Stress Echocardiogram

What is a Stress Echocardiogram?

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

When necessary, the heart can be assessed during exercise or exertion by performing a Stress or Exercise Echocardiogram, in which an echocardiogram is performed during physical exertion on a treadmill or on a couch with bicycle pedals attached (a cycle ergometer).

This exam detects changes in the functioning or structure of the heart, both in terms of the muscle (myocardium), the valves and the coronary arteries during exertion.

What is the test for? What are the indications?

The Stress Echocardiogram makes it possible to find out if there are areas of the myocardium (heart muscle) 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).

Stress echocardiography can also help clarify the severity of a valvular problem, pulmonary hypertension with stress or changes in diastolic function.

How is a stress echocardiogram performed?

• A stress echocardiogram is performed by a team of professionals made up of a cardiologist and a cardiopneumology 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 product into a vein to improve the quality of the images, which is harmless to health.
• You should allow 30-45 minutes for this examination.
• 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 Stress Echo is much greater 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, coronary CT angiography and MRI, of not using radiation.

Are there any risks? 

• It is a safe test - 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 fast before the Stress Echo Test, as you will be performing some level of exercise.
• 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 Test:

• Bring any previous and recent tests (e.g., Echocardiogram, Electrocardiogram (ECG), Stress Test, Catheterization, Coronary CT Angiography, Surgical Report if you have had surgery), and other reports or lab results.
• Bring all your medication.
• Arrive 30 minutes before the scheduled time.
• Go to Floor Zero - Outpatient Clinic - Special Tests Wing.