Imaging (Echocardiography) —
Training activity: 25

Details

Adapt protocol and report to cater for stroke

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• Before this activity, how can echocardiography be used to identify potential cardiac sources of embolic stroke (e.g., atrial fibrillation, patent foramen ovale)?
• How does the imaging protocol need to be adapted in the context of a recent stroke?
• What specific views and techniques (including contrast echocardiography) might be indicated?
• What key elements should be included in the echo report when investigating a potential cardioembolic source of stroke?

In action

• How are you modifying the standard echo protocol to assess for potential cardiac sources of embolic stroke (e.g., atrial fibrillation-related thrombus in the left atrial appendage, patent foramen ovale, aortic atheroma, prosthetic valve dysfunction)? Which specific views and Doppler techniques are you prioritising? How are you planning to structure your report to clearly document any findings that could be relevant to the patient’s stroke? Are you carefully examining the left atrium and appendage for thrombus, particularly if the patient has a history of atrial fibrillation? Are you using saline contrast to assess for the presence of a PFO? Are you looking for significant atheroma in the aorta? Are you evaluating the function of any prosthetic valves? Are you familiar with the cardiac conditions that are known risk factors for embolic stroke? Are you consciously applying specific imaging techniques and views to evaluate for these conditions?

• Are you successfully visualising the relevant cardiac structures to assess for potential embolic sources? Are you encountering any difficulties in obtaining optimal images (e.g., due to body habitus)? Are you gaining a better understanding of the cardiac factors that can contribute to stroke? Are you learning to recognise echocardiographic features that might warrant further investigation or treatment? Are you applying your knowledge of stroke pathophysiology, cardiac sources of embolism, and echocardiographic assessment techniques?

• Would transoesophageal echocardiography provide better sensitivity for detecting thrombus in the left atrial appendage or aortic atheroma, or for assessing for a PFO? If you identify a potential cardiac source of embolism, would you immediately discuss your findings with a senior colleague or the neurology team? Are the protocol adaptations and the interpretation of findings related to potential cardiac sources of stroke within the scope of your current training?

On action

• Describe the specific considerations for imaging a patient who has had a stroke (or is at high risk). Outline how you adapted the standard echo protocol, often focusing on identifying potential cardiac sources of embolism (e.g., PFO, atrial fibrillation). Note the key features you focused on in the report.
• Reflect on your understanding of the role of echocardiography in the investigation of stroke. Did you gain a better understanding of the specific findings that may be relevant? Were there any challenges in adapting the protocol or interpreting the findings? How does this relate to acquiring and interpreting cardiac images for pathological conditions?
• Identify any specific aspects of echocardiography in the context of stroke where you need to enhance your knowledge of protocols and reporting. How will you approach adapting protocols in the future? What resources will you use to further your understanding?

Beyond action

• Have you performed echocardiography in patients following a stroke to assess for potential cardiac sources of embolism (e.g., atrial fibrillation, patent foramen ovale)? How did the clinical context of stroke influence your echo protocol and reporting? Have your subsequent experiences refined your approach to these cases?
• How has your ability to tailor echo protocols to identify potential cardiac sources of stroke, including the use of contrast echocardiography, improved? Are you now more skilled in documenting relevant findings and communicating them to the stroke team?
• How will your understanding of echocardiography in the context of stroke inform your collaboration with neurologists in the investigation and prevention of embolic stroke? How will this experience support your ability to identify cardiac conditions that may increase the risk of future stroke?

Relevant learning outcomes

#	Outcome
# 1	Outcome Acquire and interpret cardiac images for a range of normal and pathological conditions.
# 2	Outcome Explain imaging results to patients and other health care professionals.
# 3	Outcome Distinguish and justify actions based on clinical and ECG findings.
# 5	Outcome Appraise new guidelines and evidence to inform practice.
# 6	Outcome Demonstrate safe practice in line with local, national and international guidelines and standards.
# 7	Outcome Assess and evaluate a patient’s clinical presentation and make recommendations for cardiac imaging.
# 8	Outcome Evaluate cardiac care pathways.
# 9	Outcome Summarise complex information into a concise and logical reports for specialist and non-specialist audiences.