Stress Echocardiography

Stress echocardiography (stress echo) is an ultrasound test performed while your heart is working harder, usually during exercise on a treadmill or bicycle, or with an intravenous medication that makes the heart beat faster and stronger. At KMH you will exercise on the treadmill. Images taken before and immediately after this ‘stress’ help assess how well the heart muscle and valves function when blood flow demand is increased, and can detect problems such as reduced blood flow from coronary artery disease or abnormal heart wall motion.

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Test Preparation

• If your appointment is for a non-stressed echocardiography test, please refer to the specific appointment preparation instructions here.
• If you take Viagra, Levitra, Stendra or Muse, please contact your doctor’s office to receive approval to discontinue for 24 hours before the test. If you are taking Cialis, please contact your doctor’s office to receive approval to discontinue for 96 hours before the test.
• Consult your doctor to determine if temporarily discontinuation of Beta blockers (like Metoprolol or Atenolol) or Calcium channel blockers (like Diltiazem or Verapamil) 24 hours prior to this test is recommended.
• Consult your doctor for approval to temporarily discontinue any medications containing caffeine i.e. prescribed Tylenol/Lenoltec 1, 2, or 3 for 12 hours prior to this test. There is no caffeine in over-the-counter Tylenol.
• Please do not stop any medications without your doctor’s approval. If your referring physician did not provide instructions to stop your medication, we will continue to do the test based on what your referring physician requested.
• Please do not consume any caffeine or decaffeinated products 4 hours prior (no tea, herbal tea, coffee, decaf coffee, chocolate, soda pop or medications containing caffeine).
• You can have a light breakfast or lunch on the day of the test.
• Do not apply any lotion, cream or oil to the chest area on the day of the test.

What to Bring

• Please wear loose fitting, comfortable clothing (athletic clothing) and running shoes.
• Please bring your health card with you to your appointment.
• If you are not covered through OHIP, please bring any insurance information.
• Bring a list of your current prescription medications and vitamins/supplements.

Other Notes

• If you do not speak or understand English, please ensure you can bring someone to your appointment that can communicate and understand English, and that they can stay for the full duration of your appointment.

Arrival Time

• Please arrive 15 minutes prior to your scheduled appointment to check-in.
• If you late cancel or no show for your appointment, you may be charged a cancellation fee.

During the Test

• Several electrode pads will be placed on your chest. The sonographer will take a few ultrasound images at rest. You will begin walking on the treadmill, and then the speed and incline will increase in stages. Your heart rate will rise, which is expected. You will be encouraged to exercise for as long as possible because this will increase the test effectiveness. When the stress target is achieved, if you cannot continue the exercise, or if the technician has a reason to stop the treadmill before the target heart rate is reached (ECG changes, symptoms or blood pressure changes), we will stop the treadmill and you have to quickly transition to the bed for more ultrasound images with an elevated heart rate. 
• After the stress part of the test is over, you will be seated for a few minutes. The ECG and your blood pressure will be monitored. The sonographer will take a few more ultrasound images for the recovery time.
• You will be regularly monitored during your appointment. Should you have any symptoms during the stress procedure, our medical staff and physician will take the necessary measures to assess and treat your condition. Please inform us if you experience any side effects or discomfort at any time throughout your appointment.
• The entire testing process typically lasts between 30 to 60 minutes.

After the Test

• You will be able to return to your normal activities when the test is complete, unless your physician or technician tells you otherwise.
• Your referring physician should receive your results in approximately 7-10 business days.

Contact Details

• You can reach us at 1-877-564-5227, extension 2. Our call centre is open Monday to Fridays from 8am-6pm, and Saturdays from 9am-5pm. If you have a next-day or same-day appointment, you can reach us outside of our call centre hours, by pressing extension 7.

Frequently Asked Questions (FAQ)

Can I access my medical images and reports through PocketHealth?

• For access to your medical images for your echo, we can provide them on a CD as needed. Please contact us directly.

How do I get to the clinic?

• For directions to the clinic and the nearest major intersection, please see Locations & Directions

Can I proceed with the appointment if I am on oxygen?

• We’ll need to understand why you’re on oxygen to determine if we can proceed. Depending on the underlying condition, we may not be able to proceed with the appointment.

Is it okay to wear body lotion or perfume for my appointment?

• Please do not wear any scented products to the appointment.

What if I've misplaced my health card?

• You can still attend your appointment if you bring a printed copy, photocopy, or photo of your health card.

Will there be any out-of-pocket costs?

• Most services, including Specialist Consults and diagnostic testing, are covered by OHIP.
• If you're paying privately, some insurance providers can be billed directly.
• In other cases, you may need to pay upfront and submit the receipt to your insurance.
• If you do not have OHIP coverage, out-of-pocket payment is required.

Do you have wifi at the clinics?

• Yes, we have wifi available.

Where can I provide feedback or file a complaint?

• You can provide feedback or file a complaint via email at [e-mail] or by visiting our website here.

Can you provide a doctor's note that can send to my employer?

• Yes, we can provide work letters on the day of your appointment. Please ask the reception team.

Can I get a flu shot prior the appointment?

• You can get a flu shot prior to the appointment. This will not have any affect on the test results.

What is an echo test?

• An echocardiogram (often called an "echo") uses ultrasound to visualize the heart's structure and function in real-time. It is used to assess the health of your heart or guide your physician in the treatment plan of any heart disorders.

Are there any fasting requirements?

• No, there are no fasting requirements for this test. You can eat normally before your echocardiogram.

How long will I be on the treadmill if I have an exercise stress test?

• If your appointment is for a stress echocardiogram test, the length of your exercise is dependent on your stress tolerance and health. You are encouraged to exercise for as long as you can until you feel fatigued or aim to reach at least 85% of your Target Heart Rate. The stress procedure follows the 7-stage Bruce’s Protocol for a maximum of 21 minutes. Each stage lasts for 3 minutes and the treadmill increases in speed and incline for every stage.

Why do we also ask female patients to get approval to discontinue Viagra, Levitra, Cialis, etc.?

• Medications such as Viagra can be prescribed for a wide range of things for both men and women. For example, Tadalafil (i.e. Cialis) can be used to treat erectile dysfunction, enlarged prostate, and also pulmonary hypertension. The stress test will have to be rebooked if these medications have been consumed.

Can I work out or exercise prior to my test?

• Yes, you can work out or exercise prior to your test.

Can I take antihistamines prior to the appointment?

• Yes, antihistamines are ok to take before your appointment. This includes, for example Benadryl, Reactine, Aerius, Claritin, Allegra and Blexten.

What should I wear to the appointment?

• Wear comfortable clothing. A two-piece outfit is best, since you will need to undress from the waist up. A gown will be provided for your comfort and privacy, and the technologist will keep you covered as much as possible during the test.

How should I prepare if I have a pacemaker or other implants?

• No special preparation is needed for an echocardiogram if you have a pacemaker or other implanted device. Please inform the technologist about any implants when you arrive for your appointment.

Is the test painful or uncomfortable?

• The echocardiogram is not painful. You may feel some pressure from the probe and the coolness of the gel, but this is normal. If you experience any discomfort, let the technologist know and they can adjust the pressure.

Will contrast dye or an injection be required?

• Not usually. In some cases, a small amount of contrast (a microbubble solution) may be injected through an IV to improve the image quality.

Am I able to drive after the test?

• This test does not affect your ability to drive. You may resume your normal activities after the test. (e.g. go to work after).