Cardiology - Exercise Stress Echocardiogram

What is an exercise stress echocardiogram (echo)?

An exercise stress echo combines exercise with an ultrasound scan of the heart (an ‘echo’).

The test helps doctors to find the cause of symptoms during physical stress or exercise. Echo pictures will be taken at the start and again through the exercise.

What exactly is involved?

There will usually be three people present during the test – a doctor, a sonographer and a nurse. The sonographer may be male or female and if, under special circumstances i.e. religious reasons, you would prefer a sonographer of the same gender, then please let us know before you attend.

You will be asked to undress to the waist and put on a gown that will open to the front. The test is done on a special exercise bed that has bicycle pedals where your feet will be, and you will be asked to pedal lying down. The exercise gets harder every 2 minutes or so, with the sonographer recording images of your heart, by passing a handheld probe over your chest at various intervals.

Once you have reached your target heart rate (based on age), we will take the final set of pictures. The doctor may also ask you to stop if you develop certain symptoms such as chest discomfort or shortness of breath. Your blood pressure will be recorded before, and at regular times during the test. Your heart rate will also be monitored on an ECG.

Overall the test should take around 30 – 45 minutes.

What happens if I cannot do enough exercise?

You will need to be able to pedal for long enough to get your heart rate to the target. If you have mobility problems or significant joint problems, this may not be the right test for you.

Some people may not reach their target heart rate, and here we may use some medication known as Atropine to help achieve the target. This is a very safe medication, but we prefer to use exercise alone if possible.

It is very important to try your best during the test, but not to push yourself to limits that make you feel unwell.

If you need Atropine, you cannot drive for 2 hours after the test.  As this cannot be predicted, it is sensible not to plan to drive yourself home aferwards. 

How safe is an exercise echo?

Extremely safe.

The risk of a complication is similar to other forms of exercise stress such as walking on a treadmill. Research suggests serious heart-related complications occur in less than 1 in 7000 tests.

A contrast agent is often injected to make the images clearer. As with any medicine there is a risk of allergy, but the risk of a significant reaction is extremely low (around 1 in 10,000 patients).

Preparing for the test

You should wear loose clothing and training shoes (‘trainers’) that will not slip off your feet.

We suggest that you do not eat a heavy meal in the two hours before your test. You may wish to bring something to drink afterwards, although water will be available.

You may need to stop specific heart medicines before the test. There is a list included with this appointment letter. If you are unsure, please ask.

The results

The results will be analysed and a report will be produced for the referring doctor. A result may be given to you on the day of the test.

At the end of the test

You will be able to return home after the test has been completed. You may undertake your day-to-day activities as usual.

Information and support

If you have any questions or would like to know more about the exercise (stress) echocardiogram, please contact the Cardiorespiratory Department on 0161 778 2028.

Drugs to stop 48 hours before a Stress Echo

Beta-Blockers:

Acebutolol - Sectral, Secadrex

Atenolol - Tenormin, Co-tenidone, Kalten, Tenoret 50, Tenoretic, Beta-adalat, Tenif

Bisoprolol - Cardicor, Emcor, Monocor

Carvedilol - Eucardic

Celiprolol - Celectol

Labetolol - Trandate

Metoprolol - Betaloc, Lopresor, Co-betaloc

Nadolol - Corgard

Nebivolol - Nebilet

Oxprenolol - Trasicor, Trasidex, Slow-Trasicor

Pindolol - Viskaldix, Visken

Propranolol - Inderal, Inderal LA, Cardinol, Cardinol LA, Angilol, Bedranol SR, Beta Progane, Slo-Pro

Sotalol - Beta-cardone, Sotacor

Timolol - Betim, Moducren, Prestim

Others

Diltiazem - Adizem-SR, Adizem-XL, Antigel SR, Angitil-XL, Calcicard CR, Dilcardia SR, Dilzem SR, Dilzem XL, Optil, Slowzem, Tildiem, Tildiem LA, Tildiem retard, Viazem XL, Zemtard

Verapamil - Cordilox, Securon, Half-Securon, Secron-SR, Univer, Verapress MR, Vertab SR, Zolvera

Ivabradine - Procoralan