Pharmacological Overload or Stress Echocardiography

What is a pharmacological overload or stress echocardiogram?

An echocardiogram is an examination carried out using a probe that emits ultrasound to obtain images of the heart. Usually, the echocardiogram is performed at rest.

When necessary, the heart can be evaluated under stress or overload by performing a pharmacological overload echocardiogram, also known as a stress echocardiogram, in which a drug is administered that will speed up the heart to simulate physical exertion.

This test detects changes in the functioning or structure of the heart, both in terms of the muscle (myocardium), the valves and the coronary arteries under stress.

What is the test for? What are the indications?

Pharmacological overload echocardiography makes it possible to determine whether there are areas of the myocardium that cannot work properly under stress, which may mean that there is not enough blood flow to irrigate that area of the heart due to obstructions in the coronary arteries.

This myocardial ischemia study can be used both in patients with suspected coronary disease and in the follow-up of patients who have already undergone revascularization procedures (after stent implantation or heart bypass surgery). It also makes it possible to study the viability of the myocardium after an infarction, i.e. to identify areas of the heart that are not working properly at rest but are capable of recovery.

Overload echocardiography can also help clarify the severity of a valvular problem, especially in aortic valve stenosis with depressed myocardial function.

Como é realizado um ecocardiograma de sobrecarga farmacológica ou de Stress?

• ​The pharmacological overload echocardiogram is carried out by a team of professionals made up of a cardiologist, a cardiopneumology technician and a nurse, all of whom have extensive experience in this area.
• The test is carried out with the patient lying down. An intravenous drip is placed through which the drugs that cause cardiac effort will be administered. Electrodes are also placed on the chest to monitor the heart rhythm and perform the electrocardiogram (ECG).
• The light in the room is dimmed so that the images on the ultrasound screen can be seen properly.
• On the chest, on the left side, a transparent gel is applied where the probe or transducer is then placed. This transducer emits and receives a beam of ultrasound reflected by the various structures it passes through, translating them into images on the ultrasound monitor.
• Images are taken before, during and after the administration of drugs that cause cardiac stress. Throughout the examination, images are recorded, the ECG is recorded continuously and blood pressure measurements are taken.
• Sometimes it is necessary to administer an echographic contrast product, which is harmless to health.
• During the test you may feel a sensation of heat and your heart beating faster and harder (palpitations), a mild headache, dry mouth, tiredness and a feeling in your chest. These effects related to cardiac exertion are temporary.
• At the end of the test, an antidote is administered - a drug that reverses all the effects of the drug that caused the heart strain.
• You should allow at least 45-60 minutes for this test.
• Preliminary information on the result of the test is given immediately.
• After the test, you should allow a few more minutes for your body to recover and then return to your normal daily routine.

Benefits

The diagnostic value of the stress echo is much higher than that of the conventional stress test. However, even with a technically adequate test, it can rarely miss lesions and diagnoses. It has the advantage, when compared to scintigraphy and coronary CT angiography, of not using radiation.

Are there any risks? 

It is a safe test. There are risks, but they are small and comparable to those of any vigorous exertion.

Ultrasounds are harmless to health, but the medication infused can cause some effects. The risks inherent in this test range from more frequent, mild reactions, such as changes in blood pressure, feeling unwell and heart rhythm changes (arrhythmias), to less frequent situations such as allergic reactions. Cases of acute myocardial infarction and cardiac arrest have been reported, but these are extremely rare. Therefore, as a precaution, medical means are available, as well as equipment to treat any complications.

How should you prepare for the exam?

The pharmacological overload echocardiogram requires a 4-hour fasting period beforehand, with a small amount of fluids allowed to take the medication.

It may be necessary to suspend some medications 1-2 days before the test, such as beta-blockers and calcium antagonists, in order to avoid interference with the medication administered during the test (you will be contacted by our team).

The following foods are prohibited in the 12 hours before the test: coffee, tea, chocolate, caffeinated soft drinks and alcoholic beverages, as they may interfere with the results and interpretation of the test.

IT IS EXTREMELY IMPORTANT THAT YOU COMPLY WITH THE PREPARATION FOR THE EXAM

 On the day of the exam:

• Bring previous and recent exams (for example: Echocardiogram, Electrocardiogram (ECG), Stress test, Catheterization, Coronary CT Angiography, Surgical report - if you have had surgery), other reports and analyses.
• Bring all medication.
• Arrive 30 minutes before the scheduled time.
• Go to Floor Zero - External Consultation - Special Exams wing.