Download Stress Echocardiogram (Stress Echo)

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
are Atenolol, Bisoprolol, Carvedilol, Propranolol Hydrochloride, Sotalol
Hydrochloride, Metoprolol Tartrate, Nadalol, Acebutolol, Oxepranolol
Hydrochloride, Diltiazem and Verapamil.
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 or drink anything in the 2 hours prior to your appointment time.
What will happen on the day?
You will need to attend the Cardiac Department (A210) 30 minutes before your
appointment time. 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 ensure that you
Patient Information
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
Patient Information
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 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.
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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.
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
Please ask if you require this information in other languages, large print, easy read accessible
information, audio/visual, signing, pictorial and change picture bank format via the Patient Advisory
Liaison Service (PALS) on (01245) 514235.
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
Document History
Department
Published/Review:
File name
Version/ref no
Cardiac Centre
December 2012 / December 2015
Stress Echocardiogram (Stress Echo)
1.0 / MEHT120352