An echocardiogram is a noninvasive (the skin is not pierced) procedure
used to assess the heart's function and structures. An exercise
echocardiogram is performed to assess the heart's response to stress or
exercise. During the procedure, a transducer (like a microphone) sends
out ultrasonic sound waves at a frequency too high to be heard. When the
transducer is placed on the chest at certain locations and angles, the
ultrasonic sound waves move through the skin and other body tissues to
the heart tissues, where the waves echo off of the heart structures. The
transducer picks up the reflected waves and sends them to a computer.
The computer interprets the echoes into an image of the heart walls and
After the resting echocardiogram images have been obtained, the person
will begin to exercise on a treadmill or stationary bicycle. The
physician will compare the resting echocardiogram with the test done
immediately after exercise.
An exercise echocardiogram may utilize one or more of four special types
of echocardiography, as listed below:
This, the simplest type of echocardiography, produces an image
that is similar to a tracing rather than an actual picture of
heart structures. M-mode echo is useful for measuring heart
structures, such as the heart's pumping chambers, the size of
the heart itself, and the thickness of the heart walls.
This Doppler technique is used to measure and assess the flow of
blood through the heart's chambers and valves. The amount of
blood pumped out with each beat is an indication of the heart's
functioning. Also, Doppler can detect abnormal blood flow within
the heart, which can indicate a problem with one or more of the
heart's four valves, or with the heart's walls.
Color Doppler is an enhanced form of Doppler echocardiography.
With color Doppler, different colors are used to designate the
direction of blood flow. This simplifies the interpretation of
the Doppler technique.
2D (two-dimensional) echocardiography
This technique is used to visualize the actual structures and
motion of the heart structures. A 2D echo view appears
cone-shaped on the monitor, and the real-time motion of the
heart's structures can be observed. This enables the physician
to see the various heart structures at work and evaluate them.
Other related procedures that may be used to assess the heart include
resting or exercise electrocardiogram (ECG or EKG), Holter monitor,
signal-averaged ECG, cardiac catheterization, chest x-ray, computed
tomography (CT scan) of the chest, electrophysiological studies,
magnetic resonance imaging (MRI) of the heart, myocardial perfusion
scans, radionuclide angiography, and ultrafast CT scan. Please see these
procedures for additional information.
Reasons for the Procedure
An exercise echocardiogram, obtained after you have exercised on a
treadmill or stationary bicycle, may be performed for the following
to assess the heart’s function and structures
to determine limits for safe exercise in patients who are
entering a cardiac rehabilitation program and/or those who are
recovering from a cardiac event, such as a heart attack
(myocardial infarction, or MI) or heart surgery
to assess leg pain with exercise (also called intermittent
claudication) in patients with suspected occlusion in the legs'
to evaluate blood pressure during exercise
to assess stress or exercise tolerance in patients with known or
suspected coronary artery disease
to evaluate the cardiac status of a patient about to undergo
There may be other reasons for your physician to recommend an exercise
Risks of the Procedure
Possible risks associated with an exercise echocardiogram include, but
are not limited to, the following:
severely high blood pressure
nausea, and extreme fatigue
heart attack (rare)
If you are pregnant or suspect that you may be pregnant, you should
notify your physician.
There may be other risks depending upon your specific medical condition.
Be sure to discuss any concerns with your physician prior to the
Certain factors or conditions may interfere with the accuracy of an
exercise echocardiogram. These factors include, but are not limited to,
smoking or ingesting caffeine within three hours prior to the
chronic obstructive pulmonary disease (COPD)
beta-blocking medications may make it difficult to increase the
Before the Procedure
Your physician will explain the procedure to you and offer you
the opportunity to ask any questions that you might have about
You will 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.
Fasting may be required before the procedure. Your physician
will give you instructions as to how long you should withhold
food and/or liquids. In some cases, cigarettes and caffeinated
beverages, such as coffee, tea, and cola may be restricted two
to three hours before testing.
If you are pregnant or suspect that you may be pregnant, you
should notify your physician.
Notify your physician of all medications (prescription and
over-the-counter) and herbal supplements that you are taking.
Notify your physician if you have a pacemaker.
Notify your physician if you have the following conditions:
aneurysm, severe hypertension (high blood pressure), severe
heart valve disease, severe congestive heart failure, recent
heart attack, pericarditis, or severe anemia (low red blood cell
For exercise echocardiogram, plan to wear loose, comfortable
clothing for the exercise portion of the test, as well as a pair
of comfortable walking shoes.
Based upon your medical condition, your physician may request
other specific preparation.
During the Procedure
An exercise echocardiogram may be performed on an outpatient basis or as
part of your stay in a hospital. Procedures may vary depending on your
condition and your physician's practices.
Generally, an exercise echocardiogram follows this process:
You will be asked to remove any jewelry or other objects that
may interfere with the procedure. You may wear you glasses,
dentures, or hearing aids if you use any of these.
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 prior to the procedure.
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 ECG monitor that records the
electrical activity of the heart and monitors the heart during
the procedure using small, adhesive electrodes. Your vital signs
(heart rate, blood pressure, breathing rate, and oxygenation
level) will be monitored during the procedure. The ECG tracing
that will record the electrical activity of the heart will be
compared to the images displayed on the echocardiogram monitor.
The room will be darkened so that the images on the
echocardiogram monitor can be viewed by the technologist or
The technologist will place warmed gel on your chest and then
place the transducer probe on the gel. You will feel a slight
pressure as the technologist positions the transducer to get the
desired image of your heart.
The technologist will move the transducer probe around and apply
varying amounts of pressure to obtain images of different
locations and structures of your heart. The amount of pressure
behind the probe should not be uncomfortable. If it does make
you uncomfortable, however, let the technologist know.
The different echocardiogram techniques described above (M-mode,
2-D, Doppler, and color Doppler) may be used. You will not be
aware of the different techniques except that during the Doppler
or color Doppler, you may hear a "whoosh-whoosh" sound, which is
the sound of the blood moving through the heart.
Once the echocardiogram images have been obtained, you will use
the treadmill or bicycle to begin exercising.
You will exercise until you have reached your target heart rate
(determined by the physician based on your age and physical
condition), or until you are unable to continue due to chest
pain, leg pain, severe shortness of breath, or severe fatigue.
Once you have reached your target heart rate, you will continue
to exercise for another minute or so.
You should notify the technologist if you feel any chest pain,
breathing difficulties, sweating, or heart palpitations.
You will again lie on the table or bed while a second set of
echocardiogram images is obtained.
After the procedure has been completed, the technologist will
wipe the gel from your chest and remove the ECG electrode pads.
You may then put on your clothes.
After the Procedure
You may resume your usual diet and activities unless your physician
advises you differently.
Generally, there is no special type of care following an exercise
echocardiogram. However, your physician may give you additional or
alternate instructions after the procedure, depending on your particular
The content provided here is for informational purposes only, and was
not designed to diagnose or treat a health problem or disease, or
replace the professional medical advice you receive from your physician.
Please consult your physician with any questions or concerns you may
have regarding your condition.
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