Stress Echo

• Detects exercise- or pharmacologically induced myocardial ischaemia by assessing regional wall motion abnormalities

• Images taken at rest and peak stress (exercise or pharmacologic)

• Indicated for suspected coronary artery disease or when baseline ECG changes limit exercise ECG interpretation

Contraindications

• Absolute:

  • Recent MI or new LBBB

  • Unstable angina

  • Uncontrolled arrhythmias

  • Severe hypertension (>180/110 mmHg)

  • Severe aortic stenosis

  • Hypertrophic obstructive cardiomyopathy (HOCM)

Risks

• Rare but serious: MI, sudden death

• Common: Arrhythmias, hypotension, syncope

• Potential ischaemic episodes in significant coronary disease

Notes:

• Ensure blood pressure control before testing, especially in severe hypertension or aortic stenosis

• Use pharmacologic stress (e.g. dobutamine) for patients with limited exercise capacity

• Preferred when exercise ECG is inconclusive (e.g. baseline ECG abnormalities: bundle branch block, paced rhythm)

• Strict contraindication screening reduces major adverse events

• Consider nuclear stress test or CT coronary angiogram if stress echo findings are equivocal or if high-risk features are present

• Patient education and monitoring protocols enhance safety and diagnostic accuracy