Key Points about Stress Echocardiogram (Stress Echo)

  • A stress echo is a test used to determine if your heart is getting sufficient blood and oxygen supply while exercising. It may also be used to determine how well cardiac procedures such as bypass grafting, angioplasty, or antiarrhythmic medications are working.
  • During a stress echo, you will walk or run on a treadmill while your doctor monitors your heart rhythm and blood pressure. When your heart rate reaches a predetermined level, your care team will take an ultrasound of your heart.
  • In preparation for a stress echo, your doctor will give you a series of instructions. Follow those instructions closely to ensure the quality of the results.
  • A test lasts 45 - 90 minutes. Your doctor will review your test results after the test. A normal result means you do not appear to have coronary artery disease. An abnormal result means you may have some coronary blockage.

Overview

A stress echocardiogram, also known as a stress echo, is a diagnostic test used to determine how effectively your heart and blood vessels are working. Ultrasound imaging is used in a stress echo to detect and record abnormal blood flow to the heart that could be caused by narrowing vessels. 

The test is performed in two parts - the resting echocardiogram and the stress echocardiogram.During both portions of the test, your heart rate and blood pressure are measured to compare the resting to the active measurements. The images taken by the ultrasound show areas of the heart are malfunctioning due to low blood supply.

Candidates for a stress echo

Your doctor may order a stress echo if you have been experiencing chest pains, angina, or had a recent heart attack. It can also be used as a part of the pre-surgery workup or before beginning an exercise program.

A stress echocardiogram will help determine:

  • How well the heart muscles and valves are functioning
  • How the heart handles physical activity
  • If you are likely to have coronary artery disease
  • If your heart function has improved after cardiac treatment
  • If you have an enlarged chamber of the heart

The test results can help your doctor determine if you have an issue with your heart muscle, and if so, what the best treatment course for your case. Results can also help your doctor evaluate whether the current treatment plan is effective. 

Preparing for a stress echo

A stress test can take place in an echocardiography laboratory, in your doctor’s office, or another medical setting.
Before a stress test, follow these guidelines:

  • Do not eat or drink anything for three to four hours before the test
  • Quit smoking before the test, and do not smoke on the day of the test. Nicotine can interfere with your heart rate
  • Do not consume anything, including food, drinks, or medications, that contain caffeine before checking with your doctor
  • Inform your doctor of all medication you are taking and inquire if you should take them on the test day; for example, do not take heart medications such as beta-blockers before the test
  • Wear exercise clothing and shoes to the test

Expectations during a stress echo

You will lie on an exam table while a technologist records different views of your heart while you are resting. This is a resting echocardiogram. This portion of the test aims to get an accurate idea of how your heart is working. The test will measure your heart rate and the regularity of your heartbeats. 

You will then be asked to lie on your side to do a resting echocardiogram. During the ultrasound, your technologist will use a transducer that will use sound waves to create images of the movement of your heart and other internal organs.

After the resting echocardiogram, you will be instructed to walk or run on a treadmill or ride a stationary bike. Your doctor will instruct you to increase the intensity of exercise until you reach the desired heart rate. You will likely need to exercise for approximately 6 to 10 minutes or until you are too tired to go farther.

As soon as you reach your maximum stress, the test will be stopped, and you will lie on your left hip with your left arm under your head. Your technologist will use the transducer to capture more images while your heart is beating rapidly. You will likely be asked to exhale and hold your breath at this point in the test. 

As your heart rate returns to normal, your doctor will monitor your heart rate and blood pressure until normal levels return.

Your technologist will store the resting and stress echocardiography images and compare them to see if any areas of the heart are malfunctioning due to low blood supply. 

Duration and results from a stress echo

A stress echo takes approximately 45 to 90 minutes. 

After the test, your doctor will explain your test results. If your results are normal, your heart is likely not blocked due to coronary artery disease. If your results are abnormal, you may have a blocked blood vessel, or a heart attack damaged your heart.