Stress Echocardiography

Stress echocardiography is a test that uses ultrasound imaging to show how well your heart muscle is working to pump blood to your body. It is most often used to detect a decrease in blood flow to the heart from narrowing in the coronary arteries.

How the Test is Performed

This test is done at a doctors office or in a hospital.

A resting echocardiogram will be done first. This assesses your heart muscle function and function of the heart valves at rest to determine if there are any abnormalities.

Most people will then walk on a treadmill (or pedal on an exercise bicycle). Slowly (about every 2-3 minutes), you will be asked to walk (or pedal) faster and on an incline. It is like being asked to walk fast or jog up a hill.

In most cases, you will need to walk or pedal for around 5 to 15 minutes, depending on your level of fitness and your age. Your doctor will ask you to stop:

• When your heart is beating at the target rate
• When you are too tired to continue
• If you are having chest pain or a change in your blood pressure that worries the doctor administering the test 

Your blood pressure and heart rhythm (ECG) will be monitored throughout the procedure. Electrodes (conductive patches) will be placed on your chest and arms to record the heart's activity. The blood pressure cuff on your arm will be inflated every few minutes, producing a squeezing sensation that may feel tight.

Rarely, people feel chest discomfort, extra or skipped heartbeats, dizziness, headache, nausea or shortness of breath during the test.

On completion of the exercise component, when your heart rate has reached its peak with exercise, more echocardiogram images will be taken. The images will show whether any parts of the heart muscle do not work as well when your heart rate increases. This is a sign that part of the heart may not be getting enough blood or oxygen because of narrowed or blocked arteries.

Why the Test is Performed

The test is performed to see whether your heart muscle is getting enough blood flow and oxygen when it is working hard (under stress).

Your doctor may order this test if you:

• Have new symptoms of angina or chest pain
• Have angina that is getting worse
• Have recently had a heart attack
• Are going to have surgery or begin an exercise program, if you are at high risk for heart disease
• Have heart valve problems 

The results of this stress test can help your doctor:

• Determine how well a heart treatment is working and change your treatment, if needed
• Determine how well your heart is pumping
• Diagnose coronary artery disease
• See whether your heart is too large

Results

Normal Results

A normal test will most often mean that you were able to exercise as long as or longer than most people of your age and gender. You also did not have symptoms or concerning changes in blood pressure and your ECG. Your heart pictures show that all parts of your heart respond to increased stress by pumping harder. A normal result means that blood flow through the coronary arteries is probably normal. The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.

Abnormal Results may be due to:

• Reduced blood flow to a part of the heart. The most likely cause is a narrowing or blockage of the arteries that supply your heart muscle.
• Scarring of the heart muscle due to a past heart attack.

After the test you may need:

• Changes in your heart medicines
• Coronary angiography
• Angioplasty and stent placement
• Heart bypass surgery