What is an Exercise Stress Echocardiogram?
An exercise stress echocardiogram (Stress ECHO) is designed to assess how your heart, lungs and blood vessels respond to increasing workload (exercise). The purpose of this test is to compare the ultrasound images of your heart before and after it is stressed. It can help provide information about the level to which you can exercise if there are any problems affecting your ability to exercise, and how your condition changes with exercise. The echocardiogram images help your cardiologist determine whether there are any major blockages in your arteries. They can also see if there has been damage to the heart muscle after a heart attack. It will also help them determine the best type of treatment you may need to correct any abnormal finding.
There are different reasons why your cardiologist may want you to have a Stress ECHO and these may include:
- Symptoms or signs suggestive of coronary artery disease (CAD), chest pain, Shortness of Breath
- Significant risk factors for CAD such as smoking, high blood pressure, high cholesterol
- Assessment of your condition after a cardiac procedure such as bypass surgery or coronary angioplasty
- Clearance for certain surgeries that are determined to be of intermediate to high risk
- Abnormal treadmill stress test
How do I prepare for the test?
- Unless otherwise indicated, please take all of your medications prescribed by your provider as directed on the morning of your test
- Avoid the use of oils, body lotions, moisturizing soaps or body washes for 3 days prior to testing. These products may affect the quality of your EKG tracings. Examples of these are “Oil of Olay” “Dove” “Ivory” “Caress” or “Aveeno”.
- Tell your doctor if you are allergic to any tape or other adhesives
- There are no dietary restrictions prior to the test, but you should avoid eating a large meal immediately before your scheduled appointment time since you will be exercising
- If you smoke cigarettes, it is advisable to avoid smoking immediately prior to your appointment
- Please come dressed for exercise. It is very important to wear a short-sleeved shirt and sneakers.
- Please DO NOT wear skirts, dresses, loose pants, slip-on shoes, boots, sandals, or flip flops
- Please secure long hair
- For female patients, it may be necessary to exercise without wearing a supportive bra, unless you wear or bring one of the following: a wireless sports bra with the opening in the front, or a tube bra that you can slide up or down quickly. The reason for this is because it is necessary to quickly step up on the exam table from the treadmill within 30 seconds of completed exercise to ensure that the best heart images are taken. If not, the quality of the study will be compromised. If you do not have those types of bras and opt to exercise without one, we will provide you with disposable modestly bras (like the ones you may see at a spa or massage therapy)
- For male patients, it will be necessary to shave any area where there is hair in order to get appropriate tracings. If you prefer, you may do this at home within at least 24 hours prior to your test.
What can I expect?
- Prior to testing, electrodes (sticky gel pads) will be placed on your chest so you can be connected to an EKG machine for monitoring during your test.
- The EKG patches need to be placed on bare skin. The areas where the patches are placed will require cleansing with an alcohol pad and a light abrasive pad.
- For female patients, it may be necessary to exercise without wearing a supportive bra, unless you wear or bring one of the following: a wireless sports bra with the opening in the front, or a tube bra that you can slide up or down quickly. The reason for this is because it is necessary to quickly step up on the exam table from the treadmill within 30 seconds of completed exercise to ensure that the best heart images are taken. If not, the quality of the study will be compromised. If you do not have those types of bras and opt to exercise without one, we will provide you with disposable modestly bras (like the ones you may see at a spa or massage therapy)
- For male patients, it will be necessary to shave any area where there is hair in order to get appropriate tracings. If you prefer, you may do this at home within at least 24 hours prior to your test. Otherwise, one of our techs will be required to shave the appropriate areas while placing the EKG patches.
- These electrodes will be attached to cables which link to an ECG machine. This will be looped around your waist with a belt during the test. A blood pressure cuff will be placed around your arm.
- Before you start exercising, the technologist will ask you to lie on your left side on an exam table for a resting echocardiogram.
- Resting images of the heart will be taken by the echo technologist. You will be asked to lie on your side during this time.
- A technologist will put a special water-based jelly on a probe and move it over your chest area. High-frequency sound waves create video images of your heart walls in real-time. The images can be viewed on a video monitor and information about the heart can be evaluated.
- The images collected will be digitally recorded for the doctor to see.
- The echocardiogram is painless and has no side effects. There is no harmful radiation or X-ray used.
- After the ECHO test, you will exercise on a treadmill.
- The EKG electrodes will be attached to cables which link to an ECG machine. This will be looped around your waist with a belt during the test. A blood pressure cuff will be placed around your arm.
- You will perform a graded EST. This means the work level will be advanced in pre-determined stages in order to increase your heart rate. The treadmill will usually begin at a very slow ‘warm-up’ pace. Every three minutes it will gradually increase in speed and incline (slope).
- Your pulse, blood pressure, and ECG are monitored during and after the test. If these reach any critical level as determined by the monitoring staff, the test will be stopped immediately.
- The test will be stopped if you become very tired, short of breath, experience severe chest pain or reach a maximum predetermined heart rate based on your age.
- You will be asked at times during the test if you have any symptoms such as chest or leg discomfort or shortness of breath. If you feel unwell you should inform us at once.
- You may request that the test be stopped at any time. However, the higher the level of exercise that you are able to complete, the better the results will be for your cardiologist.
- The length of time that you will be exercising will usually be three to ten minutes for most patients.
- After the treadmill portion is completed, you will be asked to quickly lie down on the exam table for the second set of echo images to be taken. Your EKG will also continue to be monitored during this time.
- When you cannot exercise any longer, you will get off the treadmill and quickly return to the exam table and lie on your left side so that the technologist can perform another ECHO.
What are the risks?
- In recommending this procedure your doctor has balanced the benefits and risks of the test against the benefits and risks of not proceeding. Your doctor believes there is a benefit of you having an EST.
The procedure is generally very safe however a few risks include
- Mild angina e.g. chest pain
- Shortness of breath
- Sore muscles or joint pain
- Fainting (rare)
- An abnormal heart rhythm that continues for a long time. This may require further treatment to correct (rare)
- Heart attack (extremely rare)
- Death as a result of this procedure is extremely rare, less than 1 in 10,000 patients
The risks are higher if you already have blocked arteries in the heart (Coronary Artery Disease)