FREQUENTLY
ASKED QUESTIONS ABOUT EXERCISE STRESS ECHOCARDIOGRAPHY
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Q:
What is a Stress Echo?
A: An Exercise Stress Echocardiogram, sometimes called a stress
echo, is a tool used to evaluate heart function by combining
an exercise (stress) test with a transthoracic echocardiogram.
A stress echocardiogram uses ultrasound waves to produce images
of the heart both before (sometimes during) and immediately
following exercise. Images of the heart at rest are compared
with images of the heart during and/or after exercise to evaluate
how the heart responds to exercise.
In North America the test is performed by a specially trained
technologist, called a sonographer, and is interpreted by a
physician trained in reading stress echocardiograms. During
the exercise portion of the exam there will be a medical staff
member, usually a physician, supervising the examination and
there is sometimes a third person assisting.
Patients that have physical limitations that cause them to
be unable to exercise may be given a pharmacologic stress echocardiogram
instead of an exercise stress echocardiogram.
Q: Why has my doctor requested that I have a stress echocardiogram?
A: If you are going to have a stress echocardiogram, it is
more than likely that it has been requested or ordered by
your physician or cardiologist. A stress echocardiogram is
most often requested to check for good blood flow to the
heart. An ECG may help to provide an early detection of coronary
artery blockage.
Q: What must I do to prepare for an echocardiogram?
A: Your doctor and/or the laboratory where you will have the
stress echocardiogram performed will provide you with written
instructions to help you to prepare for the test. You may
be asked to refrain from eating and drinking for a few hours
before the stress echocardiogram and you may also be asked
to limit your drinking to water and other caffeine free drinks
for up to 24 hours before the test. You may be asked to temporarily
hold off on taking some medications. You may also be asked
to stop using tobacco products for a few hours before the
test.
You should bring or wear comfortable walking shoes and wear
suitable (warm-ups/loose fitting clothes) for the test. It
is very important that you check with your doctor and/or the
stress echocardiography laboratory staff a few days before
your stress echocardiogram for any specific instructions. You
should plan on being at the echocardiography lab for anywhere
from one to two hours.
Q: What should I expect while at the exam?
A: Upon arrival at the lab you will be greeted by our staff.
We may need to obtain some insurance information from you.
You will be asked to register and may also be requested to
provide a prescription or order for your examination.
After processing these items, we will then escort you into
an examination room. The room will have a special examination
table and ECG machine, an ultrasound machine and a treadmill
(or sometimes a stationary bicycle).
You may be asked a few questions by the sonographer who will
want to know why you are having the test, if you have had any
previous stress echocardiograms, and if you have ever had open
heart surgery. Usually he/she will give you an explanation
of the procedure also.
You will then be asked to remove your clothing from the waist
up. Women will be asked to leave their bra on and will be given
a gown to wear.
A staff member will attach ECG lead wires to electrodes attached
to your chest with simple medical tape. To ensure the ECG lead
wires stay attached while you exercise, we will clean your
skin and prepare it for the electrodes. For men, it may be
necessary to shave small areas of chest hair.
A blood pressure cuff will be placed on your arm before you
begin to exercise.
You may be asked to have an intravenous line (IV) started so
that a special echocardiographic contrast material can be used
to enhance the ultrasound pictures. The lab performing the
exam will explain this procedure if they feel it will be beneficial.
The sonographer will obtain resting images before you begin
to exercise.
The lights will be dimmed to allow the sonographer to see the
monitor better.
You will be asked to lie on the bed on your left side.
The sonographer
will apply ultrasound gel to a transducer. The transducer
is a wand-like device that sends and receives
the harmless ultrasound waves. The gel allows the ultrasound
beams to penetrate your chest wall to your heart and makes
it possible to “see” the heart.
The sonographer
will then begin to acquire ultrasound images by methodically
and precisely moving the transducer around
on your chest and abdomen. The sonographer will be viewing
these images on a monitor and will take various recordings
at several different locations or “views”. During
the recording you may be asked to change your position and
to hold your breath. These variations in position and breathing
allow the sonographer to obtain the best quality pictures possible.
The sonographer will press the transducer against your skin
and this pressure may be moderate at times to facilitate the
transmission of ultrasound waves. If it becomes too uncomfortable,
please let the sonographer know and he/she will let you take
a short break. After the sonographer has obtained all of the
resting images, the exercise portion of the exam will begin.
ECG and blood pressure readings will be taken before exercise
begins and throughout the exercise portion of the test.
Usually exercise is performed on a treadmill, or less commonly,
on a stationary bicycle. When using the treadmill, the treadmill
will begin at a slow, warm-up speed. The speed and the incline
(or slope) of the treadmill will be increased every few minutes
throughout the test.
The test is most useful if your target heart rate is reached
before exercise is stopped so your doctor will want you to
exercise as long as you can. Exercise will usually continue
until your target heart rate is reached unless you experience
difficulty breathing, or other show other symptoms, and we
will immediately stop.
IT IS IMPORTANT THAT YOU IMMEDIATELY LET US KNOW IF YOU EXPERIENCE
ANY CHEST PAIN, SEVERE SHORTNESS OF BREATH, DIZZINESS, OR OTHER
SYMPTOMS DURING THE EXAM.
More images of your heart will be obtained immediately after
exercise is stopped (if you exercise on a stationary bicycle
images may also be obtained during exercise).
After the treadmill is stopped, you will be escorted very quickly
back onto the bed, and asked to lie on your left side. It is
important that you are positioned on the bed very quickly so
that we can capture images of your heart while your heart rate
is still high.
The sonographer will obtain another set of images so that the
resting images before you began exercise can be compared to
the images of your heart when it is under stress (immediately
after you have exercised).
You will be asked to remain on the bed until your heart rate
has slowed. If you experience any symptoms during this time
or at any other time, you should report them immediately to
our staff.
We will record the resting and exercise images of the exam
on a video tape and/or computer disk for later review and analysis
by a cardiologist, who is a physician in specially-trained
reading and interpreting ultrasound images.
Q: What happens after the exam?
A: Following the recording of the images, the sonographer will
remove the blood pressure monitoring cuff from your arm and
the ECG electrodes from your chest, will wipe off the ultrasound
gel, will help you off of the bed and will escort you out
of the lab.
The ultrasound images will be interpreted by the Cardiologist
(this may be the physician that was present during the stress
echo). He or she will interpret the stress echocardiogram and
will provide your general physician with a written report.
Sometimes the physician present during your stress echocardiogram
will be able to tell you his or her preliminary findings although
this immediate feedback varies depending on individual circumstances.
