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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 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. Patient Information 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