Echocardiographic examinations under dynamic or pharmacological stress are conducted with strict, and
continuous monitoring and documentation of systemic arterial pressures and ECG. Image documentation
and archiving are carried out by means of digital softwares, which allow a posterior
evaluation of the examination in quad-screen format.
Standard protocols are used for the different stress modalities.
Dynamic stress echocardiogram
Pharmacological stress echocardiogram: Dobutamine
Here a "quad-screen" presentation of the apical four-chamber view at rest (HR = 66/min), low level exercise
(HR = 97/min), maximum exercise (HR = 131/min) and recovery (HR = 100/min).
LV contractility does not seem completely normal at rest, but a clear hypokinesia can not be defined.
However, already at low level exercise, but especially a maximum exercise, a clear hypokinesia of the lateral
LV wall and the apical septum can be seen. Contractility gets better ín the recovery phase.
Besides contractility it is especially important to document tricuspid velocities during examination, with a
high sweep speed (150 to 200 mm/s) of spectral CW Doppler for offline measurement of systolic pulmonary artery pressure.
Also, the inferior vena cava must be recorded, since an inferior vena cava plethora or with blunted respiratory
response leads to a higher right atrial pressure, which must be considered in the calculation.
The assessment of systolic pulmonary artery pressure during stress echocardiography has an inportant diagnostic
and prognostic value: