Stress echocardiography combines standard echocardiographic imaging with exercise or pharmacologic stress to detect inducible wall motion abnormalities that indicate obstructive coronary artery disease. It provides both anatomic and functional information in a single study without radiation exposure.
During exercise stress echo, the sonographer acquires resting images of all standard cardiac views, then rapidly repeats the protocol within 60–90 seconds of peak exercise before heart rate recovery. Pharmacologic stress using dobutamine (with or without atropine) or vasodilators (dipyridamole, adenosine) is used when patients cannot exercise. New or worsening wall motion abnormalities in a coronary distribution indicate significant stenosis. Stress echo also evaluates valve disease severity under hemodynamic stress and unmasked pulmonary hypertension.
Stress echocardiography requires the RDCS credential with adult echocardiography specialty, plus specific training in the rapid acquisition technique, pharmacologic agent protocols, and recognition of stress-induced abnormalities. Sonographers in this area work in hospital cardiology departments, outpatient cardiology practices, and cardiac catheterization laboratories.