Pharmacological Stress Echocardiogram (Echo)

This leaflet tells you about a pharmacological stress echocardiogram (echo).

What is a pharmacological stress echo?

An echocardiogram is an ultrasound scan of your heart (a painless examination using sound waves to make pictures of the inside of your body).

This will be carried out by an Echocardiographer (someone trained to perform ultrasound scans of your heart).

You will be asked to undress to the waist and put on a gown, which should be left open to the front. You will be asked to lie on a couch on your left hand side.

The Echocardiographer will put gel on your chest and will then roll the ultrasound probe over the area. This will show a picture of your heart on the monitor of the ultrasound machine, which allows the cardiac team to check the condition of your heart.

The rhythm, rate and electrical activity of your heart will be monitored. This test is painless. Small electrodes (sticky pads with a special sensor) are put on your chest and leads (wires) are attached to them. These leads are connected to a machine to record your heart beating.

During a pharmacological stress echo, as well as the scan, you will have an injection into your vein. This will involve a cannula (a fine tube) being inserted into a vein in your arm or the back of your hand using a small fine needle.

During your procedure, you will be given some medicine to make your heart beat harder and faster while pictures are taken of your heart. Your blood pressure will also be checked regularly during the test. A Consultant Cardiologist (Doctor who looks after your heart) will be present throughout the procedure.

The procedure is carried out to allow your Doctor to understand how your heart copes when it is made to work harder.

What are the benefits of having a stress echo?

It is used to:

• Diagnose if you have angina or not

• Give your Doctor information about how severe a valve problem is

• Help your Doctor to decide what further treatment you may need.

What are the risks and possible complications?

A stress echo scan is extremely safe, but there are some risks you need to be aware of:

• Most people will feel some flushing in the face and scalp. This is the stress medication working as part of its action is opening up blood vessels in the skin and muscles.¹

• Severe heart rhythm problem that may result in hospital admission occurs in 1 person in every 700. This usually settles with medication but can result in death in less than 1 person in every 10,000.¹

• Temporary mild heart rhythm problems in 1 person in every 100. This will usually settle with medication immediately after the stress test is completed and would usually not delay going home. You may experience some palpitations and heart racing if it occurs but should not last more than a few minutes.¹

• Bad angina attack or heart attack during the test. This can occur in 1 person in every 5,000. We may recommend coming into hospital for observation or treatment if this occurs.¹

• An allergic reaction can occur if we have to give a contrast agent to improve the image quality. This has been reported in less than 1 person in every 10,000 and all of these recovered with treatment for the allergic reaction.

The allergy usually resolves completely with treatment given immediately but there are occasions when we may recommend coming into hospital for observation.²

You will be monitored during and after the procedure and staff are ready to deal with any reaction, if needed.

How long will the procedure take?

The procedure usually takes about 30 minutes to complete. You can expect to be in the unit for no more than 1 hour.

Where will I need to go?

You will be given an appointment to attend the Cardiac Investigations Unit.

Can I take my medications as usual?

You must not take beta-blocker or calcium-channel blocker tablets for 48 hours before the test. Beta-blocker tablets include Atenolol, Bisoprolol and Carvedilol, although there are others. Calcium-channel blockers are called Diltiazem and Verapamil.

These tablets prevent the stress medicine from making your heart work harder. If you do continue with beta-blocker or calcium-channel blocker drugs, the Stress Echo may need to be postponed.

If you have any worries or concerns, see the contact numbers at the end of this leaflet.

You should continue other medications as usual.

What will happen during my procedure?

A drip will be attached to the cannula. Some ‘stress’ medicine which makes the heart work harder will be injected into the drip.

The Echocardiographer will take pictures of your heart using an ultrasound probe. You may be able to feel your heart beat harder and faster. This is normal.

Some people may feel sick or dizzy. Let your Doctor know if you have any of these symptoms. Once the stress medicine is stopped, you will feel back to normal very quickly.

During the test, your Doctor may also inject contrast medium (dye) into the cannula. This will help to improve the quality of the pictures being taken.

When your heart has been made to work hard enough, your Doctor will stop the medicine. The Echocardiographer will continue to take pictures of your heart and you will continue to be monitored until the effects of the stress medicine have worn off. This may take several minutes.

What will happen after my stress echo?

After the echo, you may be asked to sit quietly for about 20 minutes. This is to make sure the effects of the stress medicine have completely worn off.

You will be able to go home after this.

Can I drive home after my procedure?

You should arrange for someone to take you home.

During the test, we may not be able to make your heart go fast enough with one type of stress medication, so we have to give additional medication called ‘atropine’ to complete the test.

We won’t know until near the end of the test whether we have to give this so we cannot predict whether you will need it or not.

If you have the ‘atropine’ medication, it can make your vision blurred and you cannot drive or operate machinery until the following day.

If you do not need it then you can drive straight away after the test.

You will be told by the Doctor if this is the case.

Will I be in pain during my procedure?

The echocardiogram is painless, but you may feel some discomfort while the needle is being inserted.

When will I be told the results of my scan?

The cardiologist may give you the results straight away after the scan. Sometimes, the scan may need to be analysed in more detail or discussed at a multi-disciplinary meeting.

In these cases, the Doctor or specialist Nurse who requested the stress test will contact you later to update you. This may be via letter or a clinic appointment.

Contact numbers

If you have any worries or concerns please contact:

Cardiac Investigation Unit

University Hospital of North Tees

Telephone: 01642 624500

Opening hours: 9:00am to 5:00pm (Monday to Friday)

Outside these hours you should contact your GP’s surgery for the Out of Hours Service number.

Further information is available from:

NHS Choices

Telephone: 111 (when it is less urgent than 999).

Calls to this number are free from landlines and mobile phones or via the website.

References

1. Dobutamine stress echocardiography: a review and update, Lauren Gray Gilstrap, R Sacha Bhatia, Rory B Weiner, David M Dudzinski, Dove Press Journal: Research Reports in Clinical Cardiology 5, April 2014.
2. The Safety of Definity and Optison for Ultrasound Image Enhancement: A Retrospective Analysis of 78,383 Administered Contrast Doses, Wei K, Mulagh SL, Carson L, et al. Journal, American Society of Echocardiography, 2008
3. Safety of Ultrasound Contrast Agents in Stress Echocardiography, Ruvin S. Gabriel, MD, Yvonne M. Smyth, MD, Venu Menon, MD Clinic, Cleveland, Ohio, Allan L. Klein, MD, Richard A. Grimm, DO, Ellen Mayer Sabik, MD, The American Journal of Cardiology 2008, Volume 102, Issue 9 – Pages 1269 – 72
4. Safety and Risk-Benefit Profile of Microbubble Contrast Agents in Echocardiography, Taikeh M, Khumri M, Main ML., Asia Pacific Cardiology, Vol 2 Issue 1.

Comments, concerns, compliments or complaints

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