Exercise Stress Echocardiogram: What is it, Risks, Test Preparation

Exercise Stress Echocardiogram - What it is

Stress echocardiogram is a diagnostic procedure combining:

Echocardiography, which uses high frequency sound wave (ultrasound) to assess motion of the heart muscle
Stress test, which assesses the capacity and reserve of heart muscle function under stressful situations or exercise conditions.

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 ways we can stress your heart: one is using medication to stress the heart, simulating an exercise environment (Pharmacological Stress Echocardiogram), and another is using treadmill test (exercise stress echocardiogram).

Exercise Stress Echocardiogram - Other Information

Is the test safe?

The test is usually performed on patients suspected of having or already have had coronary artery disease – insufficient blood supply to the heart muscle.

Possible adverse side effects for exercise stress echocardiography include:

Life-threatening heart rhythm (<0.2%)
Acute myocardial infarction (0.1%)
Death (0.1%)
Fall

As the test involves echocardiographic imaging using ultrasound waves, there is no risk of radiation exposure.

If you are not keen for this procedure, you will need to discuss with your doctor in your next clinic visit. If you are unable to exercise on a treadmill machine, you may then be requested to undergo another test that may involve use of medication (Pharmacological Stress Echocardiogram), radionuclide myocardial perfusion scan, magnetic resonance stress imaging.

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. Please call the NHCS Call Centre at +65 6704 2000 to reschedule the test.

Preparations before test

Confirm with your doctor if you are required to stop your medication for hypertension (high blood pressure) 3 days before the test.
Take a light meal if your test is scheduled in the afternoon.
Do not apply lotion, oil, or powder to the chest.
Bring your running shoes, socks, exercise attire and towel. Socks are also available at $2.00/pair. It is necessary to wear socks if you are using the running shoes provided by NHCS.
For men, please shave your chest before coming so that the ECG electrodes can be placed on your chest.
Informed consent prior to the test is required. For patients below 21 years old, please be accompanied by a parent for consent taking.

How is the test done?

Before the exercise stress echocardiogram test begins, the doctor will assess to ensure that you are fit to undergo the test. Thereafter, the Cardiac Technologist will proceed to place the electrodes on your chest, and blood pressure cuff around your arm.

There are 3 stages to this test:

Stage 1 - Resting

You will be asked to lie on your side where we will perform a baseline echocardiogram. This will be done using a transducer, which will be placed over your chest to obtain images of the motion of the heart muscle. The images will be recorded and shown on the monitor.

Stage 2 - Exercising

You will then be asked to walk on the treadmill machine. The speed and inclination of the slope will be programmed to increase every 2-3 minutes to stress your heart gradually. Once you reach the targeted heart rate, or are unable to continue because of fatigue, breathlessness or chest pain, you will then need to lie on the couch on your left side (scanning position) immediately.

Stage 3 - After Exercising

Another echocardiographic recording will then be performed and compared with images taken before the exercise.

The entire procedure will take around 1 to 2 hours, excluding the waiting time.

What can I expect after the procedure?

You will be monitored for some time after the procedure if you do not feel well. If the symptoms persist, you may be admitted for observation. If the test results turn out to be abnormal, you may also be admitted for further management after discussion with your doctor.