Stress Echocardiogram

Photo of a medical professionals preparing  a male patient for a stress echocardiogram

(Also known as: stress echo)


A stress echocardiogram is a test to determine how well the heart functions under the stress of exercise. In some cases, exercise stress may be simulated with the use of a drug (dobutamine). The test helps to diagnose the presence or absence of coronary artery disease (blockage of the arteries that supply the heart with oxygen). An echocardiogram is performed at rest, then during low, moderate and peak levels of exercise.  

  • Stress echocardiograms are conducted in the Cardiac Diagnostic Centre (H1) of the Heart Institute.


  1. The technologist will explain the procedure to you, take a brief medical history, and ask you to provide informed consent. This is required before the test can proceed.
  2. Ten adhesive electrodes will be applied to your chest area after the sites have been cleaned with alcohol, shaved (if necessary), and mild abrasion applied.
  3. The supine bicycle bed will rotate you onto your left side while the sonographer takes several resting echo views of the heart. This is done by placing gel on a small plastic ultrasound probe and positioning it on the left side of your chest. To get good quality images, it is necessary to apply some pressure with the probe.
  4. Following resting blood pressure and electrocardiogram (ECG) recordings, you will be asked to pedal a supine bicycle ergometer. On the bicycle, the resistance is very light at the beginning but will increase in difficulty every two minutes.
  5. The effectiveness of a stress echocardiogram relies on the effort made by the patient. It is very important that you pedal as long as possible to reach the target workload. The test usually takes about ten minutes.
  6. Your blood pressure is monitored throughout the procedure. Should a problem occur, the technologist will stop the test immediately. A nearby cardiologist will be called if necessary.
  7. It is very important for you to tell the technologist if you experience any symptoms, such as chest pain, dizziness, unusual shortness of breath, or extreme fatigue.
  8. Echo images will be taken at three separate times during exercise: at low level, mid level and peak level. Each time, the technologist will rotate the supine bike bed to obtain the images.
  9. Your blood pressure and ECG will be monitored for three to six minutes after exercise.
  10. The ECG tracings and the echo images will be reviewed by a cardiologist, and a report is then sent to your doctor, who will discuss the results with you.

Special Instructions

By taking the following steps, patients can help to make the results of the stress echocardiogram as accurate as possible:

  • Avoid strenuous activity for 12 hours before the test.
  • Do not eat, drink, or smoke for two hours before the test. Unless instructed otherwise by their physicians, patients should continue to take their medications. Patients who have used Viagra (sildenafil citrate), Cialis (tadalafil), Levitra (vardenafil) or other erectile dysfunction (ED) medication  within the 24 hours before to the test, should tell the technician. It may affect the safety of the test.
  • Wear comfortable walking shoes and clothing for the test.

Additional Information

An echocardiogram is not harmful in any way, but patients might feel slight discomfort from the pressure of the probe.

A stress echocardiogram is not painful, but it is physically demanding. Most patients experience some fatigue.

There is a very small risk of complications (heart attack, irregular heart rhythm). Everything is done to prevent this from happening. Medical staff and emergency equipment are on hand to assist in an emergency.