Stress Echocardiogram

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a stress echocardiogram?

A stress echocardiogram is a test that combines a stress test with an echocardiogram. The test evaluates the health of your heart at rest and after it is stressed. Your doctor may perform a stress echocardiogram to help diagnose coronary artery disease, and to see how well your heart pumps blood and how well your heart valves work.

An echocardiogram is a type of ultrasound or sonogram. It uses sound waves to make moving pictures of your heart. A stress test involves walking on a treadmill and having an EKG (electrocardiogram) to see how the stress of exercise affects the heart.

A stress echocardiogram, also called a stress echo or an echo stress test, is only one method to monitor and diagnose heart conditions. Discuss all of your testing options with your doctor to understand which options are right for you.   

Why is a stress echocardiogram performed? 

Your doctor may recommend a stress echocardiogram to evaluate the health of your heart at rest and immediately after the stress of exercise. It is not a routine test, and a stress echocardiogram by itself cannot diagnose all types of heart conditions or predict future heart problems. It does provide important information about your heart health in relation to your age, physical exam, medical history, and other tests. 

Doctors use stress echocardiograms to help diagnose or monitor the following conditions:

  • Cardiomyopathy, thickened or enlarged heart muscle 

  • Coronary artery disease (CAD), a buildup of plaque on the walls of the coronary arteries that supply blood to the heart

  • Heart attack, death of a portion of the heart muscle usually due to coronary artery disease and a blood clot that blocks blood flow to the heart

  • Heart failure, an inability of a weakened heart to pump enough blood to the body

  • Heart murmurs, unusual or abnormal heart sounds heard with a stethoscope

  • Heart valve disease including narrowed valves and leaky valves

  • Pulmonary hypertension, increased blood pressure in the blood vessels that carry blood from the heart to the lungs

Your doctor may also perform a stress echocardiogram to:

  • Determine if your symptoms are related to coronary artery disease (narrowing of the coronary arteries). Symptoms can include chest pain, dizziness, shortness of breath, fatigue, weakness, palpitations, passing out, or feeling a pounding, racing or irregular heartbeat

  • Develop a healthy, safe exercise program if you have heart disease or a high risk of heart disease due to diabetes, family history, obesity, and other conditions

  • Further evaluate abnormal heart test results such as changes on a standard resting EKG

  • Monitor your heart condition after a heart attack or heart surgery

Who performs a stress echocardiogram?

A specialized medical team performs a stress echocardiogram. The team may include a doctor, nurse or technician and a sonographer, who is trained to perform echocardiograms. The following doctors can lead the team that performs your stress echocardiogram:

  • Cardiologists and pediatric cardiologists specialize in conditions and diseases of the heart and its blood vessels. Pediatric cardiologists further specialize in treating infants, children and adolescents.

  • Diagnostic radiologists specialize in performing and interpreting imaging tests, such as ultrasounds, X-rays, angiograms, CTs, nuclear scans, and MRIs.

  • Clinical cardiac electrophysiologists specialize in diagnosing and treating abnormal heart rhythms (arrhythmias) using heart and blood vessel imaging and technical procedures.

  • Interventional cardiologists specialize in diagnosing and treating conditions and diseases of the heart and blood vessels using nonsurgical, catheter-based procedures and specialized imaging techniques.

  • Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.

How is a stress echocardiogram performed?

Your stress echocardiogram will be performed in a stress test laboratory in a hospital or heart clinic. The entire stress echocardiogram takes one to two hours and generally includes these steps:

  1. You will undress from the waist up and wear a patient gown for modesty.

  2. Your provider will attach sticky, painless patches, or electrodes, to your chest, arms and legs. The electrodes are attached to an EKG (electrocardiogram) machine by wires. The EKG machine records your heart’s electrical activity during the test. If you have a hairy chest, your provider may shave small areas to apply the electrodes.

  3. Your provider will apply a blood pressure cuff to your arm to monitor blood pressure during the test.

  4. You will lie down on a procedure table and your provider will perform a resting echocardiogram. This involves placing a painless wand or transducer on different places on your chest to take pictures of your heart and measure the flow of blood through your heart.

  5. You will then complete the stress test by walking on a treadmill or pedaling a stationary bike. You will begin to pedal harder or exercise harder as the treadmill gradually moves more quickly and the incline increases.

  6. Your provider will watch your EKG and vital signs closely throughout the stress echocardiogram and will stop the test if abnormalities occur or if you have symptoms, such as chest pain, dizziness, or shortness of breath.

  7. Your provider will repeat the echocardiogram immediately after the stress test while your heart is still beating fast.

  8. You will rest briefly after the test while your provider watches your vital signs for abnormalities.

  9. Your doctor will evaluate the stress echocardiogram test and discuss the results with you.

Your doctor will use a drug called dobutamine to simulate the effect of exercise on the heart if you aren't able to exercise due to a medical condition or illness. This is called a pharmacological stress test.
Will I feel pain?

Your comfort and relaxation is important to both you and your care team. The echocardiogram and stress test should be painless. Tell your care team immediately if you have chest pain or any other discomfort during or after your test.

What are the risks and potential complications of a stress echocardiogram? 

There are no known risks or complications of an echocardiogram. However, the stress test portion of your stress echocardiogram has a small risk of complications. Complications may become serious in some cases. Risks and potential complications of a stress echocardiogram include:

Your care team will watch you closely during your stress echocardiogram and will stop the test if you have any problems. Be assured that your team is trained and equipped to treat complications.
Reducing your risk of complications

You can reduce the risk or the seriousness of certain complications by following your treatment plan and: 

  • Notifying your care team immediately of any concerns such as chest pain, palpitations, dizziness, or shortness of breath

  • Telling your care team about your complete medical history including a history of allergies and heart problems

How do I prepare for my stress echocardiogram?

You are an important member of your own healthcare team. The steps you take before your stress echocardiogram can help your care team obtain the most accurate results. 

You can best prepare for a stress echocardiogram by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Not eating, drinking, or using caffeine before your test as directed by your doctor

  • Notifying your care team immediately of any concerns during the test such as chest pain, palpitations, dizziness, or shortness of breath

  • Stopping or taking your medications exactly as directed by your doctor. This may include not taking beta blockers.

Questions to ask your doctor

Having a stress echocardiogram can be stressful. It is common for patients to forget some of their questions about a stress echocardiogram during a doctor’s office visit. You may also think of question after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a stress echocardiogram?

  • How often will I need a stress echocardiogram?

  • How should I take my medications before and after my stress echocardiogram?

  • When and how can I expect to get my test results?

  • What other tests or treatments might I need?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my stress echocardiogram?

Knowing what to expect after your stress echocardiogram can help you get back to your everyday life as soon as possible. 

How will I feel after my stress echocardiogram?

Many people return to normal activities shortly after a stress echocardiogram. You should not feel any ill effects or have any symptoms after your stress echocardiogram. Tell your doctor or provider immediately of any symptoms, such as dizziness, chest pain, or shortness of breath. 

When can I go home?

You will likely go home right after an outpatient stress echocardiogram and speak with your doctor about the results at a later time. Sometimes, patients stay to discuss the results with the doctor and to get more tests. If you are hospitalized, you will likely stay in the hospital for further evaluation and treatment.

When should I call my doctor?

You should keep your follow-up appointments after a stress echocardiogram. Call your doctor if you have any concerns between appointments or if you have any symptoms that are new, unusual, or are not responding to your medications. Seek emergency medical care or call 911 if you have chest pain or shortness of breath.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 10
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  7. What is a Stress Test? American Heart Association.