Unlocking the Power of Stress Echocardiography: Who Needs It, How It Works, and What to Expect

The stress Echo, also known as stress Echocardiography, is a test to determine the working of the heart and the blood vessels. During the trial, the doctor may ask the person to exercise on a treadmill or a stationary bicycle to monitor the heartbeat and blood pressure. When the heartbeat reaches the peak level, the doctor will take an ultrasound image to determine whether the heart is getting enough blood and oxygen during exercise. It is an ultrasound of the heart to notice the proper functioning before and after the physical activity. 

Who should have this stress echo test?

People who usually have the symptoms of heart disease, such as Athletes, mountaineers, and divers, also need to perform the stress echo test. Signs that a patient usually faces may include:

  • Angina
  • Chest
  • Shortness of breath 
  • Irregular heartbeat

Disease detected through stress echo test:

In most cases, the stress echo test is usually performed to diagnose coronary artery disease and to notice any blockage in the blood vessels that carry blood to the heart muscles. Stress echo is also helpful for diagnosing or monitoring other diseases or conditions such as:

  • Heart valve disease
  • Cardiomyopathy
  • Heart failure
  • Pulmonary hypertension
  • Congenital heart disease

This test can also be helpful to notice the changes during the treatments, such as:

  • Angioplasty
  • Bypass-grafting
  • While using antiarrhythmic and anti-angina medications

Before the test: Before the test, the doctor also gives specific instructions regarding the test; listen to them carefully. The doctor may provide you with the following instructions before the trial:

  • Avoid caffeine for at least 24 hours before the test.
  • Avoid smoke and tobacco on the day of the test.
  • Ensure you do not eat or drink anything 3 to 4 hours before the test.
  • Use comfortable and less fitted shoes and clothes.
  • Take medicines as prescribed by the doctor’s instructions, especially before the test. Do not continue or discontinue any medication according to your own will.

During the test:

Usually, the test will be performed by a cardiac sonographer under the supervision of the physician, and this test usually takes 45 to 60 minutes. The process of the stress echo test is as follows:

  • Before performing the test, the technician attaches electrodes to your chest connected with the electrocardiogram (EKG) monitor to notice the heart condition while exercising. You may also be asked to wear the blood pressure cuff to record your blood pressure during the test.
  • Before the exercise, the sonographer also performs an initial EKG. During this process, you are asked to lie on the left side. After that, the sonographer holds a transductor on your chest in different positions to collect the images.
  • After that, you have to exercise on a treadmill, or stationary bicycle, starting slowly and gradually with increasing intensity. You must continue your exercise until and unless the symptoms appear in the body or you reach your target heart rate. The target heart rate usually depends on your health, age, and fitness level. The total time of the exercise is about 10 to 15 minutes. 
  • During exercise, if you feel any usual symptoms such as excessive pain, discomfort, and pressure in your arm, jaws, and chest, lightheadedness, dizziness, and difficulty breathing. Inform the doctor immediately before the condition gets worse.
  • Suppose you are on the treadmill and reach your target heart rate. Then you have to get off the treadmill and move to the exam table for a repeat echocardiogram. If you exercise on a stationary bicycle, your sonographer performs the echocardiogram during pedaling.

After the test:

  • After the test, you may feel increased breathing rate and heart rate which is quite normal.
  • After the test, you must wait until your body cools down and your blood pressure reaches normal. After that, you are allowed to go back home.

Results:

The stress echo test is reliable enough to detect many diseases. After getting the results, the doctor will explain the test results to you. If your heart is functioning normally and there is no blockage in your blood vessels, your test results are normal. In abnormal results, when your heart is not working correctly, and your doctor may diagnose any blockage in blood vessels or heart disease, he may proceed for further treatment and testing.

Risks:

The stress echo test is safe, and there isn’t any risk associated with this test. Some of the rare complications that patient might face include:

  • Fainting or dizziness
  • Angina
  • Abnormal heartbeat
  • Heart attack

Who should avoid stress echo test:

A stress echo test might be unsafe for people who have the following heart conditions:

  • Uncontrolled arrhythmia
  • Aortic dissection
  • Severe aortic stenosis
  • Continuous chest pain
  • Inflammation of tissues around or in the heart
  • Recent heart attack

References:

  • https://www.healthline.com/health/stress-echocardiography
  • https://my.clevelandclinic.org/health/diagnostics/16983-exercise-stress-echocardiogram
  • https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/dobutamine-stress-echocardiogram?amp=true
  • https://medlineplus.gov/ency/article/007150.htm
  • https://heartwest.com.au/shw_services/stress-echocardiogram/