Stress Echocardiogram

What is a stress echocardiogram?

A stress echocardiogram is a test that allows your healthcare provider to see how your heart muscle works both when you are resting and when your heart is stressed. The heart can be stressed with exercise. It can also be stressed with drugs that increase the heart rate or change the way blood flows through the coronary arteries.

Images of the beating heart are made by bouncing high-frequency (ultrasound) sound waves off the heart. A computer uses the echoes of the sound waves to create a moving picture of the heart. All of the heart structures, including the heart muscle and heart valves, can be carefully examined.

When is it used?

Many people with heart problems have no symptoms when they are resting. Stressing the heart causes specific changes that can be seen on the echocardiogram. Stress echocardiograms help your healthcare provider know if you need more cardiac tests and treatment.

Another type of stress test, a standard exercise treadmill test, uses only an electrocardiogram (ECG) to give information about the condition of the heart during stress. Sometimes standard treadmill tests give uncertain results. A stress echocardiogram can be a more accurate way to diagnose blockage in the arteries. For a stress echocardiogram, an echocardiogram is done along with an ECG to give information about the heart.

How do I prepare?

Usually no preparation is necessary. Your healthcare provider may ask you not to eat or drink anything for about 2 hours before the test. Ask your provider if you should avoid taking any medicines on the day of the test.

What happens during the procedure?

The test lasts 30 to 60 minutes. It can be done in a clinic, hospital, or your healthcare provider's office. A small needle may be placed in a vein in your arm. Your healthcare provider or a technologist will monitor your ECG and blood pressure while the echocardiogram is being done.

Your healthcare provider may ask you to walk on a treadmill for the echocardiogram. However, your provider may choose to use drugs instead of exercise to produce stress for your heart. Reasons for using drugs rather than exercise are:

• You have a physical problem that prevents you from walking on a treadmill.
• You have been taking medicine that won't allow your heart rate to increase enough for an exercise test to be useful.

When drugs are used to make your heart beat faster, the drug dobutamine is slowly dripped into your vein. A drug called atropine is sometimes given with the dobutamine to increase your heart rate. The amount of dobutamine is increased every 3 minutes until a target heart rate, based on your age, is reached. When you reach the target heart rate or when your healthcare provider decides you have had enough of the drug, the medicine is stopped and a final echocardiogram recorded.

What happens after the procedure?

After the test, you can go home and go back to your usual activities. Your healthcare provider will review the pictures, watching each part of the heart's muscle during the heartbeat. If there is a problem with blood supply to the heart, differences in the strength of contraction of heart muscle in different parts will show clearly.

What are the benefits?

A stress echocardiogram can show heart disease or problems with the heart valves. Your healthcare provider will use it to help decide your need for treatment or for more costly and riskier tests.

What are the risks?

On rare occasions, cardiac arrest may occur during the test. To ensure your safety, your healthcare provider will supervise the test. Your blood pressure and ECG will be watched carefully. The test team will watch for and be able to treat emergencies if they happen.

Minor side effects of the drugs are common. Dobutamine occasionally causes chest pain, low blood pressure, or nausea. It may cause or worsen irregular heart rhythms. Atropine may cause temporary dryness of your mouth and temporary blurred vision. Your healthcare provider and the test team are aware of these potential problems and can treat them if they occur.

When should I call my healthcare provider?

Call your healthcare provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.