Value of an echo tech's reading?

[Iron Horse]

How much credibility do echocardiogram techs have in spotting/diagnosing a heart attack based on an echo? Clearly there will be variation given the individual's talent/experience, but in general, how much faith should one have in an experienced echo tech's analysis?

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[southerndoc]

Diagnosing an MI by an echo? WTF? Echoes aren't designed to diagnose MI's. ELECTROcardiograms (EKG's) can diagnose MI's, but not echoes. Echoes diagnose prior MI's (e.g., damaged tissue), ischemia (with perfusion studies), or valvular abnormalities, but they do not diagnose MI -- only evidence of past MI.

 

[Iron Horse]

Fine, same question, just use past tense for the potential MI -- the point is how much stock should one put in an experienced echo tech's opinion?

 

[southerndoc]

Can be pretty reliable with a good tech, but the problem is that there is so much variability with techs.

I'd imagine even a bad tech can accurately assess a past MI if there is substantial evidence (e.g., a large infarcted area, significantly reduced ejection fraction, etc.).

 

[Iron Horse]

Thanks for the feedback. Anyone else with helpful info please post ASAP. Thanks.

 

[jlb102]

Generally speaking even a monkey can see an obvious wall motion abnormality on an echo, that being said, not all WMA's are obvious. If a tech has a lot of experience they can be quite skilled at reading major echo findings. Of course the cardiologist trained in reading echos will have the last word, but a tech's reading would be trusted unless a skilled echocardiographer said otherwise. Also, if it was not clearcut, most of the techs I know would not make a definitive statement one way or the other, thus, if a tech is saying that it is obvious or definite, they are more likely right than not.
Can you give any additional info?
JB

 

[trouserz]

Originally posted by Geek Medic
Diagnosing an MI by an echo? WTF? Echoes aren't designed to diagnose MI's. ELECTROcardiograms (EKG's) can diagnose MI's, but not echoes. Echoes diagnose prior MI's (e.g., damaged tissue), ischemia (with perfusion studies), or valvular abnormalities, but they do not diagnose MI -- only evidence of past MI.

Greek.. I think you are a bit mistaken...
Echocardiography indeed cannot tell the diff between ami and old mi but it is frequently employed when the clinical picture is not 100% clear eg non STEMI ACS. Echo, in these instances help to guide the decision of whether to treat the patient ie PCI

 

[trouserz]

During ischemic events there are mural dyskinesias. Echo is very sensitive but not very specific for AMI.

 

[Iron Horse]

Thanks to everyone for offering thoughts. I appreciate it.

 

[southerndoc]

Originally posted by trouserz
Greek.. I think you are a bit mistaken...
Echocardiography indeed cannot tell the diff between ami and old mi but it is frequently employed when the clinical picture is not 100% clear eg non STEMI ACS. Echo, in these instances help to guide the decision of whether to treat the patient ie PCI

Interesting. I've never seen this done, but doesn't mean it's not done.

We usually rely on cardiac enzymes for ACS.

 

[Surfer75]

really depends on the tech... but in general, it's not too difficult to pick up reduced LVEF/hypokinesis, valvular pathophys including reduced excursion, mild-severe insufficiencies, even stenotic valves with key signs like the hockey stick in MS..etc.. as for dx MIs... I didn't think it's a primary tool, but I'm sure it can be reliable for secondary info along with MIBIs..etc.

Anyone hear that MUGAs underestimate EF and echos overestimate EFs while caths are supposedly the gold standard?