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Stress echocardiography

Definition

Stress echocardiography is a test that uses ultrasound imaging to determine how the heart muscles respond to stress. It is mainly used to diagnose and evaluate coronary artery disease.

Alternative Names

Echocardiography stress test; Stress test - echocardiography

How the test is performed

A stress echocardiogram includes the following steps:

• A resting echocardiogram will be done first.
• You will exercise or be given medicine until you reach the target heart rate. This helps reveal how your heart works when you are active.
• Your blood pressure and heart rhythm (ECG) will be monitored throughout the procedure.
• Ultrasound images will be recorded during the procedure.
• Another echocardiogram is taken immediately after your target heart rate has been reached.
• The ultrasound images will reveal any parts of the heart that may not be receiving enough blood or oxygen because of blocked arteries.

This test differs from an exercise stress test, which does not use ultrasound images.

If you are not able to exercise, you will receive a medication such as dobutamine through a vein (intravenous line). This type of medicine will make your heart beat faster and harder, similar to when you exercise.

How to prepare for the test

Ask your health care provider if you should take any of your routine medicines on the day of the test (especially if you are taking heart medication). Some medicines may interfere with test results.

It is important to tell your doctor if you have taken any of the following medications within the past 24 hours (1 day):

• Sildenafil citrate (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)

DO NOT eat or drink for at least 3 hours before the test.

Wear loose, comfortable clothing. You will be asked to sign a consent form before the test.

How the test will feel

Electrodes (conductive patches) will be placed on your chest, arms, and legs to record the heart's activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.

The blood pressure cuff on your arm will be inflated every few minutes, producing a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before you start exercising.

You will start walking on a treadmill or pedaling a stationary bicycle. The pace and incline of the treadmill will gradually be increased.

Rarely, people experience chest discomfort, palpitations, dizziness, or shortness of breath during the test.

Why the test is performed

The test is performed to see whether your heart muscle is getting enough blood flow and, therefore, enough oxygen when it is working hard (under stress).

The results of this stress test can help your doctor:

• Determine how well a heart treatment is working and change your treatment, if necessary
• Determine how well your heart is pumping
• Diagnose coronary artery disease
• See whether your heart is too large

Your doctor may request this test if you:

• Have new symptoms of angina or chest pain
• Have angina that is becoming worse
• Have recently had a heart attack
• Are at high risk for heart disease (before having surgery or when beginning an exercise program)
• Have heart valve problems

Normal Values

A normal result means that blood flow through the coronary arteries is normal.

Note: Normal value ranges may vary slightly among different medical centers. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Abnormal results may be due to:

• Reduced blood flow to a part of the heart. The most likely cause is a blockage of the arteries that supply your heart muscle.
• Scarring of the heart muscle due to a previous heart attack.

After the test you may need:

• Angioplasty and stent placement
• Changes in your heart medicines
• Coronary angiography
• Heart bypass surgery

What the risks are

The risks are very low, and health care professionals will monitor you during the entire procedure. Rare complications include:

• Abnormal heart rhythm
• Collapse
• Heart attack

Special considerations

A stress echocardiogram is a very effective, noninvasive test that can help determine whether you have blockages in your coronary arteries. If there are blockages, it can determine the severity of the problem. Early diagnosis and monitoring of heart disease allows treatment to begin early.

This test does not require any radiation.

References

Morrow DA, Gersh BA. Chronic coronary artery disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 54.

Fleisher LA, Eagle KA. Anesthesia and noncardiac surgery in patients with heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 80.