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Stress Echocardiography

Stress Echocardiography Combines elements of both Echocardiography and Exercise Stress Testing. Echocardiography is an ultrasound test of the heart. A pear shaped device called a transducer is held against the chest and produces and receives high frequency sound waves (ultrasound) that bounce off structures in the chest cavity to form images. An echocardiography will evaluate the size, structure and function of your heart. The valves of the heart will also be closely examined.Exercise electrocardiography or Exercise Stress Testing is an ECG done during exercise. This will allow us to see how your heart responds to the demands of physical activity.

So, an ECG will be monitored during exercise and real time moving images of your heart will be taken before you exercise and immediately after you exercise. The cardiologist will be able to make comparisons between the images to identify areas of the heart that do not function properly under stress.

Stress Echo is done to

  1. Evaluate chest pain and determine its cause
  2. Determine the severity of known ischaemic heart disease
  3. Evaluate the effectiveness of stents/bypass surgery
  4. Gain more information on heart function in the setting of abnormal ECG's
  5. Evaluate valvular lesions under stress

Before the test

  • Do not eat for 4 hours before the test (you may drink water)
  • Continue taking your medication unless your doctor has specified otherwise
  • Either wear or bring comfortable clothing and shoes to walk in
  • Let the testing doctor know if you have used Viagra within the last 24hrs

Informed Consent

It is a requirement by law that we receive your consent to do your test. It is important that you understand what the test is about, how it is done and what the risks are. You will be given a form which will outline these things. If you have any questions please feel free to ask either the technician or the testing doctor who will be with you when you sign the form.

How the test is done

The test is performed by a cardiologist and a cardiac technician, who will monitor your blood pressure and heart rate and rhythm during slowly increasing levels of exercise.

Small sticky pads called electrodes are stuck to your skin to detect the ECG. To do this the technician will need a bare chest. Ladies will be given a gown.

The electrodes need to have good contact with your skin to pick up the electrical impulses from down in your heart. Men with hairy chests will be shaved in spots for the electrodes to be placed. The technician will give you skin a little scrub with rough paper and then a wipe with alcohol. This removes the dead skin cells which form a barrier. You will find that this may sting a little and it will leave red patches on you skin. This is normal and will take a couple of days to go away. Some patients with extra sensitive skin may develop small blisters from the gel used on the electrodes. This is rare and will heal quickly.

The technician will then take resting images of your heart using ultrasound. The technician will have to place the transducer against your chest will, between your ribs to gain images. A water based gel is applied to the skin to help conduction of the ultrasound waves.

Sometimes strong pressure is applied to the transducer. It can be uncomfortable in some areas (particularly for females as the heart sits under the breast). It is not unusual for patients to have tenderness on the ribs following this test that may last for a day or so.

You may be asked to change positions and to alter your breathing at times throughout the echocardiogram. It is important that you follow these instructions, and to otherwise lie quietly and relaxed, as this will help the technician to obtain the most accurate images.

Real time moving images will be electronically stored for later comparisons.

You will then be required to walk on the treadmill with the ECG still attached. Every three minutes the treadmill will get steeper and slightly faster. During exercise it is important that you tell the staff if you feel any symptoms. The test will end when you have gone as long as you can, ideally when your heart rate has increased and you are feeling puffed.

When you need to stop you will need to move back to the bed as quickly as you can for the second set of images while your heart is beating fast. You will also be required to hold you breath for a few seconds at a time (like for the resting ones). This is difficult to do when you are out of breath but it is essential to obtain the images. It only takes approximately 30 sec to obtain these images and then you will have time to rest and recover.

This test takes between 45 to 60 min to complete.

What are the risks?

Stress testing is usually performed on patients with known or suspected heart disease. Every effort is made to minimize the risks of this test, and emergency equipment and trained personnel are in attendance.

Possible adverse events related to stress testing include but are not limited to

  • Lightheadedness
  • Tiredness, fatigue
  • Leg cramps
  • Shortness of breath
  • Chest pain
  • Heart attack(about 2 in 10,000 tests)
  • Collapse
  • Arrhythmia
  • Death (about 1 in 10,000 tests)

How do I get my results?

A report will be sent to your referring doctor, usually within 24 hours. Your doctor will discuss your results at your appointment.

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