What is stress echocardiography?

Stress echocardiography combines transthoracic cardiac ultrasound with physiological stress to evaluate how the heart performs under exertion. By comparing cardiac images at rest with images obtained at peak exercise, the cardiologist can identify myocardial ischaemia (reduced blood flow), valvular dysfunction during exertion, and abnormal blood pressure or arrhythmic responses to exercise.

At HeartWise Cardiology, exercise stress echocardiography is performed on a treadmill or upright bicycle and supervised throughout by Dr Tashi Zhaxiduojie. It is significantly more accurate than a standard exercise ECG (stress test) alone.

Exercise vs pharmacological stress echo

• Exercise stress echo: Preferred when the patient can exercise. Uses a treadmill or bicycle. More physiological — reflects real-life demands on the heart.
• Dobutamine stress echo: Drug infusion mimics exercise by increasing heart rate and contractility. Used in patients unable to exercise (orthopaedic or neurological limitations).

Common clinical indications

• Chest pain on exertion (stable angina assessment): Most common indication. Identifies ischaemia and localises the affected coronary territory.
• Unexplained breathlessness on exertion: May reveal exercise-induced LV dysfunction, elevated pulmonary pressures or dynamic valve dysfunction.
• Known coronary artery disease: Assess ischaemia burden; guide need for revascularisation.
• Pre-operative cardiac risk assessment: Mandatory for intermediate-to-high risk non-cardiac surgery in patients with known or suspected CAD.
• Fitness for work / sports clearance: Objective assessment in jobs with high cardiovascular demands (pilots, heavy vehicle drivers, miners, emergency workers).
• Valvular heart disease under stress: Exercise echo in asymptomatic moderate-severe mitral regurgitation or AS reveals haemodynamic responses guiding intervention timing.
• Shortness of breath with normal rest echo: Exercise-induced diastolic dysfunction or elevated filling pressures not apparent at rest.

What happens during the test?

• Resting echocardiogram and ECG are performed at baseline
• You exercise on a treadmill using a standard Bruce or modified Bruce protocol, or a stationary bicycle
• A cardiologist monitors your ECG, blood pressure and symptoms throughout
• At peak exercise, you stop and immediately lie on the examination table for post-exercise images (acquired within 60–90 seconds of peak exercise)
• The cardiologist compares resting and post-exercise wall motion, valve function and filling pressures
• Total appointment time: approximately 60–90 minutes

Advantages over standard exercise ECG (ETT)

How to prepare

• Fast for 3 hours before the test (water allowed)
• Wear comfortable, loose-fitting exercise clothing and walking or running shoes
• Bring a list of current medications
• Certain medications may need to be withheld before the test — your GP or Dr Tashi will advise. Beta-blockers may blunt heart rate response if not withheld
• Continue antianginal medications unless specifically instructed otherwise

Safety

Stress echocardiography is a safe and well-established investigation. It is performed under direct cardiologist supervision with emergency equipment and resuscitation medications available. Serious complications are rare (<1 in 10,000 tests).

Absolute contraindications include acute MI within 2 days, unstable angina, severe uncontrolled hypertension, acute aortic dissection, or acute pulmonary embolism.

• Normal result: All segments of the heart wall move normally, both at rest and peak stress. Effectively excludes significant obstructive coronary artery disease.
• Ischaemia detected: New regional wall motion abnormality at peak stress indicates significant stenosis in the corresponding coronary artery territory. Further investigation or revascularisation considered.
• Resting wall motion abnormality: Suggests prior myocardial infarction. Worsening under stress indicates periinfarct ischaemia.
• Exercise capacity: METs achieved, heart rate response and blood pressure response provide prognostic information independent of imaging findings.

Results are reported by Dr Tashi and sent to your referring doctor, typically within 1–2 business days.