Stress Echocardiogram
What
is an Echocardiogram Stress Test?
 An Echocardiogram Stress Test (Stress Echo)
is a test that combines an ultrasound study of the heart with a stress
test. A stress echo looks at how the heart functions when it is made to
work harder. The stress echo is identical to the stress exercise test,
except, an echocardiogram is performed before and after you exercise.
The stress
echo is especially useful in diagnosing coronary heart disease and the
presence of blockages in the coronary arteries (the vessels that supply
oxygen-rich blood to the heart muscle).
What
does the test show?
An
Echocardiogram stress test is performed to evaluate the function of your
heart, mainly your left ventricle (main pumping chamber) when the heart is
under stress. This test can help evaluate the following:
- Your risk for coronary
artery disease.
- If the symptoms you are
experiencing (i.e., chest pain or pressure, shortness of breath,
unexplained fatigue, palpitations, lightheadedness, etc.) are caused by
a blockage to your heart or other heart conditions.
- It can help detect heart
problems that may not be present at rest.
- It is used for cardiac
clearance before surgery or other procedure.
- If you have already been
diagnosed with coronary heart disease, a stress test may enable the
doctor to estimate the severity of the blockages.
- If you have just undergone
balloon angioplasty or bypass surgery, a stress test can help monitor
the success of the procedure as well as determine an appropriate
rehabilitation program for you.
Normally,
all areas of the heart muscle pump more vigorously during exercise. If an
area of the heart muscle does not pump as it should with exercise, this
often indicates that it is not receiving enough blood because of a blocked
or narrowed artery. The Stress Echo shows areas of the heart muscle that do
not receive an adequate blood supply. However, it does not provide images
of the actual coronary arteries.
How
do I prepare for the test?
- Do not eat or drink for 2 hours
prior to the test. This will help prevent the possibility of nausea
and vomiting which may accompany vigorous exercise after eating. If
you are diabetic or need to eat/drink with your medication, get
special instructions from your doctor.
- Avoid any strenuous physical
activity on the day of the test because you will need to exert
yourself maximally.
- No smoking 2 hours prior to
the test. Smoking may interfere with the test results.
- Wear loose and comfortable
clothing and shoes that are suitable for exercise; women will wear a
hospital gown and men will be asked to exercise bare-chested.
- Do not wear oils or lotions
before your test. Small sticky patches (electrodes) will need to stick
to your chest.
- Take your medications as
prescribed unless your doctor has given you special instructions.
What
happens during the test?
When you
enter the stress testing room, the Cardiology Tech/Nurse will have you sign
a consent form and he/she will make sure you understand the test. Women
will be asked to change into a gown and men will be asked to take off their
shirt. Your skin will be cleaned to remove any oils or lotions on your
skin. You will be shaven if you have a hairy chest. Ten patches are placed
on your chest and torso. A belt with wires will be attached to the patches
in order to hook you up to the EKG machine. The EKG allows the doctors and
Cardiology Tech/Nurse to monitor your heart rate and rhythm. The Cardio
Tech/Nurse will take your resting blood pressure and EKG while you are
lying down and while you are standing.
The Echo
Tech obtains the resting images of your heart while you lie on a hospital
table. Gel is applied to the chest and a transducer (small probe) is moved
to various areas to obtain the pictures of your heart. The transducer sends
ultrasound waves that bounce off the various parts of the heart. These
echoes are converted into moving images of the heart. The image is
displayed on a screen and recorded on videotape.
The
Cardiologist will enter the room before you begin exercising. When the Cardiologist
enters the room, he/she will perform a quick assessment, review your
medical history, and look at the echo images.
The exercise
portion of the test is done on a treadmill. While you are walking, the
speed and the grade of the treadmill will increase every 3 minutes. Your
blood pressure, EKG and heart rate will be monitored continuously
throughout the test. The length of the test varies from patient to patient.
However, most patients walk between 6-12 minutes. The treadmill test will
stop when:
- You get too tired to
continue
- You exceed a
"target" heart rate based on your age
- The Cardiologist or Cardio
Tech/Nurse detects abnormal changes on your EKG
- You experience symptoms,
such as shortness of breath, chest pain, chest tightness, dizziness, etc.
that do not permit you to exercise any longer.
- Your blood pressure goes up
too high
After the
exercise portion of the test, you will be helped to a stretcher. It is
important that you get onto the stretcher quickly. The Echo Tech needs to obtain
the stress images of your heart while your heart rate is still high. The
Cardiologist and Echo Tech compare the two sets of images (before and after
exercise) side by side to see how your heart responds to exercise. Your
blood pressure and EKG will be monitored during the recovery period.
When
do I get the results and what do they mean?
The
Cardiologist conducting the test may be able to give you preliminary test
results before you leave the testing room. A test report will be sent to
your primary Physician in about 3-5 business days. These test results can
be discussed during a future office visit.
If your test
is positive (abnormal), the Cardiologist conducting the test, along with
your Physician, will help develop a treatment plan that is best for you.
The Cardiologist may recommend another stress test or more invasive testing
such as a cardiac catheterization.
If you have
a negative test (no abnormalities) it is likely that your risk of coronary
artery disease is low. Stress Echo tests are able to detect individuals
with heart disease about 70% of the time. This means that, if you actually
DO have heart disease, the test will accurately detect it seven out of ten
times.
It should be
noted that the Stress Echo test is not 100% reliable. Sometimes the results
are "falsely positive" meaning that there is actually no risk of
heart disease despite the test's positive results. False positive results
occur more frequently in women. Further testing will be necessary to
determine whether you actually have heart disease.
If you are
concerned about the validity of the test, you may wish to discuss it with
your doctor at greater length. You will not be diagnosed with coronary
artery disease simply from the results of a Stress Echo test.
Is
the test safe?
The
echocardiogram stress test is generally safe. There are risks involved
because it stresses the heart. Possible rare complications include inducing
an abnormal heart rhythm or causing a heart attack.
Where
is the test performed?
In the Non-Invasive Cardiology
Testing Center and the cardiac rehab facility or in your doctor’s
office.
How
long does this test take?
Approximately
30 - 45 minutes
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