It is an easy test, regardless of the examinee’s age and ability to exercise, in which no contrast is used, no radiation is involved, and it can be repeated as often as the attending physician decides.

This test helps identify narrowings in the heart’s vessels that prevent proper blood flow and increase the risk of complications, while at the same time it can check pre-existing myocardial damage, narrowing of the vessels as well as the function of the heart valves in cases of strictures or insufficiency .

Why is the Stress Echo test important?

“At rest a patient with coronary artery disease may have no symptoms and their electrocardiogram may appear normal. However, when there is activity the heart’s needs for oxygen increase and if there is a narrowing of the arteries the perfusion is not sufficient to cover them, causing a disturbance in the mobility of the myocardium. Through the Stress Echo examination, a safe and immediate diagnosis can be made for the best and timely treatment of the disease” points out the Mr. Evangelos Stefanidis Cardiologist – Head of Heart Ultrasound Laboratory, Cardiology Clinic, Metropolitan Hospital.

What cases is the test used for?

The examination using Stress Echo is applied for:

• Diagnosis of coronary artery disease
• Assessment of the outcome of cardiac interventions (Stent or Bypass)
• Control of valvular diseases
• Assessment of the effectiveness of medication
• Prognosis of cardiac diseases

What information does this particular test give us?

“Stress Echo has a wide range of indications. But mainly we use it to check the possibility of coronary artery disease, -that is, a significant narrowing of the heart’s arteries- to assess the results of the operations to which someone has undergone (angioplasty with placement of a “Stent” -the well-known balloon-) or aortocoronary bypass “By Pass”, to assess the effectiveness of the medication someone is receiving, etc. Stress Echo is a painless and safe, functional assessment of cardiac function, reproducing in an artificial way the conditions that prevail in our body and, by extension, in our heart, in cases of increased physical and/or emotional stress,” he says.

How is it different from the fatigue test?

“Like the classic treadmill exercise stress test, the Stress Echo aims to assess cardiac function under conditions of increased oxygen demand. However, unlike the stress test, the doctor monitors the heart’s function with ultrasound throughout the examination, collecting important additional information that increases the diagnostic accuracy of the examination (reliability that in most cases reaches 85-90%).

With the ability to monitor the heart and valves in real time, diagnostic questions can be answered more precisely. “Exercising” the heart can be achieved either by using an ergometric bicycle, or – more commonly – by using medication, which gradually and controllably increases the heart rate while the patient remains lying down. This is also the second important difference from the classic fatigue test, as any limitations such as easy fatigue, shortness of breath, insufficient physical condition, respiratory or orthopedic problems, advanced age, are not an obstacle. Thus, patients who cannot undergo or did not complete a classic stress test, can undergo a Stress Echo without a problem,” explains Mr. Stefanidis.

Do I need to do any special preparation before the exam?

A few hours before the examination, it is recommended to eat light food. Regarding medication, you should consult your treating doctor about whether you should stop taking certain medications 1-2 days before the examination.

How is the examination carried out?

“This examination requires the presence of experienced medical and nursing staff, while it is carried out by a doctor-specialized cardiologist. Before it starts, the doctor will take a medical history and ask you to report your symptoms, especially if you feel chest pain, dizziness or difficulty breathing.

The examination begins with the application of an electrocardiogram, measurement of blood pressure and taking ultrasound images. This is followed by the continuous slow administration of a special drug with repeated acquisition of the ultrasound images at each loading stage. The procedure is completed when the desired target heart rate is reached, where the administration of the drug stops and gradually the heart rate of the examinee returns to normal levels”, he explains.

How long does the Stress Echo test take?

The duration of the examination does not exceed 20-30 minutes. However, after its completion, you should stay for about 20-30 more minutes in order for the drug to be removed from the body and the heart rate to return to normal levels. The results of the test are available immediately after the test, so you can discuss them with your doctor.

Who is Stress Echo recommended for?

“This test is recommended for patients without severe symptoms, who are at moderate or severe risk of developing coronary artery disease, i.e. they have many risk factors, such as smoking, blood pressure, cholesterol, diabetes, etc., with or without suspicious symptoms, worsening or emerging.

In addition, the Stress Echo test can be performed in patients with motor problems, with reduced exercise capacity or with disturbances in the electrocardiogram, who are not allowed to undergo or complete the classic fatigue test, in patients in the context of preoperative control before large extracardiac surgeries and in patients who have known coronary artery disease with or without a stent or Bypass and monitoring of their disease and condition is required.

Finally, patients at intermediate or high risk for coronary heart disease with, such as new-onset electrocardiographic disturbances, as well as asymptomatic patients who underwent CT coronary angiography and have a Calcium (Agatston) Score greater than 400, should also undergo a Stress Echo examination,” he emphasizes.

Is the Stress Echo test safe?

“With this examination, the patient does not need to receive radioactive medicine, as is the case with scintigraphy, making it completely safe, in terms of uptake and emission of radioactive material to the examinee and his environment. In addition, we must point out that the contrast agent used is non-contrast, so it is not metabolized by the kidneys and thus no special preparation with fluids before and/or after the examination is required, making it safe even for patients with mild or more severe renal impairment. inadequacy.

As a load-fatigue test that it is, there is the risk that we would encounter in any fatigue test. For this reason, the Stress Echo must be carried out by a specialized cardiologist with certification in this specific procedure, with the support of an experienced nurse throughout its duration as well as the use of state-of-the-art ultrasound and cardiogram recording machines, in a specially equipped area, thus reducing any risk in the least.

We must note that cardiovascular diseases are the main cause of loss of life worldwide, as they are responsible for ~50% of total deaths. The existence of an organized cardiology clinic with specialized professionals in the diagnosis, treatment and management of the risk factors associated with cardiovascular diseases is vital for their treatment” concludes Mr. Stefanidis.

*The Metropolitan Hospital has one of the most modern Cardiology Clinics, fully equipped and organized, which competes with the leading cardiology centers abroad. Certified according to the ISO standard, it has gained the trust of the Greek public, demonstrating scientific excellence and effective treatment of cardiac cases, for 15 years. With excellent scientific and nursing staff and advanced technical equipment, the cardiology clinic serves its patients at all times, offering full support and care for any type of cardiovascular problem, 24 hours a day.