Pharmacological Stress – Echocardiogram

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What is it?
An echocardiogram or ‘echo’ is a scan that uses ultrasound (sound waves) to produce pictures of the heart. The test is painless and does not use radioactivity. During a Pharmacological Stress Echo, we will use a medication (Dobutamine) to increase your rate at which your heart is beating, whilst pictures are taken of your heart.

Why is being done?
A Pharmacological Stress Echo is performed as it allows your doctor to understand how the heart copes when it is made to work harder. A Pharmacological Stress Echo is useful to diagnose whether you have angina or not. It can also give information about the severity of a heart-valve problem.

What does it involve?
You will be taken into a darkened room. Two people will usually be present when you have the test, these may include a Cardiology doctor and at least one cardiac physiologist or a nurse. We will need to weigh you to work out how much medication to give you. We will also ask you some questions to ensure that it is safe to perform the test. You will be asked to undress to the waist. Female patients are given a gown that has openings on the front and side. You will be asked to lie on a couch on your left-hand side. Stickers will be attached to your chest and connected to the ultrasound machine.

These will be used to monitor your heart rate. Your blood pressure and oxygen level of your blood stream will also be checked regularly throughout the test. A drip will be placed in the vein in your arm to you to be given medication called Dobutamine which increases the heart rate. Pictures of your heart will be recorded on the ultrasound machine, before the medication is given, and then again when your heart is beating faster. If we are having difficulties in getting your heart rate high enough, we may give you a medication called Atropine which will usually remedy this. If your pictures are of poor quality, we may give you a dye to improve them.

When your heart rate has increased to reach its target, which is based on your age, we will record more images of the heart and then stop the medication. You will continue to have your heart rate and blood pressure and oxygen level monitored until you have fully recovered, which may take several minutes. We may give you another medication to help your heart slow down. Overall the Pharmacological Stress Echo will take around 45 minutes to one hour to complete.

Why I have been asked to stop certain medications for 48hrs prior to my test?
You may be asked in your invitation letter to stop some of your medication, those medications that can prevent your heart rate increasing (including Beta Blockers, Diltiazem and Verapamil). These can make it difficult to reach the target heart rate of the test, and the results would not be complete. If you have taken these medications, it is often better to rebook you but in most cases we can still carry out the test.

At the end of your Pharmacological Stress Echocardiogram?
We will ask you to remain in the waiting room for up to 45 minutes after the test, to make sure that all the medication has gone from your body. You will then be able to return home. If we have given you atropine, it is sometimes advisable to have someone else take you home, as your vision could be a little blurry for a few hours, although this is rare.

Are there any risks in having the Pharmacological Stress Echocardiogram?
The Pharmacological Stress Echo scan is generally an extremely safe test. There is however an extremely small risk (less than 1 in 10,000) of developing an allergic reaction if dye is used. If you have had allergic reactions to any medicines before please inform your us before starting the test. If you suffer with angina, there is an extremely small risk (less than 1 in 10,000) you may have a small heart attack during the test.

You should be reassured that all those staff undertaking these tests are fully trained in all the procedures necessary to treat any complications.

If you have any questions about your Pharmacological Stress Echocardiogram, please phone the Cardiology Department on 01908 826672 (Monday – Friday 8.30am – 5pm).