Stress Echocardiogram

What is a Stress Echocardiogram?

A stress echocardiogram (echo) is a procedure that combines an ultrasound study of the heart with a stress test. It is performed to show your physician how the heart functions when it is made to work harder.

A stress test is usually performed while patients walk on a treadmill. For patients who are unable to exercise adequately (for a variety of reasons) the procedure may be performed after an injection of dobutamine, a drug that produces an effect on the heart similar to exercise.

What does it show?

During an echo, a small device called a transducer is held against the chest. The transducer sends ultrasound waves that reflect (echo) off the various parts of the heart. The echos are converted into moving images of the heart. These images are displayed on a television screen and can be recorded on videotape.

The stress echo shows the areas of the heart muscle that do not receive an adequate blood supply. This is especially useful in diagnosing coronary artery disease, which occurs when the vessels that supply oxygen-rich blood to the heart muscle become blocked.

A stress echo does not provide images of the actual coronary arteries. If your physician suspects that you have blocked or narrowed arteries, additional diagnostic procedures may be recommended .

How do I prepare for this procedure?

Do not eat or drink anything, including water, for 4 hours prior to your procedure. Take your usual medications, using small sips of water, unless your physician has instructed you otherwise. If you are diabetic and scheduled for an early morning appointment, take your usual insulin dose, and have a glass of juice and a slice of dry toast for breakfast.

Do not eat or drink any foods or take any medications that contain caffeine for 12 hours prior to the procedure, including all forms of regular and decaffeinated coffee and tea, chocolate, and cola drinks.

Wear comfortable clothing. Most women find skirts and pants more convenient than dresses. Be sure to wear comfortable walking shoes.

How long does this procedure take?

The procedure will require about 1 - 1 1/2 hours.

What happens during the procedure?

You will be asked to remove your clothing from the waist up. Women will be provided with a gown. Prior to placing electrodes on your chest, the skin directly under the electrodes will be cleansed to remove any oils or dry skin that would interfere with clear tracings. The electrodes will then be attached to a monitor.

You will be asked to lie on your left side on an examination table. To improve the quality of the pictures, a gel is applied to the area of the chest where the transducer will be placed. A sonographer will then move the transducer over your chest, to obtain different views of your heart at rest.

The exercise portion of the procedure may vary as described below:

Treadmill stress echocardiogram: You will begin walking on a treadmill. The speed and elevation of the treadmill will gradually be increased at set intervals. You will be asked to exercise as long as you can, until you are very fatigued - but not exhausted.

At this point, the treadmill will be stopped, and you will be helped back to the table as quickly as possible, and again asked to lie on your left side. The sonographer will then obtain the post stress images of your heart.

Dobutamine stress echocardiogram: An IV will be started and dobutamine will be slowly infused. The rate of infusion will be increased every few minutes. Additional sets of echo images will be obtained during the infusion of dobutamine and afterwards.

Is this procedure safe?

The echocardiogram is a very safe procedure. There are no known risks from the ultrasound waves.

Possible side effects from the dobutamine infusion are generally mild, and may include chest pain, headache, flushing, palpitations, nausea, and shortness of breath. You will most likely feel your heart beating harder than usual during the infusion.

Any type of stress may cause potential problems in patients with heart disease, including blood pressure changes, dizziness, abnormal heart rhythms, and very rarely heart attacks.

Rest assured that experienced staff are available to handle a medical emergency.

What about the procedure results?

Your physician will review your EKG, blood pressure, and heart rate, and compare the resting and stress images of your heart to see how your heart responds to stress. How you felt during the test and whether or not you had chest pain, are an important part of your results.

The physician conducting the procedure may be able to give you preliminary results before you leave the Diagnostic Center. However, a complete interpretation may take 24 - 48 hours.

The information gained from this procedure will help your physician develop an accurate diagnosis and treatment plan for you.