Exercise Stress Echocardiogram (ESE)

Definition

An exercise stress echo test combines a treadmill stress test and an echocardiogram to increase the sensitivity of detecting blockages of the arteries of the heart. Ultrasound images of your heart are taken before and immediately after walking on a treadmill. The images are then compared to determine your likelihood of having heart artery blockages.

What are the benefits of an exercise stress echo test?

An exercise stress echo test combines the benefits of both the standard treadmill test and an echocardiogram.

Benefits of a treadmill stress test

  1. Detects heart artery blockages that can cause chest pain, breathlessness, heart attack or sudden cardiac death.
  2. Detects abnormal heart rhythms resulting in irregular heart beats or palpitations (Arrhythmias).
  3. Identifies life-threatening heart rhythms brought on by exercise that can lead to sudden cardiac death.
  4. Evaluates blood pressure response to exercise.
  5. Evaluates the effectiveness of your cardiac treatment plan.
  6. Guides the development of a safe exercise program especially in patients who have heart disease or suffered a heart attack before.
  7. Guides treatment of heart disorders eg. timing for cardiac surgery such as valve replacement, heart transplantation in patients with heart failure and cardiac bypass surgery in patients with multiple heart artery blockages.

Benefits of an echocardiogram

  1. 1
    Assesses the overall pumping function of the heart.
  • Presence and cause of heart failure
  • How well the heart pumps after a heart attack
  1. 2
    Determines the presence of any structural heart disease, such as:
  • Congenital heart diseases (“Holes in the heart”)
  • Valvular heart diseases (Disorders of the heart valves)
  • Myocardial diseases (Disorders of the heart muscle)
  • Pericardial diseases (Disorders of the outer lining of the heart)
  1. 3
    Diagnoses underlying Coronary Artery Disease (CAD
  2. 4
    Diagnoses infections affecting the heart, such as:

  • Infective endocarditis (Infections of the heart valves)
  • Myocarditis (Infection of the heart muscles)
  • Pericarditis (Infection of the outer lining of the heart)
  1. 5
    Diagnoses clots in the heart that can lead to major strokes
  2. 6
    Diagnoses cardiac tumors eg. atrial myxomas
  3. 7
    Evaluates the progression of valve disease over time
  4. 8
    Evaluates the effectiveness of medical or surgical treatments for hypertension, valvular heart disease or cardiomyopathy (weak heart muscles).

Benefits of a treadmill stress test + echocardiogram

  • Increases the accuracy of diagnosing underlying blockages of the heart.
  • Assesses the ability of the heart function to improve with exercise.
  • Prognosticates the risk of a cardiac event (eg heart attack)

Example of a stress echocardiogram of a 45 year old patient complaining of chest pain wanting to find out whether he has heart artery blockages in view of his strong family history of heart attacks.

a. Parasternal Long Axis View

b. Parasternal Short Axis View

Findings – Normal augmentation of heart function at peak exercise.

Conclusion – Normal stress echocardiogram with no evidence of heart artery obstruction.

Who will benefit from this test?

  • Patients with symptoms of
  • Chest pain
  • Shortness of breath
  • Irregular heart beats or palpitations
  • Recurrent giddiness or fainting spells
  • Patients who are planning to participate in strenuous sporting activities.
  • Patients with a family history of sudden cardiac death.
  • As part of Heart Screening

How to prepare for the test

  • Please wear comfortable sporting attire with shoes suitable for jogging.
  • Wear a shirt that can be easily removed so as to facilitate placement of electrodes on the chest.
  • Avoid any emollients or lotions on the day of the test as they interfere with the electrode-skin contact.
  • You may consume a light meal 1 hour before your stress test.
  • You may consume all your regular medications (if any) except medications which will slow down your heart rate eg beta-blockers. These medications need to be stopped for at least 24 hours before the test. Please check with the doctor if you are not sure which medications need to be stopped before the test.
  • If you use an inhaler for asthma or other breathing problems, please bring it along with you and highlight it to our cardiac technician & doctor.
  • Avoid caffeinated products (coffee, tea, cola, mountain dew, chocolate products) as it interferes with the results of the test.
  • Do not smoke on the day of the test as nicotine will interfere with the results of your test.

How is the test performed?

  • This stress test will take place in a private echo room located in our clinic and it is divided into 3 main components.

Part 1: Baseline resting 2D echocardiogram

This exam will take place in a private echo room located in our clinic.

  1. 1
    Before the test
  • Our female cardiac technician will explain the procedure to you and what the examination will entail.
  • You will be asked to remove your clothing from the waist up and we will provide a clinic gown for you to wear during the exam.
  • Three electrodes (small flat sticky patches) will be placed on your chest wall and attached to an ECG monitor that charts your heart’s electrical activity during the test.
  1. 2
    During the test

  • You will be asked to lie down on your left side on an exam table while our cardiac technician will place a probe (called a sound-wave transducer) on several areas of your chest. The probe will have a small amount of gel on the end to help produce clearer pictures. This gel will not harm your skin.
  • To obtain clearer pictures of your heart, you may be asked to change positions an hold your breath several times during the exam.
  • It is common to hear your heart sounds (Doppler signals) during the test.
  • No medications will be given and there is no radiation exposure during the test.
  • A slight pressure of the probe on your chest and a coolness on your skin from the gel will be felt during the exam but there will be no major discomfort.

Part 2: Exercise stress test

  1. 1
    Before the Test
  •  Our cardiac technician will attach 10 ECG electrodes (small flat sticky patches) on your chest and a blood pressure cuff around your right arm. The electrodes are attached to ECG monitor that charts your heart’s electrical activity continuously during the test.
  • Baseline measurements (Heart rate, Blood pressure and resting ECG) are recorded before the test is started.
  1. 2
    During the Test
  • Under continuous supervision of our cardiac technician and doctor on stand-by, you will start walking on the treadmill at a slow and gentle pace.
  • The speed and gradient on the treadmill will increase gradually at 3- minute intervals. The machine will record the changes to your heart rate, blood pressure and ECG every 3 minutes. At regular intervals, our cardiac technician will ask you how you are feeling and determine when the test should be stopped.
  • You will be asked to continue exercising until your heart rate has reached a set target or until you develop symptoms that don’t allow you to continue. These signs and symptoms may include:
  1. Moderate to severe chest, jaw or arm pain
  2. Severe shortness of breath
  3. Abnormally high or low blood pressure
  4. An abnormal heart rhythm
  5. Dizziness
  6. Certain changes in your electrocardiogram
  • When you cannot exercise any longer or you have reached your calculated maximal predicted heart rate, the treadmill will be stopped and you will be directed to quickly return to the exam table and lie on your left side so the cardiac technician can perform another echocardiogram

Part 3 : Immediate post-exercise 2D echocardiogram

After the test

  • The whole process typically takes about 60-90mins but the actual exercise time usually lasts only 7 to 12 minutes
  • When your exercise stress test is complete, you may return to your normal activities for the remainder of the day
  • Our doctor will review the findings of treadmill test and discuss the results of your test during your next follow-up appointment. Further tests may be recommended if abnormalities are detected

How does the doctor use this test to treat me?

  1. 1
    Normal test results
  • If the information gathered during the test reveals that your heart condition is normal, no further tests will be needed. However, if your test results are normal but your symptoms continue or becomes worse, our doctor may recommend further tests (eg a CT coronary angiogram or Coronary Angiogram) to gather more information about your heart condition.
  • If the purpose of your stress test was to guide treatment for a heart condition, our doctor will use data from the test to establish or modify your treatment plan, as needed.
  1. 2
    Abnormal test results
  • If the results of your exercise stress echo suggest underlying blockages of the arteries of your heart or a heart rhythm irregularity, the information gathered during the test will be used to help our doctor develop a treatment plan. You may need additional tests and evaluations, such as a coronary angiogram, depending on the findings.

More information

Stress echocardiogram

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