Exercise Stress Echocardiogram (ESE)

What is an Exercise Echocardiogram?

An exercise echocardiogram, also known as a stress echocardiogram, is a test that combines an ultrasound study of the heart with an exercise test. The test allows doctors to learn how the heart functions when it is made to work harder. The exercise echocardiogram is especially useful in diagnosing and assessing significance of blockages in the coronary arteries (coronary artery disease), heart valve disease.

Preparing for the Test

• Do not eat or drink 3 hours prior to the test. This will prevent the possibility of nausea, which may accompany vigorous exercise after eating. If you are diabetic and take medications for diabetes, get special instructions from your doctor.
• If you are currently taking any heart medications, check with your doctor. You may be asked to stop certain medications a day or two before the test. This can help get more accurate test results.
• Please advise our staff prior to the test if you have a history of significant medical conditions, like, previous/recent heart attack, aortic dissection, recent fluid or clots in the lungs, severe heart valve disease, heart arrhythmias, palpitations, or recent increase in chest pain you should advise the staff before you commence the test.
• Wear loose, comfortable clothing that is suitable for exercise. Men usually don’t wear a shirt during the test, and women generally wear a bra and a lightweight blouse or a hospital gown. You should also wear comfortable walking shoes or sneakers.
• Before the test, you will be given an explanation of the test and asked to sign a consent form. Feel free to ask any questions about the procedure.
• Several areas on your chest and shoulders will be cleansed with alcohol and an abrasive lotion, to prepare the skin for the electrodes. Men may need to have areas of their chest shaved, to ensure that the electrodes stay in place.

What Does the Test Involve?

The test is performed in the doctor’s office or at the hospital. No special preparation is necessary for this test. If you are scheduled for an exercise echocardiogram, however, you will be given special instructions|.

You will be asked to remove clothing above the waist and put on a hospital gown or a sheet to help keep you warm and comfortable. You will then lie on an examination table.Initially, ECG electrodes (sticky patches) are attached across your chest to monitor the electrical activity of your heart throughout the test.

A baseline echocardiogram (ultrasound) with gel applied to your chest is obtained in multiple views.You may be asked to breathe slowly or hold breath, in order to get a better picture.

Then, you will be asked to walk on a treadmill machine which starts at a low speed and inclination. A BP cuff is applied to your arm to monitor your blood pressure. During the stress phase, the treadmill machine will increase in speed and inclination.  Echocardiograms are obtained immediately after an exercise and later after full recovery.

The images of the heart at rest and during exercise (under stress) are compared. Normally, all areas of the heart muscle pump more vigorously during exercise. If an area of the heart muscle does not pump, as it should during exercise, this often indicates that it is not receiving a sufficient flow of oxygen-rich blood because of a blocked ornarrowed coronary artery.

What are the Risks?

This is a very low risk procedure and the risks of this test are no different to those of a standard stress test. There is no radiation exposure with this test.The most common occur only occur in 3:1,000 people and include:

• Chest pain which can be treated by stopping the test and administering medication.
• Development of fluid in the lungs which will result in the cessation of the test and administration of medication.
• An abnormal heart beat or “arrhythmia” which may be treated by stopping the test and may also be treated with or without medication.
• There is a risk of heart attack in 1:2,500 people and a risk of death in 1:10,000 people.

The Results& Accuracy of Test:

Typically, a report will be generated by the Cardiologist and the Sonographer, which will then be sent electronically to your referring Doctor.The Accuracy of Stress Echocardiography is approximately 80-85%. For a variety of technical and physical reasons there can be false positives (meaning the test suggests a severe artery blockage but subsequent angiography shows only a mild to moderate blockage) or false negatives (meaning to test appears normal and does not pick up a severely blocked artery). Depending on your symptoms, thereporting doctor or your referring doctor may recommend further testing using a different technique for example, CT coronary angiography or Invasive angiography.