Exercise Stress Echocardiography (ESE)

Think of this test as a 2-in-1 test combining the treadmill ECG and a transthoracic echocardiography into one single test.

Stress echo can assess whether the heart muscle is receiving adequate blood supply during maximum exertion (running on the treadmill).  It is frequently ordered in patients presenting with chest discomfort and breathlessness as part of the investigation for coronary heart disease.  Due to the non-invasive and radiation-free nature, this test is also used as a survey to detect relapse of heart condition in patients with known coronary artery disease or those with significant risk factors.


  1. What are you actually looking for in stress echo?
    • There are 3 major arteries bringing blood to the heart with each coronary artery suppling a distinct region. When we are calm and restive, our heart pumps slowly and only demands a baseline amount of blood flow and oxygen supply. Even in the presence of coronary artery blockage, usually enough blood get through to keep the heart muscle functioning normally.  However, when we start to exercise and put the heart under pressure, it will have to pump faster and stronger to sustain our physical demand.  In response, healthy arteries expand and allow more blood and oxygen to reach the heart muscle. Unfortunately, arteries with significant blockage will fail to deliver blood supply fast enough to keep up with the increased heart muscle demand. So what we see in the scan is certain region of the heart starts to contract poorly whilst other areas pump more vigorously in response to exercise.  This regional motion abnormalities of the heart is indicative of significant coronary artery disease and warrant further investigations and treatment.
  1. Is it a pain free test?
    • The test does not involve any needle sticks so it is pain free. But make no mistake, to ensure the heart is adequately challenged we do push you to run very hard in order to achieve your maximum heart rate.

  2. I need an all clear from the cardiologist before my knee surgery but I have difficulty walking let alone run, can I still have a stress echo?
    • Yes you can still have a stress test but instead of running on the treadmill to speed up your heart, we can infuse medication to speed up your heart instead. Please discuss this option further with your heart specialist.