Echocardiography stress test; Stress test – echocardiography; CAD – stress echocardiography; Coronary artery disease – stress echocardiography; Chest pain – stress echocardiography; Angina – stress echocardiography; Heart disease – 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 medical center or health care provider’s office.

A resting echocardiogram will be done first. While you lie on your left side with your left arm out, a small device called a transducer is held against your chest. A special gel is used to help the ultrasound waves get to your heart.

Most people will walk on a treadmill (or pedal on an exercise bicycle). Slowly (about every 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 provider administering the test

If you are not able to exercise, you will get a drug such as dobutamine through a vein (intravenous line). This medicine will make your heart beat faster and harder, similar to when you exercise.

Your blood pressure and heart rhythm (ECG) will be monitored throughout the procedure.

More echocardiogram images will be taken while your heart rate is increasing, or when it reaches its peak. 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.

How to Prepare for the Test

Ask your provider if you should take any of your routine medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.

It is important to tell your doctor if you have taken any of the following medicines within the past 24 hours (1 day):

• Sildenafil citrate (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)

DO NOT eat or drink for at least 3 hours before the test.

Wear loose, comfortable clothing. You will be asked to sign a consent form before the test.

How the Test will Feel

Electrodes (conductive patches) will be placed on your chest, arms, and legs 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.

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 provider:

• 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

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.

What Abnormal Results Mean

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:

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

Risks

The risks are very low. Health care professionals will monitor you during the entire procedure.

Rare complications include:

• Abnormal heart rhythm
• Fainting (syncope)
• Heart attack

Exercise stress test

Exercise ECG; ECG – exercise treadmill; EKG – exercise treadmill; Stress ECG; Exercise electrocardiography; Stress test – exercise treadmill; CAD – treadmill; Coronary artery disease – treadmill; Chest pain – treadmill; Angina – treadmill; Heart disease – treadmill

An exercise stress test is used to measure the effect of exercise on your heart.

How the Test is Performed

This test is done at a medical center or health care provider’s office.

The technician will place 10 flat, sticky patches called electrodes on your chest. These patches are attached to an ECG monitor that follows the electrical activity of your heart during the test.

You will walk on a treadmill or pedal on an exercise bicycle. Slowly (about every 3 minutes), you will be asked to walk (or pedal) faster and on an incline or with more resistance. It is like walking fast or jogging up a hill.

While you exercise, the activity of your heart is measured with an electrocardiogram ( ECG ). Your blood pressure readings are also taken.

The test continues until:

• You reach a target heart rate.
• You develop chest pain or a change in your blood pressure that is concerning.
• ECG changes suggest that your heart muscle is not getting enough oxygen.
• You are too tired or have other symptoms, such as leg pain, that keep you from continuing.

You will be monitored for 10 to 15 minutes after exercising, or until your heart rate returns to baseline. The total time of the test is around 60 minutes.

How to Prepare for the Test

Wear comfortable shoes and loose clothing to allow you to exercise.

Ask your provider if you should take any of your regular medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.

Tell your doctor if you are taking sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil (Levitra) and have taken a dose within the past 24 to 48 hours.

You must not eat, smoke, or drink beverages containing caffeine or alcohol for 3 hours (or more) before the test. In most cases, you will be asked to avoid caffeine for 24 hours before the test. This includes:

• Tea and coffee
• All sodas, even ones that are labeled caffeine-free
• Chocolates
• Certain pain relievers that contain caffeine

How the Test will Feel

Electrodes (conductive patches) will be placed on your chest to record the heart’s activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.

The blood pressure cuff on your arm will be inflated every few minutes. This produces a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before exercise starts.

You will start walking on a treadmill or pedaling a stationary bicycle. The pace and incline of the treadmill (or the pedaling resistance) will slowly be increased.

Sometimes, people experience some of the following symptoms during the test:

• Chest discomfort
• Dizziness
• Palpitations
• Shortness of breath

Why the Test is Performed

Reasons, why an exercise stress test may be performed, include:

• You are having chest pain (to check for coronary artery disease, narrowing of the arteries that feed the heart muscle).
• Your angina is getting worse or is happening more often.
• You have had a heart attack.
• You have had angioplasty or heart bypass surgery.
• You are going to start an exercise program and you have heart disease or certain risk factors, such as diabetes.
• To identify heart rhythm changes that may occur during exercise.
• To further test for a heart valve problem (such as an aortic valve or mitral valve stenosis ).

There may be other reasons why your provider asks for this test.

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 concerning changes in blood pressure or your ECG.

The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.

It may be hard to interpret the results of an exercise-only stress test in some people.

What Abnormal Results Mean

Abnormal results may be due to:

• Abnormal heart rhythms during exercise
• Changes in your ECG that may mean there is a blockage in the arteries that supply your heart ( coronary artery disease )

When you have an abnormal exercise stress test, you may have other tests performed on your heart such as:

• Cardiac catheterization
• Nuclear stress test
• Stress echocardiography

Risks

Stress tests are generally safe. Some people may have chest pain or may faint or collapse. A heart attack or dangerous irregular heart rhythm is rare.

People who are more likely to have such complications are often already known to have heart problems, so they are not given this test.