Unveiling the Difference Between Stress Echocardiogram and Stress Test

It is no brainer that a healthy heart is the key to having a healthy life. After the recompiled blood pressure guidelines, AHA has put over 30 million Americans under the heart risks and hypertension scale. Heartaches or heart disease term is specifically referred to conditions where the functions of the heart are compromised.

If you have ever been into a cardiac issue, your doctor must have prescribed you one of these two tests – echocardiogram (echo) or stress echocardiogram (stress test). Understanding the reason behind the two tests will clear up the confusion and eliminate the chances of rescheduling the cardiac appointment.

Read also: Cardiothoracic Field of Medicine


An echocardiogram is a detailed evaluation of the four chambers of the heart. It is performed using a hand-handled probe by which ultrasound waves pass through to create images of heart chambers and valves. These images will help identify the pumping and beating of the heart. In addition, cardiologists often use a doppler during the echo to create colored images that show the blood flow through the heart on the monitor.

Following are some complications due to which cardiologists often prescribe echoes to patients.

  • Shortness of breath (dyspnea)
  • Chest pain
  • Identification of a heart murmur (new) during the exam

If this happens to you for the first time and you visit your general physician for complications, he would also ask you to get an echo test. Because this test will rule out certain ambiguities that you may be having regarding the pain.

Besides, this test does not need any NPO (Nil per os) which is a Latin word meaning ‘nothing by mount’ that refers to abstaining from fluid or food prior to the test. The patient is allowed to have anything before the test and wear regular shoes and clothes. The test takes around one hour to be performed in normal conditions.

Once the echo test is performed and if the results fall in coronary heart disease (CHD) or any other serious heart disorder, the physician will likely recommend a stress echo test.

Stress Echocardiogram

A stress echocardiogram is performed to monitor the heart in live action. The stress test is also referred to as a treadmill test that joins the ultrasound waves to the heartbeat to analyze how the heart performs when the additional workload is applied.

The stress echocardiogram test consists of three stages.

In the first stage, the patient is asked to lie down on the examination table and a physician will measure the LV (left ventricular) function at the rest state.

The second stage is performed on the treadmill where the speed of the treadmill is increased after every three minutes to gradually put stress on the heart to monitor its behavior under increased stress. After every three minutes, before the speed is changed, the technician checks the heart health and notes the symptoms, level of pain, and heartbeat that differs between the intervals.

The patient will keep running on the treadmill until they reach their targeted heart rate or at the stage where they get short of breath or any other serious condition that may arise during the test.

At stage three, the doctor will immediately examine the patient on an examination table once again and will perform another echo test to monitor the LV (left ventricular) function.

Keep in mind that a stress echo test will only be prescribed if there is a symptom of CHD during the echo test. Also if any unusual heart behavior is found in the echo test or any other abnormality related to the heart that may require further examination.

Stress Echocardiogram Preparation

Stress Echocardiogram Preparation
Source: hopkinsmedicine.com

Unlike an electrocardiogram or echocardiogram test, a stress echo test would require an NPO. For this, the patient would be asked to refrain from food and fluids for a maximum of three to four hours but water before the test. If a patient is having treatment for hypertension (beta-blockers) or coronary heart disease, they may also be required to stop their medication for the day of the echo procedure. Beta-blockers (medicines for hypertension treatment) often decrease the heart rate response which may affect the readings of the echocardiogram that measures the LV function at rest.

A person taking beta blockers will comparatively have a lower heart rate at the examination table and they may even have a hard time on the treadmill test to reach an ideal heart rate. The stress echocardiogram will likely take 80-90 minutes to complete the test.


Depending on the results, your cardiologist would likely require you to have medications to control your hypertension, high blood pressure, pain, or any other condition that can be controlled through medicines. On the other hand, if the test results show coronary heart disease or abnormalities in your heart rate or heart behavior, you are likely to be referred to angiography or therapy for CHD.