What is it

Stress echocardiogram is a diagnostic procedure combining:
a) echocardiography, which uses high frequency sound waves (ultrasound) to assess motion of heart muscles
and
b) stress test, which assesses the capacity and reserve of heart muscle functioning under stressful situation.

The information obtained will help the doctor to indirectly assess the status of blood supply to the heart muscle. It also provides indirect information on the viability and the function of the heart muscle. This information is important and vital to the doctor in planning further appropriate measures and treatment for you.

There are two types of stress tests. The first type of stress is the treadmill exercise (called the exercise stress
echocardiogram), while the second type of stress involves the use of medication to stress the heart, simulating an exercise environment (called the pharmacological stress echocardiogram). Your doctor will decide which type of stress is more appropriate for you.

Preparations before test

· Take a light meal before the test.
· Check with your doctor whether you need to stop any medication before the test.
· Informed consent prior to the test is required.

If you have been scheduled for an Exercise Stress Echocardiogram, please bring along a pair of jogging or flat-sole walking shoes to facilitate the walking exercise. You are not required to wear any exercise attire if you are scheduled for a Pharmacological Stress Echocardiogram.

How is the test done

Exercise stress echocardiogram
The medical technologist will perform a resting echocardiogram. This is done using a transducer, which will be placed on your chest to obtain pictures of the motion of the heart muscle. The pictures will be recorded and shown on the monitor.

Thereafter, you will be asked to walk on the treadmill machine. The treadmill has been programmed to increase in gradient and speed at intervals of 3 minutes. Once you achieve the targeted exercise level or unable to continue because of exhaustion, breathlessness or chest pain, you will need to lie down, in a left lateral position, on the couch.

Another echocardiographic imaging will be performed and compared with those taken before the exercise.

Pharmacological stress echocardiogram
This form of test does not require you to perform the walking exercise on the treadmill machine. Instead, you will be given a medication called dobutamine through an infusion into the vein. The infusion rate will be increased gradually until a specific heart rate, or when symptom such as breathlessness or chest pain develops.

During the test, you may experience fast and pounding heartbeats. This is an expected response and you should not be unduly worried. You need to inform your doctor if you develop chest pain, breathlessness or other uncomfortable sensations. The medical technologist will perform an echocardiogram on you throughout the infusion period and comparisons will be made between those obtained during tachycardia (fast heart beat at 100 or more beats per minute) and earlier at rest.

The procedure will take around 1 to 2 hours and this does not include the waiting time.

Is the test safe

As the test is usually performed on patients suspected of having or already have coronary artery disease (insufficient blood supply to the heart muscle), there is a small possibility that this may evoke chest pain, irregular heartbeat, blood pressure changes or a heart attack.

The doctor will take necessary precautions to ensure your safety.

Can I undergo the test if I am not feeling well

If you are feeling unwell because of fever, running nose or acute illness, you should not proceed with the procedure. Before the procedure, you will be examined by a doctor to ensure that you are fit for it.