What is an exercise echocardiogram?

An exercise echocardiogram is also called an exercise echo or stress echo/stress test. It's a noninvasive test. It shows how well your heart is working during stress or exercise. It gives your healthcare provider information about how well your heart pumps and how well your valves work. And it helps diagnose disease in the arteries of your heart.

For the procedure, you’ll first have an echocardiogram to see how your heart works at rest. A small, handheld ultrasound device called a transducer is placed on your chest at certain places and angles. The transducer sends out high-frequency sound waves. The waves move through the skin and other body tissues to the heart. There, the waves bounce or “echo” off of the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer shows the echoes as images of the heart walls and valves. You will also have an electrocardiogram (ECG) to record the electrical activity of your heart.

After the resting echocardiogram, you will exercise on a treadmill or stationary bike for a certain period of time. You will have continuous ECG monitoring, and your blood pressure will be checked periodically. You will then have another echocardiogram during peak exercise and often just after peak exercise. The healthcare provider will compare the resting echo images with those done during the stress phase. Muscle areas that appear weaker during stress may mean you have disease in the arteries of your heart.

Why might I need an exercise echocardiogram?

You may need this test:

• To check for coronary heart disease

• To figure out how well your heart pumps and if the structures such as valves are normal

• To be sure exercise is safe for you before you enter a cardiac rehab program, or after you have had a heart attack or heart surgery

• To test blood pressure levels during exercise

• To see your heart status before surgery

• To assess symptoms of shortness of breath or trouble breathing that happens with exercise

Your healthcare provider may have other reasons to advise this test.

What are the risks of an exercise echocardiogram?

Possible risks of this test are:

• Chest pain

• Very high blood pressure

• Heart rhythm problems

• Dizziness or lightheadedness, or feeling like you are going to faint

• Extreme tiredness (fatigue)

• Heart attack (rare)

There may be other risks based on your health. Talk with your healthcare provider about any concerns before the test.

How do I get ready for an exercise echocardiogram?

Your healthcare provider will tell you about the procedure. You will also be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear. For the exercise part of the test, plan to wear loose, comfortable clothing and walking shoes.

You may need to fast before the test. Follow any directions you are given for not eating or drinking before the test. In some cases, you may be told to not have caffeinated drinks such as coffee, tea, and soda up to 12 hours before testing. You may also be asked not to smoke, if you are a smoker.

Based on your condition, your healthcare provider may have other specific instructions for you. For example, you may be told to not take medicines such as beta-blockers before the test.

Tell your healthcare provider:

• If you are pregnant or think you could be

• If you take any prescription or over-the-counter medicines, vitamins, or herbal supplements

• If you have a pacemaker

• If you have any of these health problems:

  • Aneurysm

  • Severe high blood pressure

  • Severe heart valve disease

  • Severe heart failure

  • Recent heart attack

  • Pericarditis

  • Low red blood cell count (severe anemia)

  • Chronic lung diseases that affect your breathing while exercising

  • Muscle or bone problems that limit how you exercise or walk

What happens during an exercise echocardiogram?

An exercise echo may be done on an outpatient basis. This means you can go home the same day. Or it may be done as part of a hospital stay. The process may vary based on your health and your healthcare provider’s practices. Generally, the test follows these steps:

• You will be asked to remove any jewelry or other objects that may interfere with the test. You may wear your glasses, dentures, or hearing aids if you use any of these. You should wear comfortable walking shoes.

• You will be asked to remove clothing from the waist up and will be given a gown to wear.

• You will be asked to empty your bladder before the test.

• You will lie on your left side for the first set of echo images. A pillow or wedge will be placed behind your back for support.

• You will be connected to an electrocardiogram (ECG) monitor using small, sticky electrodes. The ECG records the electrical activity of your heart and monitors your heart during the test. The healthcare team will watch your heart rate, blood pressure, breathing rate, and oxygen level. The ECG tracing that records the electrical activity of your heart will be compared with the images on the echocardiogram monitor.

• The room will be darkened so that the technologist can see the images on the echocardiogram monitor.

• The technologist will place gel on your chest and then place the transducer on the gel. You will feel slight pressure as the technologist moves the transducer to get the desired image of your heart.

• The technologist will move the transducer around and use varying amounts of pressure to get images of different places and structures of your heart. The amount of pressure should not be uncomfortable. If it does make you uncomfortable, tell the technologist.

• You may hear a “whoosh-whoosh” sound if you have a certain echocardiography technique called Doppler or color Doppler. The sound is the blood moving through your heart.

• Once the first set of resting images has been taken, you will start exercising on the treadmill or stationary bike.

• You will exercise until you have reached your target heart rate based on your age and health. Tell the technologist if you have any chest pain, leg pain, breathing problems, severe tiredness, extra sweating, or heart flutters (palpitations). This is at any point before, during, or after the test. If so, the test will be stopped.

• Once you have reached your target heart rate, you may keep on exercising for as long as you can. How long you can exercise is an important part of the stress test result.

• Right after exercising, you will lie on the table or bed while the technologist takes a second set of echocardiogram images.

• After the test is done, the technologist will wipe the gel from your chest and remove the ECG electrode pads. You may then put on your clothes.

• Ask your healthcare provider when and how you will get the results of the test.

What happens after an exercise echocardiogram?

You may go back to your normal diet and activities, unless your healthcare provider advises you otherwise. Generally, there is no special type of care after an exercise echo. But your healthcare provider may give you other instructions.

You may get your test results the same day or at a later time. Ask your healthcare provider or the technologist how and when you’ll get your results. Also ask if you need to make a follow-up appointment.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure