A stress echocardiogram is a non-invasive diagnostic test used to evaluate how well the heart muscles are working under physical stress. As the name suggests, it combines an exercise stress test and an echocardiogram.
This test allows us to detect any abnormalities in the heart’s pumping ability or areas with inadequate blood supply, which could indicate coronary artery disease or other cardiac issues that may only become apparent under the heightened cardiovascular demands of exercise.
What are the components that make up a stress echocardiogram?
To better understand what a stress echocardiogram entails, let’s explore its components in detail.
Exercise Stress Test
An exercise stress test is a diagnostic test used to evaluate how well the heart functions during physical activity and elevated stress.
You walk on a treadmill or pedal a stationary bicycle while being continuously monitored. The exercise intensity is gradually increased over time by adjusting the treadmill incline or pedalling resistance. This causes the heart to work harder and pump more blood.
The test continues until you reach a target heart rate based on age and physical condition, or develop symptoms like chest pain, shortness of breath, dizziness, or fatigue that indicate the heart is not getting enough blood and oxygen.
Echocardiogram
An echocardiogram uses ultrasound waves to visualise the structure and functioning of the heart. During an echocardiogram, a handheld probe called a transducer is placed on the chest. This transducer emits high-frequency sound waves that travel through the body and bounce off the heart’s structures (creating an echo). These bounced sound waves are picked up by the transducer and relayed to a computer, which uses the information to generate detailed video images of the heart in motion.
When is a stress echocardiogram performed?
Cardiologists often order a stress echocardiogram if you have symptoms that could indicate coronary artery disease or heart problems, such as:
- Chest pain/angina, especially with exertion
- Shortness of breath
- Fatigue
- Palpitations
It is commonly done as a follow-up if other tests like an EKG, regular echocardiogram, or cardiac CT scan show potential abnormalities that need further evaluation.
If you have already been diagnosed with a heart condition like coronary artery disease, cardiomyopathy, valve disorder, or heart failure, stress echos may be performed periodically to monitor your status.
How to prepare for a stress echocardiogram test
Here are some tips on how to properly prepare for a stress echocardiogram test:
Before the Test
- Discuss with your doctor about any medications you are taking, as some may need to be stopped temporarily before the test (e.g. beta-blockers, nitrates, etc.)
- Refrain from consuming caffeinated beverages and foods (coffee, tea, chocolate, energy drinks) for 24 hours prior, as caffeine can interfere with your heart rate response.
- Stick to light meals on the day of the test, as these can impact your exercise capacity.
- Choose clothes and shoes suitable for walking or exercising on a treadmill.
During the Test
- Don’t eat, drink, or smoke for 3-4 hours prior to your appointment time.
- You will need to sign a consent form, understanding the risks and procedure involved.
- You may need to remove clothing from the waist up and any jewellery/accessories that could interfere with the test.
- Electrodes will be attached to your chest, legs, and arms to monitor your heart rate and rhythm during exercise.
- Follow the technician’s guidance on increasing your exercise intensity levels gradually until you reach your maximum capacity.
Who should not undergo stress echocardiograms?
A stress echocardiogram should be avoided in certain high-risk patient groups due to the potential dangers from the exercise portion of the test.
These high-risk patient groups include those who have experienced:
- A recent heart attack
- Unstable angina
- Uncontrolled arrhythmias
- Critical aortic stenosis
- Advanced heart failure
The test also poses risks for individuals with dangerously elevated blood pressure, acute illnesses, or significant electrolyte imbalances.
People with arthritis in lower limbs, difficulty walking for other reasons (e.g Parkinsonism), history of falls and balance problems, neurological conditions or with other limitations should consider alternate tests.
Are there alternatives for the stress echocardiogram test?
Yes, there are several alternatives to the standard exercise stress echocardiogram test that may be used in certain situations:
- Pharmacologic stress echocardiogram: Instead of exercise, medications are given intravenously to simulate the effects of physical stress on the heart. This is an option for patients unable to exercise.
- Nuclear stress test: This combines exercise or pharmacologic stress with injection of a radioactive tracer. Special camera images show blood flow to the heart muscle to detect areas with poor circulation.
- Cardiac CT angiography: This non-invasive test uses CT imaging technology to visualise the coronary arteries and identify any blockages or narrowing, without the need for stress.
- Cardiac MRI stress test: Similar to a stress echocardiogram but uses magnetic resonance imaging (MRI) technology to assess heart function and blood flow during and after exercise or drug-induced stress.
- Coronary angiogram: This invasive procedure involves threading a catheter into the coronary arteries and injecting dye to visualise blockages via X-ray imaging.
The choice depends on your specific condition, ability to exercise, risk factors, and availability of different cardiac imaging modalities at the healthcare facility. In some cases, a combination of tests may be recommended to get a comprehensive evaluation.
What happens if my stress echocardiogram flags any serious heart conditions?
If your stress echocardiogram reveals abnormalities or signs of potentially serious heart conditions, your treating doctor will order additional diagnostic testing to precisely identify and characterise the nature of the heart problem detected.
Depending on the specific findings, treatment options can range from lifestyle modifications and medication management to more advanced procedures like angioplasty, surgery, or device implantation. Early detection from the stress echocardiogram allows for timely medical care to relieve symptoms, restore healthy heart function, prevent complications, and reduce future cardiac risks.
Where can I go for a TTE test in Melbourne?
While there are many cardiology clinics available, HeartWest is the largest cardiology group in the western and northwestern corridors of Melbourne, with four major locations and three satellite sites.
At HeartWest, our qualified experts will provide you with the best cardiology care. You will experience nothing but professionalism, care, and courtesy, from your first interaction with our staff to your tests, procedures, and consultations.
Our cardiologists have expertise in all fields of adult cardiology, including;
- General cardiology
- Heart failure
- Cardiac imaging (including stress echocardiography)
- Interventional cardiology
- Electrophysiology & pacing
- Cardiothoracic surgery
Contact us for efficient and affordable specialist heart care services in Melbourne.