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Supine bicycle stress echocardiogram

By obtaining heart ultrasound images of the heart at work, the stress echocardiogram, or stress echo test, offers an opportunity for better diagnosis

Recently I went to the hospital for an treadmill stress echocardiogram. When I got there, I found out that I was going to have a different procedure – using a supine (lying on your back) bicycle.

Typically, for an stress echocardiogram test doctors do an echocardiogramto see the heart’s function at rest, then the patient exercises on a treadmill or stationary cycle while having a constant electrocardiogram (EKG), and finally the patient lies down and has a second echocardiogram to show the heart’s performance immediately after exercise.

The advantage of the supine bicycle exercise stress echocardiogram is that it compares the performance of your heart at rest to the performance of your heart during peak exercise, as well as after exercise. Imaging can be performed continuously during supine bicycle exercise, which gives the doctors a much better opportunity to assess the functioning of your heart. The new equipment allows rotation of the patient and provides cutouts in the table surface that make it easier for the technician to conduct the echocardiogram while you exercise.

What to expect

You will probably change into a hospital gown before the test starts.

The nurses will hook you up to a 12-lead electrocardiogram (EKG), and strap you onto a bed with a cycle on the bottom. The reason you are strapped on is because the bed tilts to allow the technician to do the echocardiogram while you are pedalling It can feel a little awkward! As well, your heart rate and blood pressure will be monitored throughout the test.

First they will do an echocardiogram while you are at rest. In my case, the cardiologist was particularly concerned about the function of my bicuspid aortic valve and wanted to get a good sense of how well it was functioning before going ahead with the rest of the test. The result – borderline severe but good to go with the test!

You will then be asked to start pedaling at a constant speed beginning with a very light resistance. Every three minutes the resistance on the cycle is increased. Meanwhile, they they will be getting ultrasound images of your heart in action via the echocardiogram as well as watching your heart rate, EKG, and blood pressure.

At intervals you will be asked if you are feeling any pain and how hard you are finding the exercise.

The doctors will stop the stress echocardiogram test

  • when you reach your maximal heart rate
  • if the echo shows onset of new or worsening heart wall motion abnormalities
  • if you experience severe chest pain
  • if your EKG shows changes indicating a problem
  • if they are concerned about your blood pressure (too high or too low)
  • if you are experiencing tachyarrhythmias (very rapid heart rate). It's normal for our hearts to beat rapidly in response to exercise. During exercise, the electrical signals and rhythmic beats follow the same cycle as a resting heart only at a much faster rate. But certain conditions can interrupt this normal cycle, causing the ventricles to pump faster than the atria. The can cause symptoms such as shortness of breath, weakness, dizziness, lightheadedness, fainting, or a feeling of fluttering in the chest (heart racing).

Tips on preparing for your supine bicycle stress echocardiogram test

  • Wear comfortable clothing (a jogging suit is good) and running or walking shoes.
  • You will most likely change into a hospital gown from the waist up.
  • You will have a blood pressure cuff on your arm duing the stress test.
  • Don't wear nylon pants as they can cause static for the EKG.
  • Generally you should take your prescribed medication at the usual times, but check your instructions from the hospital or clinic or consult with your doctor.
  • Bring a list of your medications and dosages with you (actually you should carry this information with you at all times in your wallet or purse).
  • Don't put on body lotion or cream - it may prevent the adhesive pads used to attach the EKG leads to your body from sticking.
  • Don't drink coffee, tea, or soft drinks for four hours prior to your stress test - caffeine can affect the heart rate and rhythm. If you take any pain medications, check with your pharmacist to find out if they contain caffeine. If they do, you shouldn't take them for 24 hours prior to your stress test.
  • Don't drink alcohol for 12 hours prior to the test.
  • Eat lightly before your test - it can be uncomfortable to exercise with a full stomach.

The entire stress echocardiogram procedure can take approximately 45 minutes to an hour. After the test, you may get dressed and carry on with your day.


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