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?

• After being called into the scan room, there will usually be two people present during the test - 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
• The test will be explained to you and then you will be asked to sign a consent form agreeing to have the test. You will be able to ask any questions
• 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 bike that has bicycle pedals where your feet will be secured in, and you will be asked to pedal in a partial reclining position. Stickers will be attached to your chest and connected to the machine. These will be used to monitor your heart rate. Your blood pressure will also be checked regularly throughout the test. A cannula may be placed in the vein in your arm, if needed to inject contrast which improves the quality of the images recorded
• The exercise gets harder every 2 minutes or so, with the sonographer recording ultrasound images of your heart at various intervals throughout the test
• Once you have reached your target heart rate (based on age), you can slow your pedalling down. The sonographer will take the final set of pictures. The sonographer may also ask you to stop if you develop certain symptoms such as chest discomfort or shortness of breath
• You will continue to have your heart rate and blood pressure monitored until you have returned to resting levels
• 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 HOME AFTERWARDS.PLEASE CONSIDER ARRANGING SOMEONE TO ACCOMPANY YOU OR BE AVAILABLE TO DRIVE YOU HOME FOLLOWING THE TEST.

How safe is an exercise echo?

Extremely safe. Most people have no difficulties with the procedure. There are very slight risks as the heart is being exercised, but overall, the test is very well established and very safe.

The risk of 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 who will then correspond with you to decide further management.

At the end of the test

Once the test is completed, you can change back into your top garments. You will be asked to return to the chair in the waiting area for around 10-15 minutes for observation and you can then go home. You will be able to return home after the test has been completed. You may undertake your day-to-day activities as usual. If you stopped taking any medicines for the test, take them again after the test has been completed.

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