What is stress echocardiography and what is it used for?

By Cristiano Antonino Last updated Mar 7, 2023

Stress echocardiography allows the doctor to observe what changes occur in the heart when subjected to a stimulus, or ‘stress’, which can be either physical, i.e. induced by a patient’s muscular effort, or pharmacological

When the stress is pharmacological, the patient’s heart – which during the test is lying on the couch in the echocardiography laboratory – and its circulatory system are stimulated through the intravenous injection of specific drugs, which induce them to behave as if they were undergoing physical exertion.

Before performing pharmacological stress echo, the cardiologist always carries out an assessment of the heart by means of the normal echocardiogram, to consider whether the test is technically feasible and whether there are any contraindications to performing the test.

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How is stress echocardiography performed?

The patient is made to lie on a couch, on the left side, as for a normal transthoracic echocardiography.

Electrodes are applied to the chest to monitor the echocardiogram, and a sphygmomanometer, which monitors the blood pressure. At the same time, an intravenous drip (phleboclysis) administers, in a controlled dose, the drug that will cause the heart to undergo the same changes induced by physical exertion (Dobutamine) or changes in the coronary circulation (Dipyridamole or Atropine).

Other drugs deemed necessary by the cardiologist for the favourable outcome of the test (e.g. Atropine), or to reduce the heart rate at the end of the test (Metoprolol), may be administered intravenously via the drip.

The drip will then be removed at the end of the test.

Is Stress Echocardiography painful?

Stress echocardiography is not a painful test. In some cases, however, it may happen that patients with angina pectoris complain of the usual pain.

This is very important for the cardiologist, as he or she can check the correlation between the symptom and changes in cardiac function and the electrocardiogram.

When is the test interrupted?

The test is interrupted when the maximum dose of drug indicated for that particular patient has been injected; it may also be interrupted by the cardiologist, before completion of the injection protocol, in the event of the appearance of significant alterations in the electrocardiographic tracing or in the motility of the walls of the heart on the echocardiogram, for changes in the pressure parameters or when the patient complains of symptoms that the cardiologist considers significant.

Is Stress Echocardiography dangerous?

A dangerous arrhythmia, angina crisis, acute decompensation, myocardial infarction or cardiac arrest may occur during this type of test.

For this reason, in the laboratory where the test is performed, drugs and instruments are always available that can make each of these rare complications recede as quickly as possible.

The incidence of complications is however the same as for a normal exercise test on a treadmill or exercise bike, or a scintigraphy.