Stress Echocardiography

Stress echocardiography is a novel, highly specialized, radiation-free diagnostic study that allows the cardiologist to assess whether there are significant stenoses in coronary arteries. These stenoses are a manifestation of coronary heart disease, a condition associated with acute myocardial infarction and sudden cardiac death.

   It is a combination of cardiac ultrasound with exercise through a standard exercise test on a treadmill / ergometric bike, or more commonly, with the use of drugs that increase the frequency and intensity of heart contraction. The doctor examines, at the same time, with the echocardiogram whether the heart is working properly under stress conditions. When there is severe stenosis in a coronary artery, the part of the myocardium that receives blood from it does not work properly and malfunctions, with this malfunction being reflected on the echocardiogram.

• To investigate chest pain, shortness of breath, easy fatigue.
  Patients with a history of myocardial infarction, angioplasty or bypass for assessment of cardiac function and early detection of new stenosis.
   • People with risk factors for coronary heart disease (smoking, diabetes, high blood pressure, high cholesterol, family history of early coronary heart disease, chronic kidney disease).
   • Patients with valvular disease (eg aortic valve stenosis) for accurate assessment of severity and selection of the most appropriate treatment and the most appropriate time of intervention.
      • Reliable pre-operative assessment before non-cardiac surgery.

Η ταυτόχρονη απεικόνιση της καρδιάς κάτω από συνθήκες φόρτισης καθιστά της εξέταση εξαιρετικά υψηλής διαγνωστικής ακρίβειας. Σύμφωνα με τις πλέον πρόσφατες κατευθυντήριες οδηγίες της Ευρωπαϊκής Καρδιολογικής Εταιρείας το Stress echo αποτελεί εξέταση εκλογής για τη διάγνωση της στεφανιαίας νόσου, σε αντίθεση με το κλασσικό τεστ κόπωσης το οποίο χαρακτηρίζεται από μειωμένη αξιοπιστία και αυξημένο ποσοστό ψευδώς θετικών αποτελεσμάτων.

Simultaneous imaging of the heart under high stress conditions makes the examination extremely accurate for the detection of coronary heart disease. According to the latest guidelines of the European Society of Cardiology,  Stress echo is the test of choice for the diagnosis of coronary heart disease, in contrast to the standard exercise stress test on treadmill, which is characterized by reduced reliability and an increased percentage of false-positive results.
 An additional  advantage is that this test can be performed on examinees who are unable to complete or undergo a standard treadmill test (eg patients with chronic respiratory or orthopedic diseases, poor physical condition, advanced age)

Advantages of the Stress Echo are:
 • The absence of radiation. The examinee is not burdened with the cumulative and harmful effects of radiation, as is the case with coronary angiography, nor does he receive any radioactive medicine, as is the case with scintigraphy.
 • The contrast agent that will probably be used during the stress echo is not toxic to the kidneys (as is the case with coronary angiography). Also, it is not necessary to hydrate-take specific amounts of fluids before or after the test. Both of these parameters make Stress Echo attractive for people with chronic kidney disease.
    • Absence of radiation and renal toxicity allow the test to be performed as often as necessary.
    • After the exam, you can follow your daily schedule without restrictions, as is the case with scintigraphy.

Stress echocardiography is a generally safe, routine examination with very little chance of serious complications. The examinee usually tolerates the examination well and may in a few cases report a mild dizziness (1.5%), nausea, palpitations  (1.6%), headache (1.6%) during the study.
 The vast majority of side effects are mild and transient and subside within a few minutes after stopping the drug and administering the antidote. More serious side effects may occur, as in all cardiac stress tests, but are extremely rare (acute coronary syndrome rate = 0.02%), affect patients with hemodynamically significant coronary artery stenoses and are a “symptom” of coronary heart disease that is revealed during the Stress Echo.

A small cannula is inserted into a peripheral vein in the arm and either the patient is exercised on an ergometric bike / treadmill or medication is given to make the heart work harder and faster. Usually,  contrast medium is added to improve the quality of imaging. In addition, a cuff is placed for continuous monitoring of blood pressure, as well as electrodes in the chest for continuous recording of electrocardiogram.
The test takes about 30-40 minutes. The examinee remains in the waiting area for an additional 30 minutes after the end of the examination. At the end of the examination the catheter will be removed and the examinee can follow his/her daily schedule without restrictions.

Stress Echocardiography is a safe and routine examination.

The diagnostic reliability and safety of the test requires the following:
 • To be performed by a certified, experienced and specialized cardiologist.
 • Presence of experienced nursing staff.
 • Use of modern technological equipment.