A stress echocardiogram — often called a "stress echo" — combines an ultrasound of the heart with a treadmill exercise test. It shows the cardiologist how your heart performs under physical load, helping to detect coronary artery disease, evaluate valve function and assess your fitness for exercise. This guide walks through what to expect, how to prepare, and how the test compares with other heart investigations.
What is a stress echocardiogram?
A stress echocardiogram is a non-invasive test that combines two techniques: a standard echocardiogram (an ultrasound of the heart) and an exercise test on a treadmill. Ultrasound images of the heart are recorded at rest, then again immediately after exercise, while your heart is still working hard. By comparing the two sets of images, the cardiologist can see how the heart muscle and valves behave under load.
The test uses ultrasound only — there is no radiation and no intravenous contrast required for a standard exercise stress echo. It is one of the most commonly used tests in cardiology because it provides a great deal of clinically useful information without exposing the patient to radiation or invasive procedures.
A stress echo shows whether your heart muscle, valves and blood flow work normally when your heart is asked to work harder than usual.
When your doctor might recommend one
Your GP or cardiologist may suggest a stress echocardiogram for a number of reasons. The most common are:
Chest pain or breathlessness on exertion
To investigate whether exercise-related symptoms are caused by reduced blood flow to the heart muscle.
Suspected or known narrowing of arteries
To assess whether narrowings in the heart's arteries are limiting blood flow during exercise.
Heart valve disease under load
To measure how the heart and its valves behave under stress — particularly in aortic stenosis or mitral valve disease.
Functional capacity assessment
To establish a safe level of exertion before cardiac rehabilitation, surgery, or returning to activity after a cardiac event.
Before non-cardiac surgery
To evaluate the heart's reserve and stratify risk before major surgery in patients with known or suspected heart disease.
Exercise-induced rhythm problems
To detect abnormal heart rhythms that only become apparent with physical exertion.
How to prepare for your stress echocardiogram
A few simple steps will help your test run smoothly. If you have any concerns or specific questions about preparation, please call us before your appointment on (02) 8401 9598.
Comfortable exercise wear and supportive shoes
Wear loose, comfortable clothing and supportive walking or running shoes. You will be exercising on a treadmill, so dress as you would for the gym.
Light meal only — no heavy meals
Avoid heavy meals for 3–4 hours before the test. A light snack and water are fine.
Avoid for 24 hours before the test
Skip coffee, tea, energy drinks, chocolate, and nicotine products for 24 hours before your appointment, as these can affect the accuracy of the test.
Continue as usual unless told otherwise
Continue your usual medications unless your doctor advises otherwise. Bring a current list — including doses — to your appointment.
The procedure step-by-step
The full appointment takes around 45–60 minutes. The active exercise component is comparatively short — usually 6–12 minutes — and the rest of the time covers preparation, image acquisition, and recovery.
You'll lie on the examination bed while the cardiologist or sonographer records ultrasound images of your heart at rest. ECG electrodes are placed on your chest and a blood pressure cuff is fitted. These resting images become the comparison point for the post-exercise images later.
You walk on the treadmill, with the speed and incline increasing every few minutes following a standard protocol (most commonly the Bruce protocol). Your heart rhythm, blood pressure and any symptoms are monitored continuously. The aim is to reach a target heart rate based on your age, or to develop symptoms that explain why we are doing the test.
As soon as you stop exercising, you return promptly to the bed for repeat ultrasound images while your heart is still working hard. Speed matters — the post-exercise window is narrow, and these images are the most diagnostically valuable part of the test.
Your heart rate is monitored as it returns to normal. The cardiologist then discusses the findings with you and advises on next steps. A written report is sent to your referring doctor, usually within 24 hours.
Typical images on a stress echocardiogram
The two short clips below show real examples — one normal, one abnormal — of how the heart looks at rest and immediately after exercise on a stress echocardiogram. In each video, the left side shows the heart at rest and the right side shows the same view immediately after exercise.
Understanding the results
At Heartcare Sydney, the cardiologist discusses the findings with you on the same day, immediately after your test. Most stress echo results fall into one of three categories:
The heart muscle contracts uniformly and strongly under stress, with no evidence of restricted blood flow, abnormal rhythms or valve dysfunction. A normal result is reassuring and usually means no further investigation is needed.
An area of the heart muscle does not contract normally under stress, suggesting reduced blood flow to that area — most commonly because of narrowing in one of the coronary arteries. The next steps depend on the severity and pattern of the finding, and may include medication adjustments, lifestyle changes, further imaging, or a coronary angiogram.
Sometimes the test does not give a clear answer — for example, if the target heart rate cannot be reached, the ultrasound images are technically limited, or the findings are borderline. In these cases, an alternative test such as a CT coronary angiogram, nuclear perfusion scan or stress MRI may be recommended to clarify the picture.
Safety and alternatives if you can't exercise
Stress echocardiography is generally very safe. There is no radiation, no injection of contrast required for a standard study, and the test is supervised continuously by a cardiologist. Serious complications are uncommon. Minor symptoms such as transient chest discomfort, breathlessness, dizziness or a brief irregular heartbeat can occur and usually settle quickly when exercise stops.
If you have a history of unstable cardiac symptoms, severe known heart disease, or you cannot exercise on a treadmill because of joint, breathing or mobility limitations, please mention this when booking. A pharmacological alternative — where a medication is used to mimic the effect of exercise on the heart — may be more appropriate:
Dobutamine stress echocardiography
A medicine called dobutamine is given through a drip to gradually increase your heart rate and the strength of the heart's contractions, simulating exercise. Ultrasound images are recorded at each stage. This test is well-established for patients who cannot exercise.
Nuclear perfusion or stress MRI
If neither exercise nor dobutamine stress echo is suitable, other tests such as a nuclear perfusion scan (using a small dose of radioactive tracer) or stress MRI can assess blood flow to the heart muscle. Your cardiologist will recommend the most appropriate test for your situation.
Stress echo vs CT coronary angiogram
A common question from patients is whether a CT coronary angiogram (CTCA) could be done instead of a stress echocardiogram. The two tests answer different questions and are often complementary rather than interchangeable.
A CT coronary angiogram takes detailed pictures of the coronary arteries themselves and shows whether there are areas of plaque or narrowing. It is an anatomical test — it shows the structure of the arteries.
A stress echocardiogram shows whether the heart muscle is getting enough blood flow when it is working hard. It is a functional test — it shows how the heart performs under load. It also assesses valve function under stress, exercise capacity and blood pressure response, none of which a CT can show.
For some patients, only one test is needed; for others, the two tests complement each other. The decision depends on your symptoms, risk factors and what your cardiologist needs to find out. Your GP or cardiologist will recommend the most appropriate test for your situation.
For a detailed framework on choosing between stress ECG, stress echocardiography, SPECT, PET, stress CMR and CT coronary angiography by clinical scenario and pre-test probability, see our cardiac stress test selection guide for referrers.
Frequently asked questions
How long does a stress echocardiogram take?
The full appointment takes 45–60 minutes including preparation, baseline imaging, exercise, post-exercise imaging, recovery and discussion of results. The active exercise itself is usually 6–12 minutes.
Is there any radiation involved?
No. A stress echocardiogram uses ultrasound only and does not involve any ionising radiation, unlike CT scans or nuclear perfusion studies.
How strenuous is the test?
The exercise can feel demanding, but the protocol is tailored to your age and fitness level. The treadmill speed and incline increase gradually, and the cardiologist stops the test promptly if you develop significant symptoms or signs of concern. Most patients find it manageable, and many describe the level of exertion as similar to a brisk uphill walk.
Will I get the results on the same day?
Yes. The cardiologist reviews the images during and immediately after the test and discusses the findings with you before you leave. A formal written report is sent to your referring doctor, usually within 24 hours.
Can I drive home afterwards?
Yes, in almost all cases. A standard exercise stress echo does not involve sedation or contrast, so you can usually drive yourself home. The cardiologist will advise if a brief rest period is appropriate before you leave.
Will I need more tests after a stress echo?
It depends on the result. A normal study that explains your symptoms usually does not need further investigation. An abnormal or inconclusive result may lead to additional tests such as a CT coronary angiogram, nuclear perfusion scan, or coronary angiogram, depending on the findings.
What happens if I cannot exercise on a treadmill?
If you cannot exercise because of joint, breathing or mobility limitations, please mention this when booking. A dobutamine stress echocardiogram, nuclear perfusion scan or stress MRI may be more appropriate. Your cardiologist will recommend the best alternative for your situation.
Booking a stress echocardiogram
Cardiologist-led stress echocardiography in Westmead with same-day discussion of results. For patients in Western Sydney and the Parramatta region, see our local clinic page for booking, location and parking details.
Stress Echo at Westmead