How does an exercise stress echo work?

Your provider will give you specific instructions on how to prepare. Substances such as caffeine, medications, food and nicotine can interfere with the test. In general, you should:

• Avoid caffeine for 24 hours before the test.
• Follow your provider’s instructions about taking your medications on the day of the test. Don’t discontinue any medications without talking to your provider
• Not eat or drink anything in the hours before the test.
• Stop smoking or using tobacco products that day
• Wear comfortable clothes and shoes that you can walk in.

What can I expect during the exercise stress echocardiogram ?

An exercise stress echo typically follows this process:

• A technician attaches electrodes (small, flat, sticky patches) to your chest. These electrodes connect to an electrocardiograph (EKG) monitor that tracks your heart rate. You’ll also wear a blood pressure cuff to record your blood pressure throughout the test.
• While you’re resting, the sonographer performs an initial EKG and echocardiogram. For the echocardiogram, you lie on your left side. The sonographer holds an ultrasound wand (transducer) in different positions on your chest to collect images.
• You then exercise on a treadmill or stationary bicycle, starting slowly and gradually increasing intensity. You continue to exercise until you reproduce symptoms or reach your target heart rate, which varies depending on your age and fitness level. The actual exercise time is about 10 to 15 minutes.
• Let your provider know if you feel any unusual symptoms, especially pain, pressure or discomfort in your chest, arm or jaw. Other symptoms to report include shortness of breath, dizziness and lightheadedness.
• When you reach your target heart rate, you get off the treadmill and return to the exam table for a repeat echocardiogram. If you’re on a bicycle, the sonographer may perform the echocardiogram while you’re pedaling.
• It’s normal to feel your heart rate and breathing rate increase while exercising. You may also feel slightly unsteady when you get off the treadmill or bicycle.

What happens after the exercise stress echo?

After the final echocardiogram, you return to the treadmill or bike and walk or pedal slowly to cool down. Once your blood pressure and heart rate return to normal, you can go home.

Exercise stress test

This is the most common and basic heart stress test. It involves walking on a treadmill or riding a stationary bicycle. A well-trained exercise physiologist usually tailors the speed and elevation of the treadmill to your ability to walk and your overall fitness. If you can’t exercise, you receive medications that make your heart pump harder and faster or dilate the artery supplying blood to your heart (coronary arteries). An electrocardiogram (EKG) captures your heart’s electrical activity. Exercise stress tests check for signs of coronary artery disease.

Is cardiac stress testing safe?

If there are no contraindications, exercise stress tests are safe. Very few people experience complications. Trained healthcare providers, typically an exercise physiologist and a cardiologist, are present during your test in the rare event that you have a complication. They assess your performance, data and symptoms throughout the tests and immediately provide emergency treatment if it’s needed. You also have the option of stopping the stress test at any time if you become anxious or uncomfortable.

How do I prepare for an exercise stress test ?

To prepare, you should:

• Not eat anything in the hours leading up to the test. If you’re having a nuclear stress test, you might not be able to eat until after your test.
• Avoid caffeine for 24 hours before testing. This includes coffee, tea, energy drinks and certain over-the-counter medications.
• Not smoke or use tobacco products
• Stop taking certain prescription medications the day of your test. These include beta-blockers and asthma inhalers. Talk to your healthcare provider before stopping any medications.
• Try to relax. It’s natural to be nervous about heart testing, but feeling anxious can affect your results.
• Wear lightweight, comfortable clothes and sturdy walking shoes.

What happens during an exercise stress test ?

Here’s what to expect during an exercise stress test:

• A technician takes your vital signs, including your resting heart rate and blood pressure.
• They attach small, sticky disks (electrodes) to your chest and arms. The electrodes connect to the EKG machine.
• You walk on a treadmill or pedal a stationary bicycle at an easy pace.
• Over time, the pace becomes more intense but still manageable.
• Technicians and exercise physiologists periodically ask how you are feeling.
• The test ends after maintaining your target heart rate long enough to capture readings about heart function, usually about 10 to 15 minutes. Your target heart rate is higher than when at rest and based on your age and fitness level.

During The Test:

A sonographer will perform the transthoracic (external) echocardiogram. Sonographers are healthcare professionals who specialize in using ultrasound devices to produce images and videos for diagnostic purposes.
During the test, the person receiving the echocardiogram will remove their clothes from the waist up. They can wear a hospital gown if they wish to cover themselves during the exam.
The sonographer will then instruct the person to lie on a table, on either their back or their left side. They may inject a saline solution or dye into the person’s veins, which makes the heart appear more defined on the echocardiogram.
The exact procedure depends on the type of echocardiogram. For instance:

Transthoracic echocardiogram

If a doctor ordered a transthoracic echocardiogram, the sonographer will apply a gel to the chest. The sonographer will then move the transducer around the chest to get different images of the heart.
During the exam, the sonographer may ask someone to change positions or take or hold a deep breath. They might press the transducer into the chest to get a better picture of the heart.

During The Test:

Most people can return to their regular activities after having a transthoracic echocardiogram.

How do I prepare for ambulatory blood pressure monitoring ?

Your healthcare provider will tell you how to prepare. Some general tips include:

• Choose a 24-hour period that best represents your normal routine. This may mean choosing a weekday rather than a weekend.
• Plan to keep a journal of what you do during the 24-hour period. This includes when you wake up and go to bed, when you take any medications and when you eat. You should also record any symptoms you experience (like dizziness or shortness of breath).

Preparation also involves knowing in advance what you need to avoid. During your 24-hour period, you shouldn’t:

• Engage in strenuous physical activity.
• Shower or swim.
• Remove any part of the device without first asking your provider.

How you prepare ?

You are set up with a Holter monitor during a scheduled appointment at a medical office or clinic. Unless you're told differently, plan to bathe before this appointment. Most monitors can't be removed and must be kept dry once monitoring begins.
Sticky patches with sensors, called electrodes, are placed on your chest. These sensors detect the heartbeat. They're about the size of a silver dollar. If you have hair on your chest, some of it may be shaved to make sure the electrodes stick.
Wires attached to the electrodes connect to the Holter monitor recording device. The device is about the size of a deck of cards.
Once your Holter monitor is fitted and you've received instructions on how to wear it, you can return to everyday activities.

What you can expect ?

During:

A Holter monitor is typically worn for 1 to 2 days. During that time, the device records all of the heartbeats. Holter monitoring is painless. The electrodes and wires can be hidden under clothing. The device is worn on a belt or attached to a strap.
While you wear a Holter monitor, you can do most other daily activities unless you have instructions to avoid certain things. You may be given a form to record your activities and any symptoms. It's particularly important to note if and when you have any of the following symptoms:

• Pounding, fluttering or skipped heartbeats.
• Shortness of breath
• Chest pain and Lightheadedness.

After:

Once your monitoring period is over, you'll return the device. If you were asked to keep a record of symptoms that you had while wearing the device, the Holter monitor's data will be compared with your notes. This can help your care team make an accurate diagnosis.

Results:

Your healthcare professional will review the Holter monitor test results and discuss them with you. Information from Holter monitor testing can show if you have a heart condition and if any heart medicines you currently take are or aren't working.
If you didn't have any irregular heartbeats while you wore the monitor, you may need to wear a wireless Holter monitor or an event recorder. These devices can be worn longer than a standard Holter monitor. Event recorders are similar to Holter monitors and generally require you to push a button when you feel symptoms. There are several different types of event recorders.