What is an echocardiogram (echo)?

An echocardiogram (echo) is a test that uses sound waves to build a moving picture of your heart. This sort of technique is like an ultrasound that you would have if you were pregnant.

There are different types of echo scans that have specific elements to them, like a Dobutamine (stress) echo.

Exercise (stress) echocardiogram

An exercise echo, or stress echo, combines a standard echo with an exercise test. It will help your doctor understand how your heart is coping when it is working harder, like when you exercise. The test can help your doctor see if:

  • your symptoms are due to underlying heart disease
  • your heart would function better with surgical intervention
  • there is a problem with one of your heart valves

The test

We will ask you to remove any clothing from the waist up and then lie down on an echo bed, on your back. We will give you a hospital gown to wear with the front open. This is so we can track your heart's activity. We then place sticky patches (electrodes) to your chest, which are connected to the echo machine. This first echo is called a resting echo, so we can see what your heart is doing when you are resting.

We then repeat the echo, but after you have done some exercise, such as walking on a treadmill or using an exercise bike. If you are not able to do the exercise, your doctor might do a Dobutamine echo test instead.

Treadmill exercise

You find treadmills (a small, moving walkway) in most gyms. When you get on the treadmill, your cardiac physiologist will put nine more electrodes on your chest for the echo. This will record your heart's electrical activity. We will also record your blood pressure before you start and at different points of the test.

You will start walking at a slow speed, then we will increase the treadmill's speed and slope every three minutes.

When you reach your target heart - which we calculate on your age - we stop the treadmill. Your doctor might stop the treadmill early if you start getting symptoms like:

  • chest discomfort
  • shortness of breath
  • weakness
  • dizziness
  • significant changes in your blood pressure or ECG.

Once the treadmill has stopped, you will lie back down on the echo bed, and your doctor will do another echo whilst your heart is still beating fast.

You will stay on the echo bed until your blood pressure and your heart rate are back to your resting levels. As soon as you feel well enough, we will take off the electrodes.

Bicycle exercise

This test is done on a custom-made exercise bed that looks like an echo bed, but has a pedal attachment. You will stay lying down on the bed for the whole test.

When you start, your cardiac physiologist will put nine more electrodes on your chest to record your heart's electrical activity. We will also record your blood pressure before you start and at certain points during the test. To start the test, we will remove the bottom half of the bed and the bicycle pedals are then set up to best fit your legs. You will then start pedalling as you lie down, and every three minutes we will make it more difficult to pedal.

Once you reach your target heart rate - based on your age - you can stop pedalling and we will do another echo. We may get you to stop earlier if you start experiencing:

  • chest discomfort
  • shortness of breath
  • weakness
  • dizziness
  • leg discomfort
  • significant changes in your blood pressure or ECG

It is important to do your best during this test, but you should not push yourself too much so that you become unwell. At the end of the test, your doctor will get you to carry on pedalling slowly so your muscles can warm down.

You can relax on the bed until your blood pressure and heart rate return to their resting levels. As soon as you fell well enough, your doctor will take the electrodes off your chest.

For information about how to prepare for the test and how to get the results, click on the 'Information' tab. 

Cardiomyopathy is a disease that affects the heart muscle. Cardiomyopathy can often be caused by a genetic mutation, and can therefore run in families affecting one or many members, at any age.

The Trust has an inherited cardiovascular condition service, which looks after conditions such as cardiomyopathy, channelopathy and pulmonary hypertension. 


A stress echo is very safe, but as with all medical procedures, there can be risks. The level of exercise you will be asked to do is on the same level of climbing the stairs or carrying heavy shopping.

Possible risks include:

  • the heart developing an abnormal rhythm (one in every 1,000 patients). This usually settles down without the need for any treatment. If you do not need treatment, you will recieve a short electrical impulse to restore your heart's normal rhythm.
  • a bad attack of angina or a heart attack (one in every 2,000 patients).

But you will always have medical professionals with you during the test in case there are any complications.

Preparing for the test

If you take certain heart medications, you may need to stop taking them for 48 hours before the test. If you continue taking them just before the test, we may need to move your echo to a later date. We will let you know what you will need to do when you book your appointment. If you have any questions, ask us.

You will need to wear comfortable clothing for this test and wear shoes or trainers that will not slip off your feet.

You should not eat a heavy meal in the two hours before the test, and you should also not have any caffeine for 24 hours before the test. This includes tea, coffee, green tea, cola, energy drinks, hot chocolate and chocolate bars.

We will have cold drinking water available, but some patients like to bring a cold drink with them when they have the test.

After the test

After the test has finished, we may get you to rest for another 20 minutes to allow the effects of the exercise to disappear. You will then be able to go home after this. You should not drive after the test, so bring a relative or close friend with you who can drive you home, or you can take public transport.

Do not drive or operate machinery for the rest of the day.

A doctor will analyse your exercise echo, ECG and blood pressure results. They will then produce a report for your doctor. If you are an outpatient, this will be sent to your consultant for your next appointment. If you are an inpatient, the report will be in your medical notes for review on the ward.

Information and support

Where to find us

Royal Brompton Hospital

Level 3, Chelsea wing, Royal Brompton Hospital, SW3 6NP

Contact details

Monday to Friday 9am to 5pm
Telephone: +44 (0)20 7351 8209
Fax: +44 (0)20 7351 8604

Harefield Hospital

Echocardiography clinic room, Outpatients department, Harefield Hospital, UB9 6JH

Contact details 

Monday to Friday 9am to 5pm
Telephone: +44 (0)1895 823737 ext: 5586

If you have any questions or would like to know more about the exercise (stress) echocardiogram, please contact the echocardiography department.

Your stress echocardiogram - Royal Brompton Hospital - 2023 (pdf, 441KB)