A stress echocardiogram actually combines two common tests: the exercise stress test and the echocardiogram.

The exercise stress test involves walking on a treadmill while your heart is continuously monitored with an electrocardiogram (ECG). The echocardiogram is a procedure that uses ultrasound waves to look at the motion of your heart and its pumping strength. A stress echocardiogram allows your doctor to assess your heart function both at rest and during stress (exercise).

If you are having a stress echocardiogram, then you are probably having some symptoms that are prompting your physician to consider your heart as a possible cause of your symptoms. These symptoms may include (but are not limited to) chest pain, shortness of breath, fatigue or palpitations. Or you may have NO symptoms but you have a history of heart problems and your doctor wants to make sure your heart is functioning properly. This assurance may be especially important prior to a surgical procedure. Both the exercise stress test and the echocardiogram are intended to find out if your heart is the functioning properly. Neither of these tests (the exercise stress test or the echocardiogram) is perfect. That is, either test is prone to false positive and false negative results. However, by performing these two tests together, the overall accuracy increases significantly and the chances of either a false positive and a false negative result decreases.

First, a baseline echocardiogram is performed. Small patches (called electrodes) are placed on your chest to monitor your heart rhythm. Next, a colorless gel is applied on your chest over the heart. The transducer (a device that beams high frequency sound waves at your heart) of the echocardiogram machine is moved over your chest to take pictures of your heart from various angles.

After the baseline echocardiogram is completed, you will begin to walk on the treadmill. The treadmill generally starts at a reasonably slow pace. As you walk, the treadmill will go progressively faster and the elevation will be raised. These changes serve to increase the work your heart is performing. While you are exercising, your blood pressure will be assessed periodically and your doctor will be watching your electrocardiogram for any evidence of adverse effects of exercise on your heart. You will continue to exercise until either you can walk no further or your heart has reached a pre-determined target heart rate or your doctor has detected abnormalities in the electrocardiogram that preclude continuing the test.

Immediately after you stop walking on the treadmill, you will return to the examination table where another echocardiogram will be performed. The technician and the physician will be looking for abnormal movements of your heart. Normally, this "after exercise" echocardiogram is much briefer than the "before exercise" echocardiogram.

The high frequency sound waves used for the echocardiogram are not known to cause any adverse effects. Exercise stress testing may actually precipitate life threatening cardiac problems. However, the exercise stress room is equipped to handle these emergencies and the Dubuque Internal Medicine health care team is trained to respond quickly.

• Do not eat for 2 hours prior to the test.
• On the day of your test, do not drink any beverages containing caffeine.
• If you smoke, do not smoke on the day of your test.
• CLOTHING: You should wear comfortable clothing. A two-piece outfit is preferred. Also, wear shoes that are suitable for walking on a treadmill.
• In most cases, you should take your medications on their usual schedule on the day of the test, unless your physician has directed you otherwise. If you are not sure if you should take a certain medication, please contact your physician.

Please allot at least 1 ½ hours for this procedure. If you scheduled a stress echocardiogram, your appointment time is listed on the front of this pamphlet.

After your test:

The cardiologist present during the exercise stress test will be available to discuss the results of your test immediately after its completion. If additional tests are necessary based on the results of this test, you will have an opportunity to schedule these tests prior to leaving the office. If this test was ordered by another physician, the cardiologist will communicate the results of this test to your physician.

If you have a sign or symptom that may be related to heart disease, most health insurers will cover the cost of this test. However, if you are having this test for screening purposes, the test may not be covered. If you are uncertain, you need to contact your health insurer.

We hope this brochure has helped answer some of your questions related to this procedure. If you have any additional questions, please contact your physician or call the Dubuque Internal Medicine Echocardiographic technologist at 563-557-9111.

STRESS ECHOCARDIOGRAM