Stress echocardiography (stress echo) is a method in which various stimuli are used to elicit
myocardial contractility or provoke cardiac ischemia with simultaneous echocardiographic
image acquisition of left ventricular function and valvular flow, if needed. The technique is a
well-recognized, safe and widely available stress test used for the diagnosis and assessment
of prognosis in coronary heart disease, but may also prove valuable in valvular heart disease.
The stressors used include physical exercise, pharmacological agents (dobutamine, vasodilators)
and pacing stress, most often with the use of a permanent pacemaker. Two operators
should perform the test: a physician experienced in stress echocardiography (at least 100 tests
completed under supervision of an expert) and a trained nurse or another doctor. The laboratory
should feature a defibrillator and a resuscitation kit with a set of pharmaceuticals, an
intubation kit and an AMBU bag. Pacing stress echo requires an external programmer for the
implanted permanent pacemaker. Exercise should be the preferred stressor for the diagnosis
of ischemic heart disease with alternative of high-dose dobutamine test in cases of contraindications
to physical stress. Pacing stress echo is recommended for patients with pacemakers,
and dipyridamole test for the assessment of coronary flow reserve. Chest pain in patients with
intermediate probability of coronary artery disease, inability to perform physical exercise and
non-diagnostic resting or exercise electrocardiography are indications for stress echo. The test
is also used in symptomatic patients after revascularization or patients qualified for revascularization
for functional assessment of coronary artery stenosis. Low-dose dobutamine test
is usually performed in patients after myocardial infarction or with moderate-to-severe left
ventricular dysfunction to assess myocardial viability before potential revascularization.
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