Stress Echocardiogram

What is a stress echocardiogram?

A stress echocardiogram combines 2 tests, an echocardiogram and a stress test. The stress test can be in the form of physical stress test (using an exercise bike) or a pharmacological stress test (using Dobutamine). Usually the decision for which test will be carried out, will be made / confirmed on the day of your test.

This test enables your heart rate, rhythm and conduction to be assessed whilst assessing the function of the heart muscles and the valves whilst the heart is under stress.

The entire test will take approximately 1 hour but please allow 2 hours for the procedure.

Preparation

Please stop taking any of the following tablets from the list below 48 hours before the test.

1. Beta-blockers(i.e. Atenolol (Tenormin®), Carvedilol (Eucardic®), Metroprolol, Bisoprolol (Betaloc®, Lopresor®) and Sotalol (Sotacor®)

2. Calcium channel blockers(i.e. which include Diltiazem(Tildiem®) and Verapamil(Securon®)

3. And an alternative to beta-blockers called Ivabradine (Procoralan®)

Do not eat anything 1 hour prior to the appointment time but you can continue to drink water. Avoid caffeine based drinks 12 hours prior to the test.

Please wear comfortable clothing and sensible walking shoes.

Please come with somebody who can drive / take you back home. You my not be able to drive yourself home after the procedure.

Procedure

The doctor will explain the procedure and ask you to sign a consent form. 

Your weight will be recorded. You will be required to undress to the waist (you will be given a gown). A small cannula will be inserted into your arm to allow an intravenous line to be attached and / or any medication to be given. You will then be asked to lie on a couch or assisted on to the bike.

Electrocardiogram & Blood Pressure

The skin will then be rubbed with an abrasive pad to prepare the skin. Electrodes will be placed in set positions on the chest, and leads will be attached to the electrodes this will allow your heart to be monitored during the procedure. A BP cuff will also be fitted to your arm. A baseline ECG and BP will then be recorded.

Echocardiogram You will be asked to lie on your back / left-hand side and the lights will be turned down. The physiologist / doctor will then start the scan and record the baseline images.

You will notice some cold gel on your chest whilst the echo probe is moved around. You may notice a discomfort / pressure on the chest whilst the scan takes place.

You will also hear some funny noises during the scan whilst the physiologist assesses blood flow through the heart. A contrast agent maybe used during the scan to enhance image quality.

Exercise Bike Test

You will be asked to pedal as long as possible in order to evaluate your heart during exercise. You will be required to tell the team if you get any symptoms or you are unable to continue. The test will continue until either you are unable to carry on, or the team feels it is appropriate for you to stop. During the exercise your heart will be monitored continuously and your heart will be scanned at set intervals during the exercise to allow the doctor to assess your heart under stress.

Dobutamine Test

Dobutamine will be infused through the intravenous line attached to the cannula. During the infusion your heart will be monitored continuously and your heart will be scanned at set intervals during the infusion to allow the doctor to assess your heart under stress.

 The drug will cause your heart to feel like it is beating more strongly and then you will feel your heart rate increasing; this is a normal response to exercise. Occasionally patients may experience tingling in the fingers and in the back of the head or feel nauseated at peak dose, these symptoms resolve quickly once the drug is stopped. The Dobutamine infusion will be stopped when your target heart rate is achieved or the doctor feels they have the information required

Atropine

An additional drug called Atropine might be given to help speed up the heart rate. If Atropine is administered you may experience a dry mouth and this may persist for the whole day. You will not be able to drive for the rest of the day.

Recovery

You will continue to be monitored until your heart rate and blood pressure returns to baseline. Once the procedure is finished you will then be asked to wait for a further half an hour before the cannula is removed. A cardiologist will talk to you about the results before you are allowed to leave the department.

Complications

Serious side effects are very rare. If you are unwell after the procedure and you have been discharged please contact Dr Kirk (0208 050 2383) or attend A&E.