Stress Echocardiogram

Test Overview

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 It Is 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 to Prepare

• 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 It Is 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.

How long the test takes

A stress echocardiogram takes about 30 to 60 minutes.

How It Feels

You may have a brief, sharp pain when the intravenous (I.V.) needle is placed in a vein in your arm.

You will not have pain from the echocardiogram. Gel is put on your chest for the ultrasound. It may feel cool. The handheld ultrasound device is pressed firmly against your chest, but it does not cause pain. You will not hear or feel the sound waves.

If you exercise during the test, you may sweat, feel tired, and be short of breath. You might have symptoms of angina, such as chest pain or pressure.

If medicine to stress your heart is used, you may have symptoms of mild nausea, headache, dizziness, flushing, or angina (such as chest pain or pressure). These symptoms last only a few minutes.

Risks

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.

Results

Results are usually available within one day. If the test is done by a cardiologist, the results may be available immediately after the test.

Echocardiogram

Normal:	The heart chambers and walls of the heart are of normal size and thickness, and they move normally.
	Heart valves are working normally, with no leaks or narrowing. There is no sign of infection.
	The amount of blood pumped from the left ventricle with each heartbeat (ejection fraction) is normal.
	There is no excess fluid in the sac surrounding the heart, and the lining around the heart is not thickened.
	There are no tumors and blood clots in the heart chambers.
Abnormal:	Heart chambers are too big. The walls of the heart are thicker or thinner than normal. A thin heart wall may mean poor blood flow to the heart muscle or an old heart attack. A thin, bulging area of the heart wall may indicate a bulge in the ventricle (ventricular aneurysm). The heart muscle walls do not move normally because of a decreased blood supply from narrowed coronary arteries.
	One or more heart valves do not open or close properly (are leaking) or do not look normal. Signs of infection are present.
	The amount of blood pumped from the left ventricle with each heartbeat (ejection fraction) is lower than normal.
	There is fluid around the heart (pericardial effusion). The lining around the heart is too thick.
	A tumor or blood clot may be found in the heart.