Exercise Stress Echocardiogram

An exercise stress echocardiogram is an ultrasound of your heart taken before and after exercise. It produces moving images that show how well your heart functions under stress. Providers use this test to diagnose or monitor heart conditions and ensure you get the treatment you need.


What is an exercise stress echocardiogram?

An echocardiogram, or echo, is a test that shows how well your heart is working. It uses sound waves (ultrasound) to produce moving images of your heart. These images allow your provider to see the shape, size and motion of your heart and valves.

An exercise stress echo assesses your heart’s function when it’s beating fast. You create this “stress” by exercising on a treadmill or bicycle.

This test is also commonly called stress echo or echo stress test.

Are there other types of stress tests?

Other types of exercise stress tests include:

  • Exercise stress electrocardiogram: This test uses an electrocardiogram (EKG) to measure the electrical activity of your heart while you exercise.
  • Nuclear exercise stress test: In this test, you receive a small, safe injection of a radioactive substance into a blood vessel. Special imaging before and after exercise detects the radiation and highlights blood flow to your heart.

For people who can’t exercise, there are two alternate ways to create stress on the heart. Providers use these methods for stress echocardiograms, EKGs and nuclear tests:

  • Pharmacological stress test: This test uses medications, including dobutamine and vasodilators, to produce stress. Dobutamine increases the heart rate. Vasodilators expand the blood vessels, which increases blood flow through the heart.
  • Pacing stress test: You may receive this test if you have a permanent pacemaker to help stabilize your heart rhythms. Your provider programs the device to raise your heart rate during the stress test.


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When is an echo stress test performed?

Healthcare providers use exercise stress echocardiograms most often to diagnose coronary artery disease. This condition occurs when the blood vessels that carry blood to your heart muscle become blocked.

Stress echo can help diagnose or monitor the status of other conditions, such as:

Who should have a stress echo test?

You may receive this test if you have symptoms of heart disease, especially if they get worse with activity. These symptoms include:

Other people who might have an exercise stress echocardiogram include:

  • Athletes.
  • People who are about to have surgery.
  • People exposed to extreme conditions, such as when diving or at high altitudes.


Who should not have a stress echo test?

A stress echo might be unsafe if you have certain heart conditions, such as:

Who performs an exercise stress echocardiogram?

Usually, a cardiac sonographer performs this test under the supervision of a physician. It may take place at your provider’s office or a medical center.


Test Details

How does an exercise stress echo work?

An echocardiogram uses an ultrasound transducer to send out sound waves. The waves bounce, or echo, off solid tissues but move through softer tissues. The transducer captures the echoes and converts them into moving images.

An echo stress test shows how your heart responds to hard work. For example, if you have a blocked coronary artery, the muscle tissue that receives blood from that artery may not function well under stress. By comparing echocardiogram images under stress with those at rest, your provider can see this change in muscle function.

How do I prepare for an echo stress test?

Your provider will give you specific instructions on how to prepare. Substances such as caffeine, medications, food and nicotine can interfere with the test. In general, you should:

  • Avoid caffeine for 24 hours before the test.
  • Follow your provider’s instructions about taking your medications on the day of the test. Don’t discontinue any medications without talking to your provider.
  • Not eat or drink anything in the hours before the test.
  • Stop smoking or using tobacco products that day.
  • Wear comfortable clothes and shoes that you can walk in.

What can I expect during the exercise stress echocardiogram?

An exercise stress echo typically follows this process:

  1. A technician attaches electrodes (small, flat, sticky patches) to your chest. These electrodes connect to an electrocardiograph (EKG) monitor that tracks your heart rate. You’ll also wear a blood pressure cuff to record your blood pressure throughout the test.
  2. While you’re resting, the sonographer performs an initial EKG and echocardiogram. For the echocardiogram, you lie on your left side. The sonographer holds an ultrasound wand (transducer) in different positions on your chest to collect images.
  3. You then exercise on a treadmill or stationary bicycle, starting slowly and gradually increasing intensity. You continue to exercise until you reproduce symptoms or reach your target heart rate, which varies depending on your age and fitness level. The actual exercise time is about 10 to 15 minutes.
  4. Let your provider know if you feel any unusual symptoms, especially pain, pressure or discomfort in your chest, arm or jaw. Other symptoms to report include shortness of breath, dizziness and lightheadedness.
  5. When you reach your target heart rate, you get off the treadmill and return to the exam table for a repeat echocardiogram. If you’re on a bicycle, the sonographer may perform the echocardiogram while you’re pedaling.
  6. It’s normal to feel your heart rate and breathing rate increase while exercising. You may also feel slightly unsteady when you get off the treadmill or bicycle.
  7. The test should take about an hour.

What happens after the exercise stress echo?

After the final echocardiogram, you return to the treadmill or bike and walk or pedal slowly to cool down. Once your blood pressure and heart rate return to normal, you can go home.

What are the risks of a stress echocardiogram test?

Exercise stress echocardiography is safe and has few side effects. The main risks are due to your underlying heart condition. By stressing your heart, you may experience symptoms such as an abnormal heart rate (arrhythmia) or chest pain and pressure (angina). Your provider will monitor you closely for signs of distress throughout the procedure and stop the procedure if necessary.

Results and Follow-Up

What do the results mean?

The results tell you if your heart is functioning as it should or if you have heart disease. Your provider will explain the findings and discuss your next steps, which may include additional testing or treatment.

A note from Cleveland Clinic

An exercise stress echocardiogram is one of many tests providers use to diagnose and monitor heart-related diseases. It assesses your heart function under stress and can show problems that aren’t visible when your heart is resting. Your provider may recommend an echo stress test if you have symptoms of heart disease or an existing heart condition. A stress echo is a safe, quick test that provides important information about your heart health.

Medically Reviewed

Last reviewed on 07/08/2022.

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