Description
It is a highly diagnostic, modern, specialized, non-invasive, and radiation-free diagnostic test that allows the cardiologist to assess whether there are significant narrowings in the coronary arteries. These narrowings are a manifestation of coronary artery disease, the condition associated with acute myocardial infarction and sudden cardiac death.
It involves a combination of a cardiac ultrasound with cardiac stress testing via a standard treadmill or stationary bike stress test, or, more commonly, with the use of medications that increase the heart’s rate and contraction strength. The physician simultaneously uses the echocardiogram to assess whether the heart functions properly under stress conditions. When there is severe narrowing in a coronary artery, the section of the myocardium supplied by that artery does not receive adequate blood flow and malfunctions, with this dysfunction being visible on the echocardiogram.
Who is it recommended for?
Because the heart is imaged using ultrasound during “exercise,” the accuracy of this method far exceeds that of the classic treadmill stress test and approaches 90%. It is primarily used for the diagnosis of
• Coronary artery disease in patients with suspicious symptoms such as chest pain, easy fatigue, pain
or shortness of breath while walking and/or risk factors (hypertension, high cholesterol, diabetes
diabetes) in whom we want to know with certainty whether there is severe narrowing in one or more coronary arteries.
• Other patients undergoing a stress echocardiogram include those with a history of myocardial infarction,
angioplasty, or coronary artery bypass grafting (CABG) to assess heart function, determine risk stratification (preoperative evaluation) as well as to diagnose any new stenoses in coronary arteries or grafts.
• In symptomatic patients who have undergone coronary CT angiography and have a calcium score of 400 or higher
• Finally, patients with valvular heart disease, such as aortic valve stenosis or mitral valve regurgitation, may undergo a stress echocardiogram to study the behavior of the valve and the heart under stress conditions and to select the appropriate treatment .
How the test is performed
To undergo a stress echocardiogram, the patient must arrive at the lab on an empty stomach and having taken their medications as directed by their cardiologist. A small intravenous catheter is inserted through which a contrast agent is administered, gradually and controllably increasing the heart rate while the patient remains lying down. Every 3 to 5 minutes, the echocardiologist examines the heart using ultrasound, while simultaneously measuring blood pressure and recording an electrocardiogram. The images will show if any part of the myocardium is not functioning properly as the heart rate increases. This means that a part of the heart is not receiving adequate blood flow due to a narrowing of the coronary arteries. The test lasts about 30 minutes in total, and after the stress echo, the patient remains in the waiting area for monitoring for another 30 minutes or so and can then resume their normal activities. With stress echo, ischemia is diagnosed easily, quickly, non-invasively, without radiation, and with the highest reliability compared to the classic exercise test. Accurate diagnoses depend on the experience of the specialist echocardiologist performing the stress echo and the quality of the echocardiography lab (equipment, nurse, administrative staff).