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Stress echocardiography

Stress echocardiography is a test that uses ultrasound imaging to show how well your heart muscle is working to pump blood to your body. It is mainly used to detect a decrease in blood flow to the heart from narrowing in the coronary arteries.

How the Test is Performed

This test is done at a medical center or health care provider's office.

A resting echocardiogram will be done first. While you lie on your left side with your left arm out, a small device called a transducer is held against your chest. A special gel is used to help the ultrasound waves get to your heart.

Most people will walk on a treadmill (or pedal on an exercise bicycle). Slowly (about every 3 minutes), you will be asked to walk (or pedal) faster and on an incline. It is like being asked to walk fast or jog up a hill.

In most cases, you will need to walk or pedal for around 5 to 15 minutes, depending on your level of fitness and your age. Your doctor will ask you to stop:

  • When your heart is beating at the target rate
  • When you are too tired to continue
  • If you are having chest pain or a change in your blood pressure that worries the provider administering the test

If you are not able to exercise, you will get a drug such as dobutamine through a vein (intravenous line). This medicine will make your heart beat faster and harder, similar to when you exercise.

Your blood pressure and heart rhythm (ECG) will be monitored throughout the procedure.

More echocardiogram images will be taken while your heart rate is increasing, or when it reaches its peak. The images will show whether any parts of the heart muscle do not work as well when your heart rate increases. This is a sign that part of the heart may not be getting enough blood or oxygen because of narrowed or blocked arteries.

How to Prepare for the Test

Ask your health care provider if you should take any of your routine medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.

It is important to tell your doctor if you have taken any of the following medications within the past 24 hours (1 day):

  • Sildenafil citrate (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)

DO NOT eat or drink for at least 3 hours before the test.

Wear loose, comfortable clothing. You will be asked to sign a consent form before the test.

How the Test will Feel

Electrodes (conductive patches) will be placed on your chest, arms, and legs to record the heart's activity.

The blood pressure cuff on your arm will be inflated every few minutes, producing a squeezing sensation that may feel tight.

Rarely, people feel chest discomfort, extra or skipped heartbeats, dizziness, headache, nausea or shortness of breath during the test.

Why the Test is Performed

The test is performed to see whether your heart muscle is getting enough blood flow and oxygen when it is working hard (under stress).

Your doctor may order this test if you:

  • Have new symptoms of angina or chest pain
  • Have angina that is getting worse
  • Have recently had a heart attack
  • Are going to have surgery or begin an exercise program, if you are at high risk for heart disease
  • Have heart valve problems

The results of this stress test can help your doctor:

  • Determine how well a heart treatment is working and change your treatment, if needed
  • Determine how well your heart is pumping
  • Diagnose coronary artery disease
  • See whether your heart is too large

Normal Results

A normal result means that blood flow through the coronary arteries is probably normal.

The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.

What Abnormal Results Mean

Abnormal results may be due to:

  • Reduced blood flow to a part of the heart. The most likely cause is a narrowing or blockage of the arteries that supply your heart muscle.
  • Scarring of the heart muscle due to a past heart attack.

After the test you may need:

Risks

The risks are very low. Health care professionals will monitor you during the entire procedure.

Rare complications include:

Alternative Names

Echocardiography stress test; Stress test - echocardiography

References

Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 71.

Connolly HM, Oh JK. Echocardiography. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 15.

Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012;60(24): e-44-e164.

Mahajan N, Polavaram L, Vankayala H, et al. Diagnostic accuracy of myocardial perfusion imaging and stress echocardiography for the diagnosis of left main and triple vessel coronary artery disease: a comparative meta-analysis. Heart. 2010;96(12):956-966.

Update Date: 5/13/2014

Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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