Treadmill Stress Echocardiography

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The standard treadmill

The treadmill test is a cardiology examination that allows for the indirect evaluation of blockages in the coronary arteries.

It also assesses cardiovascular fitness.

Easy to perform

The treadmill test is an easy-to-perform examination that provides a lot of information.

It can be considered the “gateway” examination for checking the presence or absence of blockages in the coronary arteries.

Some examinations may be inconclusive

For various reasons, it is possible that the treadmill test may be unsatisfactory:

  • Insufficient effort to accelerate the heart rate to the required level;
  • Baseline electrical anomalies on the electrocardiogram (ECG), making conclusions impossible;
  • Doubtful electrical irregularities, with no possible conclusion;
  • Etc.


However, your doctor may request a complementary examination afterward.

The same applies to an abnormal treadmill test result that your doctor may want to clarify later with these same complementary examinations.

One of these is a treadmill done in conjunction with an echocardiogram. This is called a Treadmill Stress Echocardiography.

Two for One

As its name suggests, it consists of two complementary cardiology tests: one is the treadmill test and the other is the cardiac ultrasound.

Its usefulness

This screening test helps determine whether chest pain or other suspicious symptoms are of cardiac origin. It is also useful for monitoring the progress of a patient known to have stable coronary artery disease, meaning they have stable atheromatous plaques in their coronary arteries.

The goal is to clarify the result of a treadmill test that has remained inconclusive.

It can also confirm the result of an abnormal treadmill test by identifying the region of the heart that may have a coronary blockage.

An indirect way to assess coronary artery function

This examination helps determine, indirectly, if there are significant obstructions in the coronary arteries. In other words, it checks if cholesterol plaques are large enough to limit the distribution of oxygen to the heart muscle.

Need an appointment.

An appointment is required for this examination.

Relatively easy test

It is a relatively easy test, but it takes more time to perform. We want to “see” how the heart works during exercise compared to at rest.

For that, we must look at the heart at rest and then again immediately after the treadmill exercise.

No particular preparation

There is no need for a specific preparation nor to be fasting.

However, it is recommended not to eat too much before this test.

Taking Medication

Continue taking the medications prescribed by your doctor, unless otherwise instructed. You may be asked not to take your morning doses. In such cases, follow the given instructions.

How to prepare for the test

The examination consists of two parts: a resting study and a stress study, both conducted during the same session.

The day of your exam, you must bring comfortable shoes to your appointment. Sandals or high heel shoes are not permitted for security reasons.

You must then remove all upper body clothing and wear a hospital gown.

The technologist needs your updated list of medication to complete the information. You must therefore remember to carry your list with you.

You will be asked to lie on a bed for the installation of electrodes. These sensors placed on your skin record the electricity produced by your heart during the examination.

You will have to lay flat on your back for the installation of the electrodes. These sensors, connected to the skin, record the electricity generated by your heart throughout the test.

For a more effective electric contact

The keratin on our skin can reduce the electric amplitude of the heart. To prevent this, the skin is lightly scratched with a piece of sandpaper.

Echocardiogram at rest

The test begins with the first echocardiogram. It is the resting Transthoracic echocardiogram.


Cardiac ultrasound, or echocardiogram, is an examination that allows the evaluation of the heart’s anatomy and function using ultrasound.

Just like pregnant women

It is an examination of the same nature as the one used to see the baby in pregnant women. In this case, it is the heart that we will see.

We capture images of the left ventricle

The technologist or doctor places the cardiac ultrasound probe on the patient’s chest. The ultrasounds pass through the thorax to capture internal images.

The recording focuses on the heart’s function, particularly the left ventricle. Several views from different angles are necessary to obtain a complete picture.

Once these images are recorded, the second part of the examination begins with the use of the treadmill.


A box at your waist

The sensors are connected with wires to a box that records information. This box is at your waist during the test.

Tensiometer on your arm

A device to measure your blood pressure at different moments during the test is installed around your arm.

We are now ready for the treadmill

In the vast majority of cases, patients scheduled for a stress echo are already familiar with a treadmill stress test.

The goal of the test is to accelerate the heart rate

The goal of the test is to have your heartbeat increase to a certain level in order for the exam to be worth it.

The heartrate that must be attained varies with age.


  • You should walk on the treadmill as if you were walking on the street. You do not walk leaning forward on the street. It is the same on the treadmill.
  • Take long strides. Short, fast steps will tire you out quickly.
  • Preferably, do not hold on to the bar at the front of the treadmill. You may however place one hand on it to gain confidence.
  • It is important to follow the technologist’s recommendations. To obtain the most accurate results, he or she will encourage you to give it all you have.

Your blood pressure is monitored

Throughout the exam, the technologist will take your blood pressure.

The stages of the exam

The treadmill works by stages. The inclination and the speed are constant for two to three minutes according to the procedure chosen.

We can see how your heart responds to the effort.

The length of each stage allows your heart to respond to each level. Once the heart has shown its reaction, we move on to the next level until we obtain the desired heartbeat necessary for the exam to be valid according to your age.

Normal dizziness at the end of the treadmill test

Do not be surprised to feel dizzy when the treadmill stops. This is caused by you walking, but not moving forward. It will come back to normal quickly.


La deuxième échographie transthoracique

Once the treadmill stops, you will be quickly directed to the bed to record the contraction of the heart muscle. We must act without delay because we want to capture the images before it rests. The technician or doctor has about a minute to record all the required images.

You may be asked to hold your breath to obtain better images. It’s not always easy, but with your cooperation, the imaging will be better.

Why accelerate the heart rate - what are we looking for?

Coronary artery disease is responsible for blockages in the coronary arteries. These blockages can limit the oxygen supply to the heart muscle.

Physical activity requires increased circulation to the muscles being used. Consequently, the heart must work harder to meet this demand.

But the heart is also a muscle. The increased workload also requires more oxygen.

If one or more blockages prevent sufficient oxygen from reaching the heart, the heart suffers. This suffering alters the strength of the heart muscle’s contraction in the affected region. That’s why a second echocardiogram is performed immediately after the treadmill exercise.

The importance of comparing the images of your heart’s function at rest with those of your heart working under stress cannot be overstated. Each muscle region of the left ventricle is observed. We look for a region of the heart that contracts less effectively during exercise compared to its normal function at rest. This can indicate that reduced vigor in that region during stress may be associated with a blocked artery.

And it’s done

After this second recording, you can change back into your regular clothes and leave.

The results are sent to your doctor

The results are communicated to the doctor who asked for the exam.

You may ask for a copy for another doctor

You may ask for a copy of your results to be sent to another doctor. You simply have to give the name and contact information to the personnel. You may ask at any moment.