The Stress Echocardiogram is a combination of the exercise tolerance test with a limited echocardiogram exam taken at rest – before the exercise – and right after the exercise.
This test shows whether your heart pumps normally during physical stress, and whether your coronary arteries can meet an increased demand for blood supplied to the heart muscle.
First, an echocardiogram is done at rest in four different views. They show the size, wall thickness, and the motion of the plumbing in chambers of the heart with each beat. These are the images of your heart at rest.
Second, an exercise tolerance test is done by walking on a treadmill or riding a stationary bicycle (see stress test). By exercising, your heart rate and blood pressure gradually increase; so more demands are placed on your heart.
A second echocardiogram is done in four different views, as above, immediately after you finish exercising. These are the images of your heart pumping at a peak of exercise. The computer compares, side-by-side, the images of your heart at rest; and at exercise in each of the four views.
The normal test response is a more dynamic and forceful contraction of the heart pumping blood at the peak of the exercise. This test is negative.
An abnormal response, a positive test, is seen as abnormal wall motion of an area(s) of the heart muscle, such as lack of hyperdynamic wall motion, new motion abnormality, worsening wall motion, unchanged wall motion, etc. This abnormal response means a possible narrowing, spasm, or unusual anatomy of one or more of the coronary arteries. However, in some patients the coronary arteries are a normal by coronary angiography despite a positive stress echo because of mitral valve prolapse, for example, and other conditions.
The indications for stress echocardiogram are similar to those listed under the exercise stress test. This test is very valuable in patients with complaints suggestive of hardening of the coronary arteries.
This test is especially useful in patients with:
- Inconclusive or no diagnostic exercise stress test
- Not interpretable exercise testing and because of:
- Left bundle branch block
- Pacemaker
- Marked ST-T changes in the ECG
- Evaluation after angioplasty, stent, or bypass graft surgery
- High probability of a false positive results on exercise test due to several heart conditions and some medications
- Clear indication for exercise testing in whom increased sensitivity or specifically is desired.
