Echocardiograms and Exercise Tolerance Tests

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An echocardiogram, commonly referred to as an echo, is a type of cardiac ultrasound test that provides direct visualisation of your heart, particularly the left and right ventricles and the nearby blood vessels. An echocardiogram assesses the heart from an anatomical, structural and functional point of view. It looks at the heart size and structure and how well blood flows around the heart.

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An echocardiogram has multiple functions, including:

·      Assessing the overall function of your heart.

·      Assessing the size and structure of your heart.

·      Detecting any issues with the heart valves, such as any narrowing or regurgitation.

·      Detecting any issues with the chambers of the heart.

·      Detecting any diseases of the pericardium (the membrane that surrounds your heart).

·      Detecting heart failure, congenital heart defects, heart infections, heart diseases and other heart conditions.

What Does an Echocardiogram Test Involve?

An echocardiogram is performed by a cardiologist or physiologist. During the echo, a probe sends high-frequency sound waves into your heart. The sound waves bounce off different parts of your heart and the surrounding areas, creating a moving picture of your heart valves and chambers whilst pumping and functioning.

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There are several different types of echocardiograms, including:

1.      Transthoracic echocardiograms.

2.      Exercise stress echocardiograms.

3.      Transoesophageal echocardiograms.

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Echocardiograms usually take between 20 and 30 minutes and are most commonly performed if you experience symptoms such as shortness of breath, palpitations, chest pain, dizziness or fainting episodes.

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An Echocardiogram is an important diagnostic and screening test. It allows the cardiologist to identify any abnormalities in the structure or function of your heart. If the echo shows that one of the walls of your heart is contracting less than others, this could be an indirect sign of a possible blockage in the coronary arteries (the arteries delivering the blood to your heart muscle). In this situation, this could prompt your cardiologist to request an Exercise Tolerance Test (ETT).

Exercise Tolerance Tests (ETTs)

An exercise tolerance test (ETT) is an important electrocardiogram (ECG) test. It assesses the electrical activity of your heart while under physiological stress. It also looks at your heart rate and rhythm and how well blood circulates around your heart while you are exerting yourself. As part of the ETT, you will be first attached to an ECG machine at baseline. You will then exercise on a treadmill or a stationary exercise bike while the cardiologist assesses your heart.

ETTs and Echocardiograms

Following your echocardiogram, an exercise tolerance test may be recommended. This could be for multiple reasons.  

If your cardiologist suspects coronary artery disease, they will recommend an ETT. During exercise, your heart rate increases the blood flow in your coronary arteries. If you have coronary artery disease, your symptoms are more likely to manifest during exercise and the ECG machine will display abnormal results. An ETT can give an idea of which coronary artery is blocked and how severe the blockage or damage is. This will then prompt further testing, such as a coronary angiogram or a CT coronary angiogram.

If your echocardiogram shows that one of the walls of your heart is not contracting correctly, this could suggest that you have previously had a heart attack. An ETT can help detect any blocked arteries which could result in another heart attack.

You may also be recommended an ETT if your heart contracts more slowly than normal, which could be consistent with bradycardia. An ETT can show whether your heart rate increases normally during exercise and whether your heart can pump strongly enough.

In some cases, an echocardiogram may be combined with an ETT in a treadmill stress echocardiogram