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Patient Information
Cardiac Department
Physiologist Led Exercise Stress
Echocardiogram (Stress Echo)
This leaflet is designed for patients who are having a stress echocardiogram performed
and for their carers/families/friends to help prepare them for the cardiac test
What is a Stress Echo?
A Stress Echo is a specialist ultrasound scan of the heart. High frequency sound waves
are transmitted into the body and echos are received back onto a monitor showing the
heart’s internal structure. The scan is performed at intervals whilst the patient is cycling
(Exercise stress echo). An alternative to the exercise method is through the infusion of a
drug, Dobutamine (Dobutamine stress echo). The Dobutamine drug creates the same
effects as exercise by making your heart beat harder and faster and is used on patients
who are unable to exercise. If on the day the Physiologist/nurse performing the test feels
that you are unable to perform the exercise required you maybe rebooked to attend
another day for the Dobutamine version of the test.
Will it hurt?
The ultrasound scan is a painless test. The insertion of the cannula (a soft plastic tube)
used to deliver the contrast drugs into your system causes a short sharp scratch
sensation. The area should not be painful once the tube has been inserted.
Do I need to do anything before the test?
Some medication, such as beta blockers can make the test less accurate.
A list of medications that should be stopped 48 hours prior to the appointment; this
may mean not taking 3 doses. These medications are Atenolol, Bisoprolol, Carvedilol,
Propranolol Hydrochloride, Sotalol Hydrochloride, Metoprolol Tartrate, Nadalol,
Acebutolol, Oxepranolol Hydrochloride, Celiprolol Hydrochloride, Esmolol
hydrochloride, Labetalol Hydrochloride, Nebivolol, Pindolol, Diltiazem, Verapamil,
Ivabradine, and Timolol (eye drops)
It is important that you stop any medication included on this list.
Please continue taking all other medications not listed. If you are unsure, please
contact one of the nurses in the Cardiac Angiography Suite on (01245) 514418.
Do not eat anything 1 hour prior to your appointment time. You may continue with
fluids as necessary.
What will happen on the day?
You will need to attend the Cardiac Department (A210), you will then be met by the
receptionist or a nurse who will admit you to the Cardiac Angiography Suite within the
department. Here you will be prepared for your procedure and recovered following. Please
Patient Information
ensure that you bring with you comfortable clothing suitable for exercise,
trainers/comfortable shoes and your medications.
We regret that relatives are not allowed in the Cardiac Angio Suite as it is a theatre area.
You should expect to stay in the department for approximately 2 hours.
Upon admission to the Angio Suite the procedure will be further explained and you will be
asked to sign a consent form. The nurses will insert the cannula into your arm. When you
are ready the nurses will escort you to the clinical room, ready for the test, where you will
be asked to remove the top half of your clothing and given a gown to wear.
The test will be performed in a private/darkened room with generally 3 people present-a
Chief Cardiac Physiologist, Cardiac Physiologist/Associate Practitioner and a nurse.
If you wish to have a male/female member of staff performing the scan, please contact the
Cardiac department as soon as possible so we can accommodate this. Please note this
may delay your appointment by a couple of days, due to limited male staffing numbers.
Exercise Stress Echo
You will be asked to lie on your back on a couch. Stickers will be attached to your chest
and connecting to the recording machine. These will be used to monitor your heart rate
and rhythm. You will also be connected to a blood pressure monitor via a cuff on your
upper arm. Your blood pressure will be checked regularly throughout the test.
You will be asked to lay on the couch and place your feet on the pedals. The straps will be
adjusted so you are comfortable and in the correct position for scanning
The couch will be rotated to the left as this ensures a clear echo window to scan the heart.
Gel will be applied to the chest area and a small probe (recorder) moved over the skin.
Once the resting images have been obtained you will be asked to begin cycling. The
cycling will gradually get more difficult until the cardiac physiologist decides that you have
performed enough exercise, or if you are unable to continue. Occasionally, the cardiac
physiologist will take pictures of your heart whilst you are exercising. During the test the
nurse may also inject a contrast agent into the drip in your arm. This helps to improve the
quality of the pictures that are being recorded, if necessary
After you have finished cycling, the couch will be returned to the flat position whilst you
recover. Your heart rate and blood pressure will be regularly monitored until you have fully
recovered, which may take several minutes.
How long will it take?
The scan may take up to 45 minutes to complete but you should expect to stay in the
department for a maximum of two hours.
What happens after the test?
You will be recovered in the Angio Suite where the cannula will be removed. You will be
able to leave as soon as the Chief Cardiac Physiologist and nurses are happy for you to
Patient Information
go, once your heart rate and blood pressure have returned to resting levels. The Chief
Cardiac Physiologist will write a report, which will be forwarded to your own doctor and/or
consultant at the hospital. You will not receive any results on the day of the test.
Benefits
This test will allow your doctor to have information about your heart’s pumping chambers
and valves from outside the chest wall during stress, which could aid your diagnosis and
treatment.
Risks
The echocardiogram uses ultrasound, which does not use radiation or x-rays. There are
no risks associated with an echo.
The test may occasionally cause heart rhythm problems or chest pains. There is an
extremely small risk (<1 in 10,000) you may have a small heart attack during the test. All
staff are fully trained to deal with these problems.
There is a small risk of bruising around the cannulation site, which will return to normal
within 2 weeks.
There is also an extremely small risk (<1 in 10,000) that you may be allergic to the contrast
(if used), in which case you will be treated immediately to reverse the effect.
Alternatives
The alternatives to this scan may be a Dobutamine Stress Echocardiogram, a myocardial
perfusion scan, coronary angiogram, Cardiac MRI or CT scan. Each of these tests may
have risks associated with them, depending upon the individual case and may involve
visiting another hospital.
References/ Sources of evidence
British Heart Foundation Website: www.bhf.org/uk/heart-health/tests
British Society of Echocardiography Website www.bsecho.org and click on Education then
Patient Information Leaflets
Nice Guidelines Website: www.nice.org.uk
Contacts / Further Information
Cardiac Department: Tel: 01245 514185 (Reception)
Cardiac Angio Suite: Tel: 01245 514418 (Nursing care)
Stress Echo Bookings: Tel: 01245 514209
MEHT can provide health information in different formats and languages. Please contact
the Patient Advisory Liaison Service (PALS) on 01245 514130. In addition to the leaflets
we have available, you may also wish to look at the Patient UK website that also provides
access to additional information and is available in a number of different languages.
Patient Information
Mid Essex Hospital services NHS Trust is smoke-free. You cannot smoke on site.
For advice on quitting, contact your GP or the NHS smoking helpline free, 0800
169 0 169
Charitable donations can make a very real difference to the level of patient care at our
Trust. As well as contributing to new facilities, donations can be used to buy specialist
equipment and smaller items to make patient’s stay in hospital more comfortable. For
information about making a donation please contact the Charities Office on 01245 514559
or visit the website at: http://www.meht.nhs.uk/get-involved/
Document History
Department
Cardiac Centre
Published/Review: October 2015 / October 2018
File name
Physiologist Led Exercise Stress
Echocardiogram (Stress Echo)
Version/ref no
2