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Stress Echo Freeland Systems


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									                                   Stress Echocardiographic Study Report
Name:                                    Patient ID:                                Sonographer:
Exam Date:                               Exam Number:                               Prior Study:
DOB:                                     Age:           Yrs                         Gender:
Height:        inches                    Weight:          lb                        BSA:            m
Referring Physician:                                           Interpreting Physician:

 TREADMILL, EKG, AND ECHO DATA SUMMARY                                                          Echo exam quality:

                    Exercise Protocol                                               EKG Data
Protocol:                                                      Worst-case ST Slope:      ST Level:
Total minutes:                                                 Pre-exercise EKG:
Reason for stopping:                                           Exercise EKG:

            Heart Rate and Blood Pressure                                             EKG SUMMARY
Resting blood pressure:       /                                1.   No significant ST changes with exercise.
Baseline heart rate:       Target heart rate:                  2.   No CP with exercise.
Percent of Max HR:      % Predicted Max HR:                    3.   Exercise capacity was good.
Blood pressure at peak exercise:       /                       4.   Normal heart rate response to exercise.
Maximum heart rate achieved:
                                                               5.   Normal blood pressure response to exercise.
Rate pressure product:
                                                               6.   No arrhythmias were observed.

                                               ECHOCARDIOGRAM FINDINGS
 Rest Echo Study: Normal wall motion and systolic thickening of all left ventricular segments. No resting wall motion
 abnormalities. Resting ejection fraction is       %.
 Immediate Post-Exercise Echo Study: Increased wall motion and systolic thickening of all left ventricular segments
 with decrease in end-systolic dimensions. (Visual estimate) No immediate post exercise abnormalities noted.


        REST Score: 1.0                IMPOST Score: 1.0
                                                                     1   Normal                         1   Hyperkinetic
                                                                     2   Hypokinetic                    3   Akinetic/
                                                                     2   Hypokinetic (Mild)             4   Dyskinetic
                                                                     2   Hypokinetic (Moderate)         5   Dilated and Thinned
                                                                     2   Hypokinetic (Severe)           x   Not Visualized
                                                                     2   Hypokinetic (Borderline)

Electronically Signed

Stress Echocardiographic Study                                                                                       Page 1 of 1

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