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Patient Information
Cardiac Department
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 either
cycling (Exercise stress echo) or during 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. The
doctor present on the day of the test will ultimately decide which type of stress echo
individuals will have.
Will it hurt?
The ultrasound scan is a painless test. The insertion of the cannula (a soft plastic tube)
used to deliver the Dobutamine/contrast drugs into your system causes a short sharp
scratch sensation. The area should not be painful once the tube has been inserted.
The Dobutamine can sometimes make your chest feel tight, which is not something to
worry about, but please tell the doctor supervising your test if you experience this.
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 pyjama/jogging bottoms, trainers/comfortable shoes, a
dressing gown, some slippers and your medications.
We regret that relatives are not allowed in the Cardiac Angio Suite as it is a theatre area.
You will need to be collected from the Cardiac Angio Suite following the procedure by a
relative or friend, as you will be unable to drive for 24 hours. You should expect to stay in
the department for approximately 2 hours.
Upon admission to the Angio Suite you will be further explained the procedure and asked
to sign a consent form. The nurses will insert the cannula into your arm. The doctor
supervising the test will meet with you at this stage to decide which form of stress echo
you will be having. 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
doctor, a cardiac physiologist and a nurse/assistant.
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.
Dobutamine Stress Echo
You will be asked to lay on your back on a couch. Stickers will be attached to your chest
connecting you 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.
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 the dobutamine drug will be connected to the
cannular in your arm and infused making the heart work harder and faster. Whilst this is
happening the cardiac physiologist will take pictures of your heart. During the test the
doctor 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
We often have to train echocardiographers or junior doctors. If the person doing the scan
has to bring in a more senior person, don’t worry. This is usually because they are being
supervised, not because some abnormality has been found.
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.
Patient Information
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 doctor 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 doctor 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 45mins to complete but you should expect to stay in the
department for approximately two hours altogether.
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 doctor and nurses are happy for you to go, once your heart
rate and blood pressure have returned to resting levels. The doctor will write a report,
which will be forwarded to your own doctor and/or consultant at the hospital. The doctor
will also discuss the results with you on the day. You will also be advised on your
medication
We ask that you do not drive home following your appointment, as a medication you may
be given during the test can cause temporary blurred vision. A relative or friend should
collect you or, alternatively, public transport/taxi would be fine.
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 Dobutamine drug may occasionally cause heart rhythm problems or chest pains (<1 in
1000). There is an extremely small risk (<1 in 2,000) you may have a small heart attack
during the test. All staff are 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.
Patient Information
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 myocardial perfusion scan, coronary angiogram or
may involve a trip to another hospital for a Cardiac MRI or CT scan. Each of these tests
may have risks associated with them, depending upon the individual case.
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.
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
Published/Review:
File name
Version/ref no
Cardiac Centre
October 2015 / October 2018
Stress Echocardiogram (Stress Echo)
2.0 / MEHT120352