This leaflet answers common questions about an exercise stress echocardiogram, or echo. If you would like further information, or have any worries, please do not hesitate to ask your nurse or doctor.

In all cases, a doctor will explain the procedure to you and answer any questions you may have. In most cases it will be possible for a friend or relative to accompany you for all or part of the procedure. 

What is a stress echocardiogram (echo)?

An echocardiogram (echo) is a scan that uses ultrasound (sound waves) to produce pictures of the heart. The scan is painless and does not use radioactivity.

During a stress echo we scan your heart before and after the heart rate is raised. This helps doctors to find the cause of the symptoms you experience during physical stress or exercise. We will either perform the test using exercise to raise your heart rate, or we will give you some medication, such as dobutamine, through an injection in your arm.

Dobutamine increases activity in the heart muscles, making your heart beat harder and faster, like when you exercise. The doctor will choose the most appropriate test for you on the day.  The decision is not based on your ability to exercise but rather which test is the most likely to give the doctor the best information related to your condition.

Why do I need this test?

A stress echo helps your doctor understand how your heart copes when it is made to work harder, such as during exercise. It can help to see if symptoms are due to underlying heart disease (such as angina or breathlessness) or assess the severity of established heart disease.

How is the test carried out?

You will be asked to remove your clothes from the waist up, put on a hospital gown and leave it open at the front. We attach special stickers (electrodes) to your chest so that we can monitor your heart.

The stickers are connected to the echo machine by thin wires.

You will lie on a couch on your left side. A doctor and a physiologist are with you when you have the scan. We take the first echo, called a resting echo while you are on the couch.

After the resting echo, we inject a contrast agent (special liquid) through a small, plastic needle into a vein in your arm, ready for the second echo. The contrast helps to give clear pictures of your heart for your consultant to see on the screen.

You may then be asked to walk on a treadmill or pedal an exercise bike. If the doctor has determined that a dobutamine stress echo is more appropriate for you, we will inject some dobutamine into a vein in your arm instead. This makes your heart work in the same way it does during exercise, beating harder and faster. The doctor will take the second echo when your heart rate is increasing. Your heart rate is monitored during the entire test.

Sometimes the doctor may decide it is better if you have the dobutamine injection, even if you are able to do the exercise. The decision depends on your specific condition and what information your doctor needs from the test.

A stress echo takes about 45-60 minutes to complete.

The test takes place in a room that is darker than usual so we can see the scan pictures on the screen better.

If you have the dobutamine injection during the test:

  • You may notice your heart beating harder and faster, like when you are exercising. You may feel warm.
  • We stop the injection once your heart is working hard enough.
  • We continue to monitor your heart until the effects of the medicine have disappeared. This usually takes only a few minutes.
  • You may feel slightly sick or dizzy from the injection, but this goes away quickly after we stop the injection.
  • Please let the doctor know of any other side effects, or discomfort, you experience during the test. They will take care of any side effects, if needed.

How do I prepare for the test?

Medicine

Unless instructed otherwise by your doctor, it is important that you stop taking any rate controlling medication such as beta-blockers (atenolol, bisoprolol, metoprolol, propranolol, nebivolol and carvedilol), calcium-channel blockers (diltiazem and verapamil), or the angina drug ivabradine, 48 hours before the test.

These drugs prevent the stress medicine from making your heart work harder. If you continue taking these medications in the 48 hours before the test, your stress echo may need to be moved to a later date.

If your doctor wishes you to remain on these drugs for the test, you will be informed.

You should continue taking all your other medication as prescribed by your doctor. If you have any questions about your medication, please contact your doctor, or the echo department on 020 375 82069.

Caffeine

You should not have any caffeine products 24 hours before your examination as they may interfere with your test – this includes tea, coffee, green tea, cola, and energy drinks. Caffeine can also be found in both hot chocolate drinks and chocolate bars.

What happens after the test?

Getting home after your test

After the stress echo, we may ask you to sit and rest for a few minutes to allow the effects of exercise, or the medication, to completely disappear. You can go home after this.

We advise you not to drive after a dobutamine test, so please ask a friend or relative to drive you home. Please be aware that you should not drive or operate machinery for the rest of the day. You will be well enough to travel on public transport.

What are the risks of having the test?

All medical procedures carry some risk. It is important to remember that we would not recommend any procedure if we did not believe the benefits outweigh any risk. The risks will be different for each patient, so we will discuss the risks that apply to you in more detail before the procedure.

A stress echo is very safe, but there are some risks you need to be aware of:

  • The heart may develop an abnormal rhythm in 0.1 per cent of patients (one in 1,000) having this test. This usually settles down without the need for any treatment. If treatment is needed, administration of a drug or a short electrical impulse to the relevant area restores the heart’s normal rhythm.
  • A bad angina attack or heart attack may happen in less than 0.05 per cent of patients (one in 2,000) during the test.
  • The medicines used may cause an allergic reaction in less than 0.01 per cent of patients (one in 10,000) during the test. If you have had allergic reactions to any medicine before, please tell your doctor before the test.

Is there anything else I need to know?

If you require female members of staff, you can ask us in advance, and we will try to accommodate you. While it is often not possible to guarantee which staff are available on the day, we will work with you as best we can.

Cancellations

If you are unable to come to your appointment, please contact the echo department on 020 375 82069 as soon as possible.

We can give your appointment time to another patient and arrange a new time for you.