Objective of the examination
The stress test that is most frequently carried out in the cardiology department is the exercise test (cycle test). In some cases, however it is insufficient to be able to fully exclude a narrowing of the arteries of the heart.
Before referring the patient for a more invasive diagnosis, i.e., the coronarography, an additional stress test may already shed some more light.
The aim of this examination is to make the heart beat faster so the heart muscle will start to use more oxygen (as it does for example when running or cycling). If the heart's arteries are narrowed the patient will start to experience a lack of oxygen and the heart muscle will contract less as a result. This becomes clear when the heart is required to make an effort.
The additional stress test is carried out by means of an echocardiogram and there are two options: the stress echocardiogram on the recumbent bicycle and the dobutamine stress echocardiogram.
A stress echocardiogram is used for patients who are capable of making a physical effort such as cycling.
- You can eat or drink before this examination.
- Because the reason for the examination varies you will need to discuss with your cardiologist whether your medication needs to be adapted or stopped.
- We recommend that you wear clothes which are suited for cycling.
You will be asked to get onto a recumbent bicycle which will be slightly tilted into a left lateral position. Electrodes will be placed on your chest and back for continuous ECG monitoring. The stress test starts with a slight effort. The resistance will be gradually raised. In addition to the electrocardiogram we will also carry out an echocardiogram in order to detect narrowing of the coronary arteries during the test.
This type of stress echocardiogram is also used to evaluate certain valve disorders or certain disorders of the heart muscle, including thickening of the heart muscle (hypertrophic cardiomyopathy).
This test lasts about 30 minutes.
- The risk associated with a stress test is small but present nevertheless. Careful monitoring in most cases will allow the doctor in most cases to respond to possible complications such as arrhythmias in a timely and adequate manner.
- Please immediately notify the doctor of any complaints during the test, including pain in your chest.
- You can go home after the test.
Dobutamine stress echocardiogram
The dobutamine stress echocardiogram was specifically developed for patients who are incapable of making a physical effort (for a cycle test for example).
Because of their reduced physical capacity certain complaints may remain hidden such as pain in the chest. To generate and detect these disorders a dobutamine stress echocardiogram is carried out.
- A brief stay in the day clinic (EH19) will be scheduled. Two catheters will be placed in the patient's arm. The dobutamine IV will be inserted in one catheter, a contrast dye can be injected during the test through the other catheter for better image quality (Sonoview). It will not be used if the patient is allergic to contrast dyes or in case of unstable complaints relating to the narrowing of the heart arteries or in case of significant underlying pulmonary disorders.
- You can have a light lunch, but after that you will not be allowed to drink or eat.
- The test aims to raise your heartbeat and to this end all medication that slows down your heart rhythm will have to be stopped 48 hours before the examination. We recommend that you confer with your cardiologist to see how you can stop your medication with beta blockers and calcium antagonists in a responsible way. If you experience any problems during this time, due to the stopping of your medication, you need to contact your physician or cardiologist.
You will be asked to lie on the examination table with a bare torso. Electrodes will be placed on your back and chest for ECG monitoring.
Dobutamine will be administered through an IV and the dosage will be increased. By administering dobutamine we will mimic a physical effort, making the heart beat faster as if the patient were making a physical effort.
This stress will lead to an increased need for oxygen in the heart muscle and if the heart's arteries have significant narrowing then this will become obvious because of the lack of oxygen in your heart muscle. The ultrasound images made by the cardiologist will then highlight deviations, as well as the lack of oxygen.
Usually heart muscle disorders, which are detected with echocardiograms, will occur sooner.
The test lasts about 30 minutes.
These tests are usually carried out in the afternoon so you can leave the hospital around 4 p.m.
- As with every stress test there are always possible complications but this test is widely considered to be safe in medical literature and serious complications are very rare.
- In case of complaints while cycling, including palpitations or chest pain, you immediately need to notify the doctor.