Stress echocardiography

Definition

Stress echocardiography is a test that uses ultrasound imaging to show how well your heart muscles are working to pump blood to your body. It is mainly used to detect a decrease in blood flow to the heart -- coronary artery disease.

Alternative Names

Echocardiography stress test; Stress test - echocardiography

How the test is performed

This test is done at a medical center or health care provider's office.

A resting echocardiogram will be done first. While you lie on your left side with your left arm out, a small device called a transducer is held against your chest. A special gel is used to help the ultrasound waves get to your heart.

Most people will walk on a treadmill (or pedal on an exercise bicycle). Slowly (usually every 3 minutes), you will be asked to walk (or pedal) faster and on an incline. It is like being asked to walk fast or jog up a hill.

Usually, you will need to walk or pedal for around 5 to 10 minutes. Your doctor will ask you to stop:

• When your heart is beating at the target rate
• When you are too tired to continue
• If you are having chest pain or a change in your blood pressure that worries your doctor

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

Your blood pressure and heart rhythm (ECG) will be monitored throughout the procedure.

More echocardiogram images will be taken while your heart rate is increasing, or when it reaches its peak. The images will show whether any parts of the heart muscle do not work as well as your heart rate increases. This is a sign that part of the heart may not be getting enough blood or oxygen because of narrowed or blocked arteries.

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. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.

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 blood pressure cuff on your arm will be inflated every few minutes, producing a squeezing sensation that may feel tight.

Rarely, people feel chest discomfort, extra or skipped heartbeats, 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 oxygen when it is working hard (under stress).

Your doctor may order this test if you:

• Have new symptoms of angina or chest pain
• Have angina that is getting worse
• Have recently had a heart attack
• Are going to have surgery or begin an exercise program, if you are at high risk for heart disease
• Have heart valve problems

The results of this stress test can help your doctor:

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

Normal Values

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

The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.

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 narrowing or blockage of the arteries that supply your heart muscle.
• Scarring of the heart muscle due to a past 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. Health care professionals will monitor you during the entire procedure.

Rare complications include:

• Abnormal heart rhythm
• Fainting (syncope)
• Heart attack

Special considerations

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References

Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 71.

Connolly HM, Oh JK. Echocardiography. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 15.

Fraker TD Jr., Fihn SD, Gibbons RJ, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.

Mahajan N, Polavaram L, Vankayala H, et al. Diagnostic accuracy of myocardial perfusion imaging and stress echocardiography for the diagnosis of left main and triple vessel coronary artery disease: a comparative meta-analysis. Heart. 2010;96(12):956-966.