Treadmill Stress Echocardiogram (TSE)
You have been asked to attend to have a Treadmill Stress Echocardiogram (TSE). This leaflet is designed to help you understand the procedure.
What is a Treadmill Stress Echocardiogram (TSE)?
A treadmill stress echocardiogram (TSE) is an ultrasound scan of the heart taken after you have performed exercise.
The exercise is usually performed by you walking on a treadmill. You may need to walk quickly but will not be asked to run. Immediately after being on the treadmill, you will be asked to lie down so someone can perform the ultrasound.
The TSE is performed for one of the following reasons:
- To assess for narrowings in the heart arteries (most common reason). When your heart rate increases with exercise and the heart muscle pumps harder, it needs more blood supply. If there are significantly narrowed blood vessels, an area of the heart may not receive the required blood flow and not contract as well, which we can see with ultrasound.
- To provide detailed assessment of the function of the heart valves: valves are like doors that open and close in the heart, allowing blood to flow in the correct direction, and stops it going the wrong way. Sometimes is it unclear whether a patient’s symptoms are due to a problem with the heart valves. On other occasions, a patient can have a severely narrowed or leaky valve and it is unclear whether this is truly causing symptoms or causing strain on the heart or lungs. By taking pictures of the heart and valves and assessing them after you have exercised, we can help answer these questions.
- To assess the heart muscle in patients with potential heart muscle disorders: assessing the pumping of the heart during exercise is important in the assessment and treatment of some heart muscle disorders, known as cardiomyopathies.
These can include the following:
- Hypertrophic cardiomyopathy (HCM or HOCM): this is thickening of the heart muscle and on exercise can lead to shortness of breath or dizziness as the blood can struggle to leave the heart properly due to the thickened heart muscle.
- Athlete’s Heart vs. Cardiomyopathy: in some people who do a lot of exercise, the heart can become enlarged, or the heart muscle can become thickened. This is a normal feature to help the heart meet the demands of your exercise and is known as ‘Athlete’s Heart’. However, in some cases, the enlargement or thickening of the muscle may be due to an underlying condition. Assessing the heart’s pumping whilst exercising or after a moderate amount of exercise can help distinguish between Athlete’s Heart and cardiomyopathy.
Do I still take my medications?
PLEASE READ CAREFULLY
Certain medications must be stopped for 48 hours before the test (i.e. do not take on the morning of the test or the day before) as these medications can hinder exercise. If you have taken them within 48 hours prior to the test, the test will not be performed.
THE DRUGS THAT MUST BE STOPPED FOR 48 HOURS ARE:
- Beta-blockers: Atenolol, Propranolol, Nebivolol, Bisoprolol, Carvedilol, Metoprolol
Eating and drinking before the test
Please do have a light meal before the test and avoid caffeine containing food or drink, such as tea, coffee and coke. Being well hydrated is however important so please drink plenty of water before the test.
What should I wear?
Please wear comfortable closed flat shoes. If possible, please avoid long dresses/outfits that may become tangled by you walking on the treadmill. A two-piece outfit, e.g. skirt or trousers/jogging bottoms and a top are preferable
What happens when I arrive at the hospital?
Please report to the reception desk to check you in.
You will be asked to sit in a chair in the waiting area until you are called in to have the scan.
After being called into the scan room, a doctor or sonographer will come and see you to explain the test and then will ask you to sign a consent form agreeing to have the test. You will be asked some questions and you will be given time to ask questions.
Before your procedure you’ll be asked to remove all clothing from the top half of your body as the test can only be performed on a bare chest.
Occasionally we may need to administer a contrast agent (dye) in through a cannula (plastic tube in a vein) to see the heart more clearly. This is not the same contrast that is used in CT scans and does no harm to the kidneys, but people can very rarely be allergic to this.
How is the TSE done?
The first part of the test is performed by taking pictures of your heart while you are lying on your left side at rest. The resting blood pressure will be measured and the rhythm of the heart will be monitored throughout the procedure.
You will then be asked to go on the treadmill. You will start walking slowly at the beginning and every 3 minutes the speed and incline of the treadmill will gradually increase.
Once you have achieved your target heart rate (based on your age), which represents the peak of the exercise for the test, we’ll suddenly stop the treadmill and you will be guided and supported to reach the bed and lye on the left hand side to take additional pictures of your heart whilst the heart rate is still at target.
After the scanning you can relax on the bed until your blood pressure and heart rate return to resting levels.
Are there risks to having the procedure?
Most people have no difficulties with the procedure. There are very slight risks as the heart is being exercised, however overall, the test is very well- established and very safe.
Risks associated with the TSE are chest pain, shortness of breath, abnormalities of the heart rhythm as well as a smaller risk of a heart attack.
The contrast agent (dye) is safe for the majority of people, however there is a rare risk of an allergic reaction, that would range from a rash with itchiness to throat swelling, or anaphylaxis.
What happens after the test?
Once the test is completed you will be able to change back into your top items of clothing and you will be free to go home.
If you stopped taking any medications for the test, you can take them again after the test has been completed.
Will I know the results of the test?
The doctor or sonographer who performed the procedure will examine the pictures saved during the TSE and the full report will be sent to your referring specialist who will then correspond with you and your GP to decide further management.
Contact information:
If you have any questions about your planned Treadmill stress echocardiogram, please contact (Monday to Friday, 9:00am to 4:30pm):
Diagnostic Cardiology – ECG Department (Chelsea and Westminster Hospital)
Tel: 020 33153443 / 5
Diagnostic Cardiology – ECG and ECHO Department (West Middlesex University Hospital)
Tel: 020 8560 5336
This leaflet was written by:
Teresa Rutigliano (Senior Chief Cardiac Physiologist)
Reviewed and approved by:
Dr G Sunthar Kanaganayagam
Consultant Cardiologist and Cardiology Imaging Lead