Exercise Echocardiogram

What is an Exercise Echocardiogram?

An Exercise Echocardiogram is done to assess the heart's response to stress or exercise and compare the results to when the heart is at rest.

The exam is performed during or immediately after physical exertion on a treadmill or on a couch with bicycle pedals attached (a cycle ergometer).

It allows the study of ischemia (coronary disease), clarifying the severity of a valvular problem, pulmonary hypertension with exertion or changes in diastolic function.

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

This exam 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 and in the follow-up of patients who have already undergone revascularization procedures (after stent implantation or heart bypass surgery).

Exercise Echocardiography can also help clarify the severity of a valvular problem, hypertrophic cardiomyopathy, pulmonary hypertension with stress or changes in diastolic function.

How is an exercise echocardiogram performed?

• An Exercise Echocardiogram is performed by a team of professionals made up of a cardiologist and a technician, all of whom have extensive experience in this area.
• The technician will prepare the chest by applying electrodes to the chest. It may be necessary to shave the areas where the electrodes will be applied in order to record the electrical activity (ECG) of the heart during the test. A cuff will be placed on the arm to record blood pressure at specific times during the examination.
• Once the preparation is complete, the baseline echocardiogram images are taken (at rest), with the patient lying on a couch.
• After the images, the effort/exercise begins on a treadmill. The treadmill starts at a low speed and as the exam progresses, the speed and inclination of the treadmill will progressively increase. Occasionally, echo images can be taken during exercise.
• When the doctor decides that the necessary effort has been made or the patient has reached maximum fatigue and/or symptoms appear, the treadmill is suddenly stopped and the patient lies down on the couch so that the images of the effort can be taken. At this stage the light in the room is reduced so that the images on the ultrasound screen can be viewed properly.
• Sometimes it is necessary to administer an ultrasound contrast agent into a vein to improve the quality of the images, which is harmless to health.
• The time it takes to perform this examination varies and is usually between 30 to 45 minutes.
• Preliminary information on the results of the examination is given immediately.
• After the examination, 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 Exercise Echo is much greater than that of the conventional stress test. However, even with a technically adequate 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 radiation.

Are there any risks? 

• The test is safe - the risk of this test exists, but it is small and comparable to that of any more vigorous exertion.
• Ultrasounds are harmless to health.
• Complications related to exertion are rare and can include: chest pain or angina, dizziness or fainting, changes in blood pressure - hypertension or hypotension (sudden drop in blood pressure), cardiac arrhythmias (changes in heart rhythm).
• Cases of acute myocardial infarction and cardiac arrest have been reported, but these are extremely rare. Therefore, as a precaution, medical resources and equipment are available to treat any complications.

How Should You Prepare for the exam?

• You should not be fasting before the Exercise Echo, as you will be performing some level of effort.
• It is recommended to wear practical and comfortable clothing, and, if possible, sneakers or other comfortable walking shoes.
• You may need to stop taking certain medications 1-2 days before the test, such as beta-blockers and calcium antagonists (your doctor will provide instructions).
• If you use an inhaler (a pump) for asthma or other respiratory issues, you must bring it to the test.

IT IS EXTREMELY IMPORTANT TO FOLLOW THE PREPARATION GUIDELINES FOR THE TEST.

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.