Stress Echocardiogram

cardiac diagnostic heart tests

What tests are available at London Heart Clinic?

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General Heart Health FAQs

View our short videos designed specifically to answer all your questions about heart health, including tests available at London Heart.

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Overview l Suitability l Preparation l Procedure l Risks l Benefits l Results


What is a stress echocardiogram?

We use an echocardiogram (echo) to create an image of your heart and nearby blood vessels with sound waves. With these images, we can look at the size and structure of your heart. We can also analyse how blood flows through your blood vessels. An echocardiogram allows us to diagnose and monitor various heart conditions.

A stress echocardiogram involves raising your heart rate before we perform the echo to assess how well your heart works. It’s also known as a stress echo or echocardiogram stress test. We may increase your heart rate with exercise or dobutamine.

Who needs a stress echo?

Performing a stress echo can increase the safety of a surgical procedure if you have an existing heart condition. 

If you are due to have surgery, we may recommend a stress echocardiogram to check your risk of complications. We can also see which arteries may need surgical intervention and which ones are less likely to.

We may recommend having a stress echo if you are experiencing concerning symptoms, such as symptoms of heart disease.

These include breathlessness, chest pain or pressure, feeling lightheaded or dizzy, rapid or irregular heartbeat (arrhythmia).

Athletes and people exposing themselves to extreme conditions may also consider having a stress echo. With a stress echo, we can check how their heart will respond to stress and whether they need to take precautions.

Who should not have a stress echo?

A stress echocardiogram is not suitable for everyone. We may not recommend having a stress echo if you have one of the following heart conditions: Aortic dissection, recent heart attack, constant chest pain, severe aortic stenosis, uncontrolled arrhythmia, and inflammation of the tissues in and around the heart including endocarditis, myocarditis, and pericarditis.

If you are unable to exercise, we may recommend a dobutamine stress echocardiogram. We explain what this is further down the page.

How do I prepare for a stress echo?

Our cardiologist will let you know exactly how to prepare for your echocardiogram stress test. Two hours before the test, we may ask you to stop eating. We might also ask you to avoid caffeine for twenty-four hours before.

If you are taking medications for your heart or another condition, you may need to stop taking them temporarily. Forty-eight hours before your stress test, stop taking beta-blockers, rate-limiting calcium-channel blockers, and other heart-slowing drugs. Unless we tell you otherwise. These medicines may affect the results of the test.

We recommend bringing or coming in comfortable clothes and shoes for your stress echo. You might also need to take off certain pieces of jewellery.

What happens during a stress echocardiogram?

A stress echocardiogram takes around an hour. It involves taking an echocardiogram while your heart is at rest, then another after we expose it to stress. Two common echocardiogram stress tests are exercise and dobutamine.

Before each test, we connect you to an electrocardiograph to measure your heart rate throughout the stress test. We will also measure your breathing rate, blood pressure, and oxygen levels. You may need to replace your upper clothing with a gown so we can effectively track your heart’s activity.

At the start of each test, we’ll perform the resting echocardiogram. We’ll ask you to lie on your left side, but you may need to change positions during the test. We will likely darken the room to improve our ability to monitor each echocardiogram.

We will put a special gel on your chest to help the sound waves reach your heart from the transducer. A transducer is a small device, also known as an ultrasound wand, that releases sound waves. These sound waves allow us to collect images of the heart.

After the first echocardiogram, you’ll either need to exercise to increase your heart rate or we’ll use dobutamine. We’ll explain which method we recommend and why before you come for the stress test.

Types of stress echocardiogram


We will discuss the type of exercise you will perform before the test so you can arrive prepared. Exercise stress echocardiograms often involve using a treadmill or bicycle for a short time. 

You will start slowly, and we will gradually ask you to increase your speed. We will usually have  a target heart rate for you to reach, and we’ll advise you when to stop exercising. Immediately after you stop exercising, we will perform the second echocardiogram.

We may ask you to stop exercising before you reach your target heart rate if you experience concerning symptoms.


During a dobutamine stress echocardiogram (DSE), we gradually increase your heart rate using an intravenous injection (into the vein). We determine the amount of dobutamine we plan to use by your weight. 

We will administer the dobutamine until you reach your target heart rate or experience symptoms. If you don’t reach your target heart rate, we may use a small amount of atropine. Atropine helps us increase your heart rate further to reach your target.

While your heart rate increases, and once you’ve reached your target, we will take more echocardiogram images.

Dobutamine may cause you to feel or be sick, you may experience light-headedness or a headache. If your blood pressure increases significantly, you may experience blurred vision or a buzzing in your ears. Read on to learn about the risks of a stress echocardiogram.

Risks of a stress echocardiogram

As we mentioned, a stress echocardiogram can cause concerning symptoms. 

These include

  • Weakness
  • Abnormal heart rate (arrhythmia)
  • Feeling sick
  • Extreme tiredness/ fatigue
  • Shortness of breath
  • Lightheadedness or dizziness
  • Chest pain/ discomfort
  • Severely high blood pressure

In rare cases, people experience a heart attack. Though, your risk of this will depend on your heart’s health and other factors. We will discuss this with you before the test.


Some heart problems involving your coronary arteries – arteries supplying the heart with blood – may only surface during physical activity. 

A stress echo can identify problems with your coronary arteries as both forms cause your heart to pump faster. For example, if you have coronary artery disease, a stress echo can help us detect this.

We can also identify or monitor:

  • Heart failure
  • Cardiomyopathy
  • Pulmonary hypertension
  • Signs of a heart attack
  • Congenital heart disease
  • Heart valve disease

A stress echocardiogram allows us to determine whether your heart would benefit from surgical intervention. It is a low-risk, non-invasive test. Unlike some alternative tests, a stress echo also involves no radiation.


After the test, we will need to look at our findings before reporting back to you. Normal results will indicate that your heart is working as we expect. For example, you exercised for as long as or longer than the average person your age and sex. Our cardiologist can explain each aspect of your results to you.

If you have abnormal results, your heart may not pump blood effectively. It could be due to a previous heart attack or suggest that you have coronary artery disease. We may recommend further tests, medication changes, or surgical intervention.

You will receive your results almost immediately on the day, and we can discuss what they mean for you.

Book an appointment

Our Consultant Cardiologist and Heart Rhythm Specialist, Dr Syed Ahsan, can perform a stress echocardiogram if you require one. You can also request a stress echocardiogram along with a range of cardiac diagnostic tests to assess your heart health.

Get in touch with us today to discuss whether you need or want a stress echocardiogram. Our friendly team can arrange a private consultation and provide you with more information.

Dr Syed

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What our patients say

“After suffering from a heart condition for a number of years I was very happy to meet Dr Ahsan, from the first consultation where he believed there was a solution I have now completed the surgery and had my final consultation with him today…”


“I am very grateful to have Dr Syed Ahsan as my consultant. Dr Ahsan always greets you warmly on each visit despite his busy workload. Dr Ahsan explains everything clearly and helps you to understand even the most complex medical terms…”


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