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  1. #1
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    TEE Transesophapgeal ECO

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    What are the indications of TEE? if you know any other or a protocol please share it.

    You do a TEE to see the valves of the heat and before cardioversion of Atrial Fibrilation to make sure there are no thrombi

    but
    Are you suppose to ALWAYS do a TEE before cardioversion of Atrial Fibrilation?
    Thanks
    Moderator: USMLE AND Residency Forums.

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    why even bother with the obvious. Just know where you are need it and where you can help the most.

  2. #2
    Protoman2050 is offline Member 510 points
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    Quote Originally Posted by IMG SURVIVOR View Post
    What are the indications of TEE? if you know any other or a protocol please share it.

    You do a TEE to see the valves of the heat and before cardioversion of Atrial Fibrilation to make sure there are no thrombi

    but
    Are you suppose to ALWAYS do a TEE before cardioversion of Atrial Fibrilation?
    Thanks
    If the patient has not been anticoagulated for at least 2 weeks prior, or you can't get that info ie emergency cardioversion. If they have been anticoagulated, why waste money with a TEE?

  3. #3
    OveractiveBrain is offline Newbie 511 points
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    If there is nonemergent cardioversion in AFib, you ALWAYS get the TTE --> TEE to rule out atrial thrombi. If they were anticoagulated can you guarentee there is no thrombi? Why would you "waste" money on a TEE? So they dont stroke out and live the rest of their life in a nursing home (average cost 150,000 a year).

    TEEs are gotten any time you want to evaluate any valve. You start with a TTE and proceed to TEE if the TTE is negative. If the TTE is positive, you stop, and treat as needed.

    This would be for primarily for the diagnosis of Endocarditis and identification of Thrombi. They are also used in cardiac surgery to ensure ideal placement of prosthetic valves prior to coming off a heart-lung machine.

    For Afib:
    (1) EKG diagnosis
    a. if unstable, dc cardioversion
    b. if stable but symptomatic, rate control with CCB or BB
    c. if stable and asymptomatic, routine care
    (2) Consider Cardioversion
    a. if onset within 48 hrs and low risk of stroke (CHADS2 score low) may cardiovert now (DC Cardioversion or Amio). This is usually reserved for EKG recorded cardioversion to Afib in hospital
    b. if onset > 48 hrs or high risk of stroke (CHADS2 score high)
    i. do a TTE-->TEE.
    ii. If Echo negative, may cardiovert now (DC Cardioversion or Amio)
    iii. If Echo positive, anticoagulate x3 wks, then go back to 2.b.i
    c. Cardioversion with Amiodarone or DC Cardioversion is performed only when negative for thrombus. patients with afib cardioversion require coumadin x 3-12 weeks, bridge with heparin
    Last edited by OveractiveBrain; 06-21-2010 at 02:42 PM.

  4. #4
    Montgomery is offline Newbie 510 points
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    Quote Originally Posted by IMG SURVIVOR View Post
    What are the indications of TEE? Thanks
    Evaluation of Native valve disease
    Prosthetic heart valve function/dysfunction
    Cardiac masses
    The ICU patient with hemodynamic instability
    Congenital heart disease
    Thromboembolic risk in patient with atrial fibrillation and inadequate anticoagulation
    Detection of Aortic dissection
    Complications of endocarditis
    Potential etiologies of stroke
    Adjunct to Percutaneous cardiac procedures
    Cardiac surgical procedures

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