Stress Echocardiogram: About This Test

What is it?

An echocardiogram (also called an echo) uses sound waves to make an image of your heart. A device called a transducer is moved across your chest. It looks like a microphone. The transducer sends sound waves that echo off your heart and back to the transducer. These echoes are turned into moving pictures of your heart that can be seen on a video screen.

In a stress echocardiogram, an echo is done while your heart is at rest and after your heart is made to work hard (stressed). You exercise to make your heart work hard.

Sometimes, instead of exercise, a medicine is used that makes your heart respond like you have been exercising.

Why is this test done?

A stress echocardiogram is done to check for heart problems that can be seen while the heart is working hard (stressed). It may be done to diagnose and monitor many different heart diseases.

For example, this test may be done to:

• Check for coronary artery disease, which can reduce blood flow to the heart muscle during stress.
• Look at the heart valves and check how well they work.
• Check to see how well blood flows through the heart, heart valves, and blood vessels.

How do you prepare for the test?

• Do not smoke or eat a heavy meal before this test.
• Wear flat, comfortable shoes (no bedroom slippers) and loose, lightweight shorts or sweatpants. Walking or running shoes are best.
• Understand exactly what test is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your test. Your doctor will tell you if you should stop taking any of them before the test and how soon to do it.

How is the test done?

An echocardiogram is done while your heart is at rest. This is called the baseline. Then you will exercise, or you will get a medicine that makes your heart work hard. Then you will have another echocardiogram.

To do the baseline echocardiogram:

• You may take off your clothes above your waist and change into a gown.
• You will lie on your back or on your left side on a bed or table.
• You may receive medicine through a vein (intravenously, or I.V.). The I.V. can be used to give you a contrast material. This helps your doctor get good views of your heart.
• Small pads or patches (electrodes) will be placed on the skin of your chest to record your heart rate during the test.
• A small amount of gel will be rubbed on the left side of your chest to help pick up the sound waves.
• The transducer will be pressed firmly against your chest and moved slowly back and forth. It is usually moved to different areas on your chest to get specific views of your heart.
• You will be asked to do several things, such as hold very still, breathe in and out very slowly, hold your breath, or lie on your left side.

If you will exercise during the test, you will start after the baseline echocardiogram is finished. You may walk on a treadmill or pedal a stationary bicycle. During the test:

• You might be asked to use numbers to say how hard you are exercising. The higher the number, the harder you think you are exercising.
• You will exercise until you or your doctor feels you need to stop.
• You will then lie on a bed or table, and another echocardiogram will be done.

If medicine will be used to stress your heart, you will get the medicine after the baseline echocardiogram. During the test:

• The medicine will be given through an I.V.
• The medicine will make your heart beat harder and faster, as if you were exercising.
• Echocardiogram images will be taken while you get the medicine.
• The medicine will be stopped, and your heart rate will return to normal. Then more echocardiogram images will be taken.

What are the risks of the test?

An echocardiogram is safe, because the test uses only sound waves to evaluate your heart. These high-frequency sound waves have not been shown to have any harmful effects.

The exercise or medicine part of the test can cause low blood pressure, nausea, irregular heartbeats, or a heart attack.

If contrast material is used, there is a slight risk of having an allergic reaction. Most reactions can be controlled with medicine.

What happens after the test?

• You will probably be able to go home right away. It depends on your reason for the test.
• You can go back to your usual activities right away.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have symptoms of a heart attack, such as:
  • Chest pain or pressure.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain that spreads from the chest to the neck, jaw, or one or both shoulders or arms.
  • Dizziness or lightheadedness.
  • A fast or uneven pulse.
  After calling 911, chew 1 adult-strength aspirin. Wait for an ambulance. Do not try to drive yourself.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You do not get better as expected.