of November last year warning of serious reactions when using Definity. I personally didn't receive the letter, and Brian in Oregon posted here recently, concerned about the notice's contents and asking how other Echo Labs were addressing it.

I called the company yesterday and spoke to a gentleman in the Adverse Reactions department, who said they've had three customers notify them of an incident in each of their labs within the past year, however each reaction occurred between 1-1.5 hours after administration (My understanding is that Definity is gone from the system within, at most, a half hour); however, this needs to be reported - the package insert is being changed, but takes up to two months to get out, and in the meantime, the company sent out the notification for users to be made aware.

The three reactions, all in a questionable time frame, coincide with the data already being presented in the warnings of use. I'll be on my toes, as usual, but it doesn't sound to me like there's much more to be concerned about than there was before. Each lab has to address its own way of handling this.

I was faxed the letter that was sent out, if you'd like a copy. Post your fax number and I'll send it.

Jana <mbm219@...> wrote:

I have missed some important information about the use of Definity...please recirculate information or respond with the latest news!! Thanks to everyone!!!!

Bre <bmercer@ohvi.org> wrote:

We have also had a policy change that has cut way back on our use of
Definity. Essentially, if we think that the use of Definity would be
diagnostically useful, then the patient has to be referred back to us
from the PCP. The patient gets some education about the possible side
effects caused by Definity and instructed that they will have to be
observed for 90 minutes after the study to make sure that there are no
adverse reactions.

--- In echocardiography@yahoogroups.com, James Schrimsher
<jschrim102@...> wrote:
>
> We,ve had our administration stop the use of definity.We've (staff)
wondered what the rest of the world is doing about this and why.
>
> Confidentiality Note:
http://www.huntsvillehospital.org/footer/disclaimer/
>

Food fight? Enjoy some healthy debate
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#9526

From: <bclusetti@...>
Date: Thu Mar 1, 2007 8:58 pm
Subject: Re: Heart Transplant

bclusetti

Offline

I have to agree with Rob
MV inflow is very important we watch the same things as well as the MV dec time
should be between 125-150 if not can indicate early rejection. Brooke
---- Robert Simmons <azranch2004@...> wrote:
> I disagree, MV inflow and TDI are very important in tracking OHT pts. The MDs
I work for are concerned with stiffness of the LV/restrictive MV inflow pattern
as much as LV FX.
>
>   Regards, Rob
>
> Carlos Barrios <cardiomonkey@...> wrote:
>             I do not think that diastilic function and Tissue Doppler are very
accurate since these values relate to age (note that the donor heart may be in a
different age group). I believe that systolic function and wall thickness can be
used as indications for rejection only and like you said the atria appears
enlarged since this is the site for the anastomosis.
>
>   Carlos
>
> Andre <akory99@...> wrote:
>       Hello Group -
>
> Besides elongated atria, what other charachteristics do the
> transplanted hearts exibit? Cardiomyopathies? Valvular problems? What
> about diastolic function - is mitral E/A and annular Tissue Doppler
> accuarate in these patients?
>
> Thank you for your feedback - Andre
>
>
>
>
>
> ---------------------------------
>   Now you can have a huge leap forward in email: get the new Yahoo! Mail.
>
>
>
>
> ---------------------------------
> Food fight? Enjoy some healthy debate
> in the Yahoo! Answers Food & Drink Q&A.

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#9525

From: "loredlore" <loredlore@...>
Date: Thu Mar 1, 2007 9:35 pm
Subject: Re: Chat Sessions

loredlore

Offline

--- In echocardiography@yahoogroups.com, "Rick Duncan" <rick@...>
wrote:
>
> Hi,
>
> Is anyone here know of someone that can present a chat session on
Diastology
> or Echo in Space?  We are looking for a guest host on these
subjects.  Any
> recommendation s would be appreciated.
>
> Rick
>

HELLO,
I REMEMBER SOMEONE, SOMETIME LAST YEAR HAD A CLIP ON DIASTOLOGY,
WISH I MYSELF HAD SAVED IT. IF SOMEONE MAY HAVE SAVED IT PLEASE
FORWARD TO THE GROUP, OR IF THE SENDER CAN RESEND, GREAT!

LORE

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#9524

From: Clifford Thornton <cmt51597@...>
Date: Fri Mar 2, 2007 6:46 am
Subject: RE: Definity

cmt51597

Offline

why have you stopped using Definity?

"Hogan, Candy" <candy.hogan@...> wrote:

Did they stop using contrast in Radiology too?

-----Original Message-----
From: echocardiography@yahoogroups.com on behalf of James Schrimsher
Sent: Wed 2/28/2007 7:23 AM
To: echocardiography@yahoogroups.com
Cc:
Subject: [echocardiography] Definity

We,ve had our administration stop the use of definity.We've (staff) wondered what the rest of the world is doing about this and why.

Confidentiality Note: http://www.huntsvillehospital.org/footer/disclaimer/ <http://www.huntsvillehospital.org/footer/disclaimer/>

Food fight? Enjoy some healthy debate
in the Yahoo! Answers Food Drink Q&A.

#9523

From: "kpilotte" <kpilotte@...>
Date: Fri Mar 2, 2007 4:41 am
Subject: RE: Definity

kpilotte@...

Have used Definity since the withdrawal of Optison. Use an average of 10-15 doses per month of contrast for the last 4 years. No problems to date. Contrast is great stuff and has had a huge impact on a significant number of echos, would hate to loose its use because of what I see as an over reaction. Or am I under-estimating the potential threat to patients? We are a cardiology practice, not hospital based.

-----Original Message-----
From: echocardiography@yahoogroups.com [mailto:echocardiography@yahoogroups.com]On Behalf Of James Schrimsher
Sent: Wednesday, February 28, 2007 7:23 AM
To: echocardiography@yahoogroups.com
Subject: [echocardiography] Definity

We,ve had our administration stop the use of definity.We've (staff) wondered what the rest of the world is doing about this and why.

Confidentiality Note: http://www.huntsvillehospital.org/footer/disclaimer/

#9522

From: Amy Poland <ekkohearts@...>
Date: Fri Mar 2, 2007 1:35 am
Subject: Re: Looking for a job

ekkohearts

Offline

We are also interviewing for a full time Echo tech that is atleast registry eligible. You can apply at www.sentara.com or contact Kathy Cross at 757-388-8192 for more information.

Gerson Lichtenberg <gersonsl@...> wrote:

We are interviewing for a registered echocardiographer. Please contact Kate Kzeski in Human Resources at 773=257-5463 if you are available in our area.

Gerson Lichtenberg, RDCS
Echo Lab Coordinator
Mt. Sinai Hospital
Chicago, Illinois

allanjacob_091603 <allanjacob_091603@yahoo.com> wrote:

Good Day! Im looking for a job opening for echo techs. Are there any
vacancies available in the United states? Thank You!

Gerson Lichtenberg, RDCS
Echocardiography Coordinator
Mt. Sinai Hospital
Chicago, Illinois

Don't pick lemons.
See all the new 2007 cars at Yahoo! Autos.

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#9521

From: "Echo Ken" <KenCVT@...>
Date: Wed Feb 28, 2007 9:37 pm
Subject: RE: Looking for ECHO pay scales in Florida

KenCVT@...

http://www.ultrasoundjobs.com/salary.htm

Paula ,

I Found a salary survey on ARDMS's ultrasoundjobs.com's website . Although it does appear to be a few years old. Dont know if it may be helpful or not, but here it is :) .It does a nice break down on states, citys, registered, non-registered, levels or experience and so on. I found it interesting.

www.ultrasoundjobs.com

enjoy,

Ken, CCT, RDCS

From: "smart_girl1998" <smart_girl1998@...>
Reply-To: echocardiography@yahoogroups.com
To: echocardiography@yahoogroups.com
Subject: [echocardiography] Looking for ECHO pay scales in Florida
Date: Tue, 27 Feb 2007 15:15:56 -0000

Good morning,
I am looking for ranges of pay for non registered and registered
ECHO techs in North FL. There appears to be big differences in the
private sector and Hospitals. Thank you
Paula Gehr, RVT
Southern Heart Group,P.A.
Jacksonville, FL 32258

Mortgage rates as low as 4.625% - Refinance $150,000 loan for $579 a month. Intro*Terms

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#9520

From: Jana <mbm219@...>
Date: Wed Feb 28, 2007 7:24 pm
Subject: Re: Re: Definity

mbm219

Offline

I have missed some important information about the use of Definity...please recirculate information or respond with the latest news!! Thanks to everyone!!!!

Bre <bmercer@...> wrote:

We have also had a policy change that has cut way back on our use of
Definity. Essentially, if we think that the use of Definity would be
diagnostically useful, then the patient has to be referred back to us
from the PCP. The patient gets some education about the possible side
effects caused by Definity and instructed that they will have to be
observed for 90 minutes after the study to make sure that there are no
adverse reactions.

--- In echocardiography@yahoogroups.com, James Schrimsher
<jschrim102@...> wrote:
>
> We,ve had our administration stop the use of definity.We've (staff)
wondered what the rest of the world is doing about this and why.
>
> Confidentiality Note:
http://www.huntsvillehospital.org/footer/disclaimer/
>

Food fight? Enjoy some healthy debate
in the Yahoo! Answers Food Drink Q&A.

#9519

From: "Hogan, Candy" <candy.hogan@...>
Date: Thu Mar 1, 2007 3:28 pm
Subject: RE: Definity

candy.hogan@...

Did they stop using contrast in Radiology too?

	 -----Original Message-----
	 From: echocardiography@yahoogroups.com on behalf of James Schrimsher
	 Sent: Wed 2/28/2007 7:23 AM
	 To: echocardiography@yahoogroups.com
	 Cc:
	 Subject: [echocardiography] Definity



	 We,ve had our administration stop the use of definity.We've (staff) wondered
what the rest of the world is doing about this and why.

	 Confidentiality Note: http://www.huntsvillehospital.org/footer/disclaimer/
<http://www.huntsvillehospital.org/footer/disclaimer/>

#9518

From: Robert Simmons <azranch2004@...>
Date: Thu Mar 1, 2007 3:32 am
Subject: Re: Heart Transplant

azranch2004

Offline

I disagree, MV inflow and TDI are very important in tracking OHT pts. The MDs I work for are concerned with stiffness of the LV/restrictive MV inflow pattern as much as LV FX.

Regards, Rob

Carlos Barrios <cardiomonkey@...> wrote:

I do not think that diastilic function and Tissue Doppler are very accurate since these values relate to age (note that the donor heart may be in a different age group). I believe that systolic function and wall thickness can be used as indications for rejection only and like you said the atria appears enlarged since this is the site for the anastomosis.

Carlos

Andre <akory99@aol.com> wrote:

Hello Group -

Besides elongated atria, what other charachteristics do the
transplanted hearts exibit? Cardiomyopathies? Valvular problems? What
about diastolic function - is mitral E/A and annular Tissue Doppler
accuarate in these patients?

Thank you for your feedback - Andre

Now you can have a huge leap forward in email: get the new Yahoo! Mail.

Food fight? Enjoy some healthy debate
in the Yahoo! Answers Food Drink Q&A.

Reply | Forward | Messages in this Topic (6)

#9517

From: Gerson Lichtenberg <gersonsl@...>
Date: Thu Mar 1, 2007 1:47 pm
Subject: Re: Looking for a job

gersonsl7

Offline

We are interviewing for a registered echocardiographer. Please contact Kate Kzeski in Human Resources at 773=257-5463 if you are available in our area.

Gerson Lichtenberg, RDCS
Echo Lab Coordinator
Mt. Sinai Hospital
Chicago, Illinois

allanjacob_091603 <allanjacob_091603@...> wrote:

Good Day! Im looking for a job opening for echo techs. Are there any
vacancies available in the United states? Thank You!

Gerson Lichtenberg, RDCS
Echocardiography Coordinator
Mt. Sinai Hospital
Chicago, Illinois

Reply | Forward | Messages in this Topic (3)

#9516

From: "Bre" <bmercer@...>
Date: Wed Feb 28, 2007 4:09 pm
Subject: Re: Definity

wilnbre2

Offline

We have also had a policy change that has cut way back on our use of
Definity.  Essentially, if we think that the use of Definity would be
diagnostically useful, then the patient has to be referred back to us
from the PCP.  The patient gets some education about the possible side
effects caused by Definity and instructed that they will have to be
observed for 90 minutes after the study to make sure that there are no
adverse reactions.

--- In echocardiography@yahoogroups.com, James Schrimsher
<jschrim102@...> wrote:
>
> We,ve had our administration stop the use of definity.We've (staff)
wondered what the rest of the world is doing about this and why.
>
> Confidentiality Note:
http://www.huntsvillehospital.org/footer/disclaimer/
>