260.3 🩺 內科專科考前版

260.3.0.1 1⃣ TEE Bacteremia Risk

  • Transient + low
  • 2024 IDSA: no routine antibiotic prophylaxis (changed from earlier recommendations)
  • High-risk patient (severe heart disease, prosthetic valve, prior IE) — case-by-case

260.3.0.2 2⃣ Stress Echo Interpretation

  • Inducible wall motion abnormalities at peak stress = ischemia
  • Worsening LVEF at peak = significant ischemia
  • Viability assessment with low-dose dobutamine: biphasic response (improvement at low, deterioration at high) = ischemic but viable
  • Sensitivity + specificity ~ 85% / 85% for CAD

260.3.0.3 3⃣ POCUS in Cardiac Arrest

  • Bedside echo during pulse check
  • Identifies tamponade (drainable), severe RV strain (PE; consider thrombolytics), severe LV dysfunction
  • May reveal pulseless electrical activity (PEA) cause
  • Limits interruption to chest compressions

260.3.0.4 4⃣ AI-Echo (2023+)

  • FDA-approved tools for automated EF
  • LV strain analysis automation
  • Reduces inter-operator variability
  • Increasing integration in workflow
  • Limitations: validation in diverse populations + lesion-specific accuracy

260.3.0.5 5⃣ Cardio-Oncology + GLS

  • Cancer therapy-related cardiotoxicity (CTRCD) monitoring
  • Anthracyclines (doxorubicin), HER2 (trastuzumab), TKIs, immune checkpoint inhibitors
  • Baseline GLS + serial GLS during chemo
  • GLS drop > 15% = early dysfunction, consider cardioprotection (ACEi, BB, statins)
  • Many institutions standard of care

260.3.0.6 6⃣ HFpEF Diagnosis with Echo

  • HFpEF criteria: HF symptoms + EF ≥ 50% + diastolic dysfunction
  • E/e’ > 14 or septal e’ < 7 cm/s or lateral e’ < 10 cm/s
  • LA dilation > 34 mL/m²
  • PASP > 35 mmHg
  • Diastolic dysfunction grade 2-3

260.3.0.7 7⃣ Endocarditis TTE vs TEE

  • TTE first-line screening
  • TEE if:
    • Negative TTE + ongoing clinical concern
    • Prosthetic valve (TTE has poor windows)
    • Suspected paravalvular abscess
    • Suspected pacemaker / ICD lead infection
    • Initial TEE recommended in modified Duke criteria when TTE negative

260.3.0.8 8⃣ Bubble Study for PFO

  • Right-to-left shunt detection
  • Agitated saline injection
  • Detect bubbles in left atrium within 3-5 beats
  • During Valsalva for sensitivity
  • PFO closure consideration for cryptogenic stroke + young (Ch 269+)

260.3.0.9 9⃣ 健保 / Taiwan

  • 健保 TTE + TEE + stress echo widely available
  • Cardiology + emergency POCUS expanding
  • AI-echo emerging in tertiary

260.3.0.10 10. Future + Innovations

  • AI integration in real-time imaging
  • Handheld + smartphone ultrasound
  • Multimodality fusion (echo + CT + MRI)
  • 4D imaging
  • Smart guidance for novice operators