Exercise Stress Echo

Definition:

An echocardiogram (often called "echo") is a graphic outline of the heart's movement, valves and chambers, using high-frequency sound waves that come from a hand-held wand placed on your chest. Echo is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart’s valves.

The exercise stress echo test involves exercising on a treadmill or stationary cycle while you are closely monitored. The test is used to evaluate your heart and valve function at rest and with exertion.

Your doctor uses the exercise stress echo to:

• Determine how well your heart tolerates activity
• Evaluate the function of your heart and valves
• Determine your likelihood of having coronary artery disease (blocked arteries)
• Evaluate the effectiveness of your cardiac treatment plan

• DO NOT eat or drink anything except water for four hours before the test. DO NOT drink or eat caffeine products (cola, Mountain Dew, chocolate products, coffee or tea) for 24 hours before the test. Caffeine will interfere with the results of the test.
• Ask your doctor what medications should be taken on the day of your test. DO NOT take the following heart medications on the day of the test unless your physician tells you otherwise or if the medication is needed to treat chest discomfort:
  • Beta blockers [for example: atenolol (Tenormin), metroprolol (Lopressor, Toprol), Propranolol (Inderal)]
  • Isorbide dinitrate (for example: Isordil, Sorbitrate)
  • Isosorbide mononitrate (for example: Ismo)
  • Nitroglycerin (for example: Deponit, Nitrostat)
  
  Bring your medication with you on the day of the test. Your physician may also ask you to stop taking other heart medications on the day of the test. If you have questions about your medications — ask your physician. Do not stop any medication without first talking with your doctor.
  

  Since many over-the counter medications contain caffeine (such as diet pills, No Doz, Excedrin and Anacin), DO NOT take any over-the-counter medication that contains caffeine for 24 hours before the test. Ask your physician, pharmacist or nurse if you have questions about other mediations that may contain caffeine.

• If you have diabetes and take medications to manage your blood sugar, ask your physician how to adjust your medications the day of your test. Do not take your diabetes medication and skip a meal before the test. If you own a glucose monitor, bring it with you to check your blood sugar levels before and after your test. If you think your blood sugar is low, tell the lab personnel immediately. Plan to eat and take your blood sugar medication after your test.
• If you use an inhaler for breathing, bring it to the test.
• Wear comfortable clothes. Bring shoes suitable for walking. You will need to change into a hospital gown to wear during the procedure. You will be given a locker to store your belongings during the test. Do not bring valuables.

• Before the test, a cardiac sonographer (an allied health professional who has been trained specifically to perform ultrasound examinations), nurse or physician will explain the procedure in detail, including possible complications and side effects. They will be available to answer any questions you may have.
• You will be given a hospital gown to wear.
• First, the sonographer will gently rub ten small areas of your chest, and place small sticky electrode patches to these areas. The electrodes are attached to an electrocardiograph (ECG) monitor, which charts your heart’s electrical activity during the test.
• Before you begin to exercise, the sonographer will perform a resting ECG, measure your resting heart rate and take your blood pressure.
• The sonographer will ask you to lie on your left side on an exam table so he or she can perform a resting echo. The sonographer will place a wand (sound-wave transducer) on several areas of your chest. The wand will have a small amount of cool gel on the end, which will not harm your skin. This gel helps get clearer pictures of the heart's movement. This should not hurt. Sounds are part of the Doppler signal. You may or may not hear the sounds during the test.
• Then, you will exercise either on a treadmill or stationary bicycle. The lab personnel will ask you to start exercising and gradually increase your rate of exercise. You will be asked to exercise very hard until you are exhausted. It is normal for your heart rate, blood pressure, breathing and perspiration to increase. This information will allow your physician to assess your heart's ability to function.
• At regular intervals, the lab personnel will ask how you are feeling. If you feel chest, arm or jaw pain or discomfort, short of breath, dizzy, lightheaded, irregular heart beats or if you have any other unusual symptoms, tell the stress lab personnel immediately.
• The lab personnel will watch for changes on the EKG monitor that suggest the test should be stopped.
• When you cannot exercise any longer:
  • you will get off the treadmill, quickly return to the exam table and lie on your left side so the sonographer can perform another echocardiogram. It is normal to feel a little unsteady when getting off the treadmill and onto the exam table for the echo, as you stop exercising suddenly.
  • if you were exercising on a bike, the sonographer may perform the echo test while you are still pedaling. You may be asked to quickly return to the exam table for another echocardiogram after exercising.
• Your heart rate, blood pressure and EKG will continue to be monitored after exercising until the levels are returning to normal.

The appointment takes about 60 minutes. The actual exercise time is usually between 7 and 12 minutes.

After the cardiologist reviews your test, the results will go into your electronic medical record. Your physician will have access to the results and will discuss them with you. Ask you doctor if you have any questions about the echocardiogram.