Julio Perez, MD

Question: My doctor has sent me for a stress EKG every year for the past 5 years. This year, he wants me to get a stress echocardiogram. What is the difference? I am 60 years old, female and recently seem short of breath after exercise.

Answer: When you have an exercise electrocardiogram (EKG) we measure your heart’s electrical efficiency – is the pattern normal, too fast, too slow, or erratic? We can also learn if there is abnormality in the shape or size of the heart. An EKG is a good first test, and can show when there is an irregularity that would be associated with heart disease, in up to 65 percent of cases.

However, an EKG is not very accurate in evaluating the pumping ability of the heart. For that, an echocardiogram is recommended.

An echocardiogram (echo) is an ultrasound of the heart, which shows the internal structure, and how the blood flows through it. It is a non-invasive method of diagnosing many heart conditions – electrodes are placed on the chest and a wand like device sends sound waves painlessly through your heart. The echo measures the size and shape of the heart, how well the valves are functioning, how the left and right side communicate, and the velocity of the blood leaving the heart. From this we diagnose coronary artery disease, heart valve disorders, or enlargement or thickening of the heart muscle. The stress echo combines the information from an EKG and the echo into one test. It can raise the accuracy of the diagnostic test into the 80 percentile. Echos are especially helpful in diagnosing heart problems in women.

At the Heart Care Institute in West County, we perform an echo on a patient while resting, then have the patient exercise on the treadmill (or administer medicine that simulates exercise), and then do another echo. The purpose is to capture images in a stressed state. As an academic medical center, we set the standards other facilities will use and evaluate patients at the highest level they can tolerate.
Your physician is contacted immediately if the test is positive so you can be further evaluated. It may be reassuring to know that in most cases echocardiograms are negative. All echos are ordered by physicians or cardiologists who will interpret the results to you.