Consent Form for Stress Echocardiogram - pending


The Stress Echocardiogram measures the function of the heart, lungs and blood vessels and helps diagnose blocked arteries in the heart (coronary artery disease). It also provides specific information about valvular disease and pressure in the heart and lungs. 


In the first part of the test, a cardiac sonographer performs an echo using an ultrasound machine to check how your heart functions when resting. You lie on your left side. To ensure good contact between your skin and the probe, some electrodes and ultrasound gel are placed at several different sites on your chest. You may develop a skin irritation from the placement of the electrodes or the gel. Please advise the technician who prepares you for the test if you are allergic to any tape or adhesives.

In the second part of the test, your heart is exercised or ‘stressed’. If you can walk easily, you can walk on the treadmill. The speed and slope of the treadmill will increase every 2 or 3 minutes. This makes your heart do more work and you will exercise harder. The test will be stopped if you have chest pain, become very tired or very short of breath. You must advise staff if you are unable to keep going on the treadmill. You should also continue walking on the treadmill until the treadmill has been brought to a complete stop. You must at all times hold onto the front bar when the treadmill is running.

When your heart is working as hard as possible or you have reached the required target heart rate, you stop exercising and quickly lie down on the bed. More echocardiogram pictures are taken. These images are then compared to the previous pre-exercise images. If you feel unwell you should tell staff at once.

The results will be sent to your referring doctor. Please organize an appointment with your doctor.

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