Pharmacological Stress Echocardiogram

What is a Pharmacological stress Echocardiogram?

A Pharmacologic Stress Echocardiogram is a type of echocardiogram that uses medications to cause the heart to work harder. An intravenous drug is administered which will accelerate the heart to simulate physical exertion. 

It can be used to assess ischemia (coronary disease), viability after an myocardial infarction or to clarify some valve problems.

What is the purpose of this examination? What are the indications?

The Pharmacologic Stress Echocardiogram allows the cardiologist to identify areas of the myocardium that might be unable to work properly in effort, meaning that there is not enough blood flow irrigating a specific part of the heart due to an obstruction of the coronary arteries.

This myocardial ischemia study can be used both in patients with suspected coronary disease, as well as in the follow-up of patients who have already undergone revascularization procedures (post-stent implant or cardiac bypass surgery). It also studies the myocardial viability after a heart attack, that is, to identify areas of the heart that do not work properly at rest, but that have recovery capacity.

Stress echocardiography can also help to clarify the severity of some valvular problems, especially in aortic valve stenosis with depressed myocardial function.

How is a Pharmacological stress Echocardiogram performed?

• ​The Pharmacological Stress Echocardiogram is carried out by a team of professionals - a cardiologist, a technician (cardiac sonographer) and a nurse, all of whom with 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 causes the 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 ultrasound contrast agent, 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 to work harder.
• The time it takes to perform this examination varies and is usually between 45 to 60 minutes.
• 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 a stress echocardiogram is much higher than that of a conventional stress test. However, even with a technically advanced examination, lesions and diagnoses may, although rarely, not be detected.

It has the advantage, when compared to scintigraphy perfusion scan and coronary CT angiography, of not using ionizing radiation.

Are there any risks? 

This exam is safe. There are risks involved but they are slight and comparable to that of any more vigorous effort.
Ultrasound is innocuous to one’s health, but the medication administered can cause some side effects. The inherent risks range from more frequent reactions, such as blood pressure changes, feeling ill and heart rhythm alterations, including arrhythmias, to less frequent situations such as allergic reactions. Cases of acute myocardial infarction and cardiac arrest have been described, but these are extremely rare. Therefore, as a precaution, medical assistance is available, including the equipment necessary in the event of any complications.

How should you prepare for the exam?

The Pharmacological Stress 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 cardiac exams (e.g. Echocardiogram, Electrocardiogram (ECG), Treadmill Stress test, Cardiac CT, Coronary angiography, Surgical report - if you have had surgery), other reports and blood tests.
• Bring all medication.
• Arrive 30 minutes before the scheduled time.
• Go to Floor Zero - Outpatient Consultations - Special Exams unit.