Stress echocardiography

Why would a stress echocardiography be recommended?

The left ventricle (one of the four cavities inside the heart) contracts to push oxygenated blood (from the lungs) into the aorta and this “feeds” the various bodily organs. To function correctly, the left ventricle receives oxygenated blood from the coronary arteries. If one or a number of these arteries is “clogged” (presence of atheroma plaques), the blood cannot flow freely. Whilst the left ventricle may function normally at rest in this case, when more blood needs to circulate (during effort for example), it is not correctly supplied by the affected artery or arteries and the left ventricle’s contractions become abnormal.

The stress echocardiography is used to assess the contraction of the left ventricle, either during effort, or under the effects of medication to simulate the conditions of effort.

The machine used is an ultra-sound imaging device. In the same way as for a normal trans-thoracic echocardiography, an ultra-sound sensor is attached to the thorax, this emits and receives ultra-sound waves. The particularity of the test is the recording of the left ventricle’s contractions at different heart-rates (the heart-rate increases as the exam progresses). The objective is to show which part of the left ventricle is insufficiently irrigated by a coronary artery, in which the flow is restricted by the atherosclerosis.

The stress echocardiography procedure in detail

Preparation

You may eat or drink normally; your GP will tell you what medication you can continue to take before the test. Most importantly this will concern any – regularly prescribed – medication for pain associated with angina. In certain cases, as specified by the doctor who has prescribed the test, Beta-blocker treatment, which slows the heart-rate (such as Ténormine®, Cardensiel®, Seloken®, Sectral®, Temerit®, Lopressor®, Kerlone®, Corgard®…) should generally be stopped 24 hours before the test. No sedatives will be necessary. You will remain conscious throughout the test such that you can express any unusual or repeated sensations (palpitations, angina pain, lack of breath, etc.). Where echo-dobutamine is to be used, an intravenous drip will be set up to inject the product which reproduces the conditions of effort.

The location of the test

In the echocardiography laboratory, in a room equipped for resuscitation procedures, this is an essential precaution if the doctor suspects that the heart arteries are clogged. These are the exact same conditions as those required for an effort electrocardiogram.

The duration of the test

The test takes 20 to 25 minutes to complete, except in special cases. However the completion of a trans-thoracic electrocardiograph and the installation of the intravenous drip will lengthen the duration of the test to about one hour.

The test methods

On arrival you be asked a few questions about your identity, recent symptoms and your cardiovascular antecedents. Any recent chest-pains or cardiac arrhythmia should be signalled. Once the intravenous drip has been set up, electrodes will be places on your thorax and arm to to monitor your heart rate via an electrocardiogram.

Depending on the type of test, you will be either in the left decubitus lateral position (lying on your left side) on a standard examination table, or in a semi-seated slightly position slightly inclined to the left on a special table with pedals (effort echocardiography).

During the test palpitations are quite normal; this is the acceleration of the heart rate caused by the physical effort or the medication. You may also feel short of breath, you should signal this to the doctor or the nurse. Any other symptoms you experience, especially angina pain similar to that which is at the origin of the test prescription, should be immediately signalled such that specific treatment may be administered.

At the end of the test you should remain in the same position for a number of minutes whilst the doctor monitors your electrocardiogram and the functioning of your heart muscle after the end of the physical exertion or the effects of the medication. An “antidote” is often administered at the end of the test to restore the heart rate to normal as quickly as possible. No symptom should be present once the drip has been terminated. If cardiac arrhythmia (palpitations) or angina chest pains arose during the test a specific treatment will be administered which will treat these symptoms in a matter of seconds or minutes. The intravenous drip (dobutamine-echo) will be quickly removed and you will be able to return home or to your hospital bed once an electrocardiogram has been taken to check that everything has returned to normal.

This test is important for the insurance cover of your condition. When you arrive at the laboratory do not hesitate to ask for more information, you will be received either by a nurse who is specialised in this kind of procedure or the doctor who will be performing the test.
Potential risks:

Benign symptoms may arise such as palpitations or thoracic pain which will cease rapidly at the end of the test or medication injection. More serious symptoms may occur very rarely: in around 0.3% of cases during the physical exertion test; 1% of cases where medication is used to simulate effort; these are largely lasting chest pains or heart rate anomalies requiring emergency intervention (this is why resuscitation equipment must be present in the room).

The benefits of the test:

This test reproduces the conditions that cause angina chest pains, it provides a means to localise the exact area of the heart muscle which is insufficiently irrigated. It can also identify an area of the muscle which does not function normally at rest and which could be improved through a specific therapeutic intervention. This could then represent a reserve which could serve to predict the normalisation of the heart muscle function, once the artery which irrigates it has received specific treatment (medication, dilation or bypass).

Practical information

Dr Coraline CHALARD, Cardiologist, Ex-Paris Hospital Intern, DIU echocardiography, specialist in cardiac insufficiency and oncocardiology.

Dr Clémence DARRORT, Cardiologist, Ex-Paris Hospital Intern – Ex-Assistant Clinic Head.

Dr Camille DEGUILLARD, Cardiologist, Ex-Paris Hospital Intern, DIU echocardiography, DIU Sports Cardiology.

Dr Laura ROSTAIN, Cardiologist, Ex-Paris Hospital Intern, DIU echocardiography, DIU in interventional cardiology. Specialist in ischemic cardiopathy.

Dr Rith SAN, Cardiologist, Ex-Paris Hospital Intern, DIU echocardiography, DIU of cardiac imagery, coroscanner and myocardial MRI.

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