Your Doctor has decided that you need a Pharmacological Stress Echocardiogram
What is this test?
• An Echocardiogram or Echo is a heart scan that uses sound waves, to produce images of the heart. It is painless and does not use radiation.
• During a Stress Echo, you will either be given some medication (Dobutamine) to make the heart beat harder and faster, as if you are exercising, or we will ask you to cycle on a special exercise bike, whilst we take pictures of your heart.
Why is it being done?
• This test is being performed as it allows us to understand how the heart copes when we make it work harder.
• It is a useful investigation to diagnose whether you have angina or not. It can also give information about the severity of any heart valve problems, and allows us to guide treatment.
• YOU MUST STOP any beta-blocker medicine for 48 Hours before the test. If your test is on a Monday, your last dose of these medications should be the Friday before.
The drugs to stop include:
Beta-blockers
For example:
• Atenolol
• Bisoprolol
• Carvedolol
• Sotalol
• Propanalol
• Nebiverol.
You must also stop any calcium channel blockers called DILTIAZEM and VERAPAMIL.
Diltiazem
For example:
• Adizem
• Tildiem
• Slozem
• Angitil
• Dilzem
• Zemcard
• Viazem
• Dilcardia
Verapamil
For example:
• Securon /Half-Securon
• Verapress
• Univer
• Vertab
• Ivabradine (Procorolan).
If the above medicines are not stopped, it may not be possible to proceed with the test. Take all your other medications as normal. Please note that there are other medicines that prevent the heart from working harder, and if you have any doubts, please contact either the Cardiac Department or your Consultants secretary for more information.
Please do NOT eat for approx 2 hours prior to the test, but you may drink water. Please wear comfortable clothes and shoes suitable for cycling (if appropriate).
• There will usually be 2-3 staff present. The test is performed in a specialised darkened imaging room.
• You will need to undress to your waist, and put on a gown, that needs to be left open to the front. You will be asked to lie on a couch on your left hand side or on the exercise bike.
• ECG stickers and a blood pressure cuff will be attached to you, and checked regularly. If your blood pressure is too high at the start we may need to postpone the test.
• A drip will be put into a vein in your arm; this will allow us to administer the medication if you are not going to be cycling. Whilst the medication is being administered, we will take pictures of your heart at regular intervals, using ultrasound.
• During the test we may also give you a contrast agent, that improves the quality of the images.
• Sometimes we will need to use a second medication called Atropine to help to increase your heart rate.
• Once the heart has been made to work hard enough, we will stop the medication (or you can stop cycling) and allow your heart rate to return to normal. We will monitor you until your heart rate and blood pressure are back to normal. This may take several minutes.
• Overall the test takes around 45mins to 1 hour to complete.
- If a drug stress test is carried out, the stress medicine makes your heart pump more forcefully and faster which you may notice.
- Occasionally the medicine may make you feel sick or dizzy, or you may develop chest pains. Let us know if you feel any symptoms. Once the stress medicine is stopped, you will feel back to normal very quickly.
After the test, you will be asked to sit quietly in the waiting room for approx 15-20mins, to ensure the effects of the stress medication have worn off completely.
You will be able to then return home. It is advisable that you do not drive yourself for the rest of the day.
A stress echo is very safe, but there are some risks that you do need to be aware of :-
• Rarely (around 1 in 1000) the stress medicine will make the heart develop an abnormal rhythm. This often settles on its own after we stop the medicine, but very occasionally you may need extra treatment for this.
• There is a very small risk (1 in 5000) of a more serious complication occurring, such as a heart attack.
• There is a very small risk (1 in 10000) of you developing an allergic reaction to either the stress medicine or the contrast medicine.
If you have had allergic reactions to medicines in the past please inform us before we start the test.
