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Stress Echocardiograms

Stress Echocardiogram Information

Your Consultant has recommended you undergo a Stress Echocardiogram.

A Stress Echo is a specialist ultrasound scan of the heart.  High frequency sound waves are transmitted into the body and echoes are received back onto a monitor showing the heart’s internal structure.  The scan is performed at intervals whilst the patient is either cycling (Exercise Stress Echo) or during the infusion of a drug, Dobutamine (Dobutamine Stress Echo).  The Dobutamine drug creates the same effects as exercise by making your heart beat faster and harder and is used on patients who are unable to exercise.  It will depend on your ability to exercise which type of Stress Echo you will have.

The ultrasound scan is a painless test. 

This test will give your doctor information regarding your heart’s pumping chambers and valves from outside the chest wall during stress, which could aid your diagnosis and treatment.  

Beta blockers and calcium channel blockers can make the test less accurate. The following medications should be STOPPED 48 hours prior to the appointment.

Atenolol
Bisoprolol
Carvedilol
Propanalol Hydrochloride,
Sotalol Hydrochloride,
Metoprolol Tartrate,
Nadalol,
Acebutolol,
Oxepranolol Hydrochloride
Diltiazem
Verapamil

Normal dosages should be presumed following the procedure unless advised otherwise by the doctor.
All other medications should be taken as normal.

Please do not eat or drink for two hours prior to your appointment time.
You should expect to stay in the department for approximately two hours.

On the day of the Procedure

Please wear comfortable clothing (i.e. jogging bottoms), trainers/comfortable shoes and bring your medications with you.

We regret that relatives are not allowed in the Cardiac Angiography Suite as it is a theatre area.
Please leave all jewellery at home (except wedding rings which can be taped) and do not bring any valuables into hospital with you.  It is Mid-Essex Hospitals Trust Policy that we cannot accept responsibility for valuable items.  Every effort is taken to ensure the safety of personal items.  However, once again, we cannot be responsible for the loss or damage to ANY belongings.

Mobile phones must be left on silent at all times and it will not be possible to get a signal due to the lead lining of the walls etc.

Please arrive at the Cardiac Department (A210) 30 minutes before your appointment time.  You will then be met by the receptionist or a nurse who will admit you to the Cardiac Angiography Suite within the department where you will be prepared for your procedure.

Admission

You will be shown to a chair within the department where the usual observations are recorded (blood pressure, pulse etc.) and your current medications and dosages are listed.  (The nurse will check that you have STOPPED any Beta-blockers prior to your admission for the stated time)   You will be asked if you have any allergies/sensitivities.

A cannula (a tiny plastic tube) is inserted into your arm/hand through which any necessary medication is given. 
The Unit adheres to the Single Sex Policy wherever possible.  You will remain dressed at all times when not in the procedure room and ladies and gentlemen are kept as separate as possible when it has not been possible to arrange single sex lists.  Your dignity is maintained throughout.

We accept no responsibility for valuables within the unit and upon admission you will be required to sign that you understand and accept this policy.   

You will need to sign the Consent Form without which, the procedure will not be able to go ahead. 

Consent

Name of Procedure:
Stress Echo +/- Dobutamine +/- Contrast
Benefits
To assess if there is any background coronary artery disease

Risks

Nausea/Dizziness/Chest Pain/ 1:1000 Arrhythmia/ 1:2000 Heart Attack/
1 :10,000 Allergy to Contrast Dye

The echocardiogram (used at the beginning of the procedure) uses ultrasound, which does not use radiation or x-rays.  There are no risks associated with an echo.

Please be assured that should any adverse effect happen, the staff are trained to deal with any event.

It is important to get an accurate weight and height for medication purposes so this is carried out on the morning of admission.  It is also important to document when you had your last (if any) episode of chest pain.
You will be seen by a member of the cardiac team before going into the room.

The Procedure

The whole procedure could take up to 45 minutes.  You can expect to be in the department for approximately two hours.

If you wish to have a male/female member of staff performing the scan, please contact the Cardiac Department as soon as possible so we can accommodate this.  Please note this may delay your appointment by a couple of days, due to limited male staffing numbers.

The test will be performed in a private/darkened room with generally 3 members of the cardiac team present. 
You will need to remove the top half of your clothing and will be given a gown to change into.  (Your dignity will be maintained at all times).   

You will hear verbal checks being taken at this point.  Although this seems very repetitive, the same checks are carried out numerous times at different stages of your stay within the department, by numerous members of staff.

Dobutamine Stress Echo

You will be asked to lie on your back on a couch.  Stickers will be attached to your chest connecting you to the recording machine.  These will be used to monitor your heart rate and rhythm.  You will also be connected to a blood pressure monitor via a cuff on your upper arm.  Your blood pressure will be checked regularly throughout the test.  

The couch will be rotated to the left as this ensures a clear echo window to scan the heart.  Gel will be applied to the chest area and a small probe (recorder) moved over the skin.  Once the resting images have been obtained the Dobutamine drug will be connected to the cannula in your arm and infused making the heart work harder and faster.  Whilst this is happening the cardiac physiologist will take pictures of your heart.  During the test the doctor may also inject a contrast agent into the cannula in your arm.  This helps to improve the quality of the pictures that are being recorded, If necessary.

We often need to train echo cardiographers or junior doctors.  If the person doing the scan has to bring in a more senior person, don’t worry.  This is usually because they are being supervised, not because an abnormality has been found.

Exercise Stress Echo

You will be asked to lie on your back on a couch.  Stickers will be attached to your chest connecting you to the recording machine.  These will be used to monitor your heart rate and rhythm.  You will also be connected to a blood pressure monitor via a cuff on your upper arm.  Your blood pressure will be checked regularly throughout the test.  You will be asked to place your feet on the pedals.  The straps will be adjusted so you are comfortable and in the correct position for scanning.

The couch will be rotated to the left as this ensures a clear echo window to scan the heart.  Gel will be applied to the chest area and a small probe (recorder) moved over the skin.  Once the resting images have been obtained, you will be asked to begin cycling.  The cycling will gradually get more difficult until the team decides that you have performed enough exercise, or if you are unable to continue.  Occasionally, the cardiac physiologist will take pictures of your heart whilst you are exercising.  During the test, the nurse may also inject a contrast agent into the cannula in your arm.  This helps to improve the quality of the pictures that are being recorded, if necessary.

After you have finished cycling, the couch will be returned to the flat position whilst you recover.  Your heart rate and blood pressure will be regularly monitored until you have fully recovered, which may take several minutes.
You will be given some paper towel to wipe away the jelly.  When clean you can get dressed and will be given cold water to drink and escorted back to recovery. 

Recovery 

When in recovery/a chair, you will be monitored at 15 minute intervals.  Tea/coffee and refreshments are offered and you may then be seen by a Doctor who will give you the results of the test and discuss any further action/tests required.  Alternatively you may receive the results via a letter.

The cannula will be removed and you will be reminded to drink plenty of fluids and to continue any medication as normal when leaving the unit unless advised otherwise.    You will be given a letter to take to your GP. (A detailed letter will be forward to your doctor at a later stage).

We ask that you do not drive home following your appointment as a medication you may be given during the test can cause temporary blurred vision.  You will need to have a family member/friend available to take you home.  If this is not possible, public transport/taxi is acceptable.

Overall stay is expected to be 2 hours and patients should not drive for 24 hours following the procedure.   

Contact/Further information

Cardiac Department........... Tel: 01245 514185  (Reception)
Cardiac Angio Suite............ Tel: 01245 514418  (Nursing care)
Stress Echo Bookings......... Tel: 01245 514209  (Chrissy Gould)

We hope this information is of use to you. Should you have any queries please do not hesitate to contact us.  In the meantime, we look forward to welcoming you to the department.

References/Source of evidence

British Heart Foundation Website: www.bhf.org/uk/heart-health/tests
British Society of Echocardiology Website www.bsecho.org  and click on Education then patient information leaflets

Nice guidelines Website: www.nice.org.uk

We look forward to welcoming you/your relative to the Angio Suite and hope this information has given you sufficient insight into the procedure you/your relative will be undertaking in the near future.  (This electronic information is in addition to the written and verbal instructions/information our patients are given).  However if you have ANY queries regarding the procedure, please do not hesitate to contact us on 01245 514418