Exercise Stress Echocardiography (ESE)
What is Exercise Stress Echocardiography?
Echocardiography uses ultrasound waves (high-frequency sound waves) to assess the motion of heart muscle and blood vessels.
Exercise Stress echocardiography (ESE) is an exercise stress test that allows the cardiologist to study the capacity and reserve of heart muscle function under stressful condition.
You need to exercise on Treadmill machine so your heart will beat faster and harder. Ultrasound images are then obtained to study the heart’s function immediately after exercise. These are then compared to the images obtained at rest to determine if any part of heart contracts abnormally.
What is the purpose of this test?
When the heart or coronary arteries are narrowed, the heart muscles may receive adequate blood supply in the resting state. However, the blood flow may be insufficient to meet the increasing oxygen demands of the heart muscles during stress. This relative lack of blood supply causes cardiac chest pain and may be a warning sign of a heart attack. ESE is a safe test for inducing cardiac chest pain. ESE is also much more accurate than an ordinary treadmill exercise electrocardiogram (ECG) test for detecting narrowing of the underlying coronary arteries (the heart’s blood vessels).
What can I expect?
The test is performed in the Clinic Echo Laboratory.
The doctor supervising the test will explain the procedure and you will also be required to sign a consent form before the test. Multiple ECG leads will be placed on your chest to monitor the heart rhythm; excess chest hair may sometimes have to be shaved. Your blood pressure and ECG will be monitored throughout the test.
The technologist will ask you to lie on your side. A baseline echocardiogram will be performed involving the use of a transducer, which will be placed over your chest to obtain pictures or images of the motion of the heart muscle.
You will then be asked to walk on the treadmill machine. The speed and inclination of the slope will increase every 3 minutes to stress your heart gradually. Once you reach the target heart rate, or are unable to continue because of fatigue, or if you developed symptoms such as breathlessness, chest pain, or when your doctor ask you to stop, you will then need to lie on the couch in the left lateral position ( on your left side) immediately.
A cardiac technologist will then place the probe on your chest to obtain the best possible ultrasound images immediately after exercise.
At the end of the examination, the technologist will help you clean up the gel, which is water soluble easily wiped or washed off. The ECG leads and pressure cuff will be removed.
What should I do before the test?
Please arrive 15 minutes prior to your scheduled appointment time for registration and test preparation.
- Avoid food and drink for at least 2 hours before the test.
- No decaffeinated, caffeine or chocolate beverages 24 hours prior to procedure
- Need to wear comfortable clothes and walking shoes.
- Take your medicines as usual with water and on schedule
- Hold Beta Blockers 24 hours before test (bring dose with you to take after the test)
- Hold Theo-Dur or any Theophylline like drug 24 hours before the test (may use inhalers)
- Hold Persantine (Dipyridamole) 24 hours before the test.
- Long acting persantine must be held for 3 days before the test
- Please check with your doctor if any of your medications need to be omitted
Bring a list of all the medications you are currently taking. Patients who have fever and influenza within one week should not do strenuous exercise, please inform the technologist or supervising doctors if you are having fever or had fever in last 1 week.
What are the potential risks and complications?
Ultrasound is extremely safe and has no material side effects, even with repeated examinations.
Major complications are very rare. Heart attack (Acute myocardial infarction 0.1%) and severe heart rhythm abnormality (Life threatening heart rhythm <0.2%), death (0.002%) and Fall ( patient require to exercise adequately / does not stop themselves) have been reported. Various medications and emergency trolley with defibrillator are available to counter these problems in the unlikely event of their occurrence.
If you feel chest pain or any other discomfort during the test, please inform the technologist or supervising doctor.
When will I know the result?
The supervising doctor will need to review recorded computed images and ECG recordings of the ESE procedure. Your doctor will inform you of the results, usually at your next outpatient clinic visit. A formal report should be available in 24 to 48 hours. You may be contacted earlier if there is a severe abnormality or if an urgent management decision is required pending the results.
