A trained professional will use an echocardiographer to collect the necessary images. A gel is used to obtain these images (this is water based and is hypoallergenic). You will be placed electrodes to monitor the electrical activity of the heart to correlate with the images collected. You will also be asked to stand on a naked torso and move in various positions to get the best pictures. The examination is carried out in a specific area, optimised for your privacy and proper collection of images. The examination itself is painless and non-invasive. Current transthoracic echocardiography requires the use of Doppler technology (mapping of blood flow, making it possible, for example, to determine its velocity) to obtain all the appropriate information.

It varies depending on the reason of the request and what is being found in the exam. A complete transthoracic echocardiogram requires two phases: the collection of images and the completion of the report. The image collection phase itself may take from 15 to 60 minutes, depending on the complexity of the case.

It evaluates the morphological and functional alterations in the cardiac chambers, valves, vessels and structures close to the heart when the heart is at rest (the complete examination involves 2D and Doppler techniques and possibly "M-Mode"). If it is considered necessary and technically possible (it is not always), an analysis with Stress technology (assessment of myocardial deformity) will be performed.

The procedure is performed by a team consisting of a cardiologist, a nurse and a cardio pneumology technician.

You should inform the professionals if you have any oesophagus disease, if you have had surgery or have had any treatment in that area or if you have difficulty swallowing. You should also mention if you have any allergies, any clotting abnormalities, or if you are taking anticoagulant medication.

It is vital that you are fasting (fluid and solid) for at least 6 hours before the procedure. You will also be asked to remove any prosthesis or dental mobile device from the mouth immediately prior to the start of the procedure.

It is imperative that you give your informed consent (without this signed document the examination will not be carried out) and, accepting to do it, you must also inform the team of the presence of any of the situations described.

Throughout the procedure your vital signs will be monitored (oxygen level, blood pressure and reaction to medications).

You will be given an intravenous tube in the arm (which is not painful), where you will be given a sedative to help you relax.

Your throat will be anesthetised with a special spray. You should swallow this liquid and not swallow any more saliva from this moment, for the risk of choking. The exception will be at the time the doctor asks you to swallow.

A small plastic protector will be placed between your teeth, through which the probe will be inserted, and you will be asked to lie on the left side of the body to perform the procedure.

The catheter will be inserted through the mouth into the oesophagus until it reaches the back of the heart (it should assist in the passage of the catheter and when asked by the doctor to "swallow"). Ultrasound imaging of the heart, heart valves, and blood flow will then be obtained and recorded.

According to the images that are being obtained, it may be necessary to perform certain manoeuvres, which it will be explained to you.

The effects of sedation generally disappear within a few hours. The risks associated with performing a TEE are rare, but they do exist. For a few days after the examination you may notice some discomfort in the throat ("scratchy" throat, hoarseness) associated with the passage of the catheter. Possible rare risks include inflammatory/infectious processes, perforation of the oesophagus, oesophageal haemorrhages, cardiac arrhythmias and exceptionally fatal situations.

You will not be able to eat or drink anything for about two hours after the procedure because your throat may still be numb.

You will not be able to drive for the rest of the day and it is advisable not to sign legal documents on the day of the exam.

It will be necessary to arrange for someone to take you home after the procedure, as you may feel numb from the sedative.

The examination report will be made available to you later, after the analysis of the images.

Benefits: The diagnostic value of a stress ultrasound is much higher than that of a conventional stress test. However, even with a technically advanced examination, lesions and diagnoses may, although rarely, not be detected.

Risk: This exam is safe. There are risks involved but they are slight and comparable to that of any more vigorous effort.

Ultrasound is innocuous to one’s health, but the medication administered can cause some side effects. The inherent risks range from more frequent reactions, such as blood pressure changes, feeling ill and heart rhythm alterations, including arrhythmias, to less frequent situations such as allergic reactions. Cases of acute myocardial infarction and cardiac arrest have been described, but these are extremely rare. Therefore, as a precaution, medical assistance is available, including the equipment necessary in the event of any complications.

The pharmacologic stress echocardiogram, allows the cardiologist to identify areas of the myocardium that might be unable to work properly in effort, meaning that there is not enough blood flow irrigating a specific part of the heart due to an obstruction of the coronary arteries.

This myocardial ischemia study can be used both in patients with suspected coronary disease, as well as in the follow-up of patients who have already undergone revascularization procedures (post-stent implant or cardiac bypass surgery). It also studies the myocardial viability after a heart attack, that is, to identify areas of the heart that do not work properly at rest, but that have recovery capacity.

The stress echocardiography can also help to clarify the severity of a valve problem, especially in aortic valve stenosis with depression of myocardial function.

The pharmacological stress echocardiogram is performed by a team of professionals consisting of a cardiologist, a cardiopneumologist technician and a nurse, all with extensive experience in this area.

The examination is performed while the patient is lying down. An intravenous serum is placed through which the drugs that cause the cardiac effort are administered while electrodes are placed on the chest to monitor the heart rhythm and perform the electrocardiogram (ECG).

The light in the room is dimmed so that the images on the ultrasound screen can be better viewed.

A transparent gel is applied on the left side of the patient’s chest where the probe or transducer is placed. This transducer emits and receives an ultrasound beams reflected as images on the ultrasound monitor. Blood pressure measurements are also collected.

Images are obtained before, during and after the administration of the medications that cause cardiac stress. Throughout the exam, images are recorded and the electrocardiogram is recorded continuously. It is also sometimes necessary to administer an ultrasound contrast.

During the exam a warm sensation may be felt and the heart may beat faster and stronger (palpitations). A slight headache, dry mouth, tiredness and a strange sensation on the chest may be felt. These effects, which relate to cardiac exertion, are temporary.

At the end of the exam, an antidote is administered to reverse all the effects of the medication used to cause the cardiac effort.

The duration of this exam is 45-60 minutes.

After the exam, the patient must give himself a few additional minutes for the body to recover, before returning to a normal daily routine.

The pharmacologic stress echocardiogram requires a period of fasting of 4 hours. A small quantity of liquids can be taken with medication if necessary.

It may be necessary to suspend some of the patient’s normal medication for 1-2 days before the exam in order to avoid interference with the medication administered for the pharmacologic stress echocardiogram.

In the 12 hours prior to the exam, the following food is prohibited, as they may interfere with the test results and their interpretation: coffee, tea, chocolate, soft drinks and alcoholic beverages

Stress Echocardiography detects coronary disease with a greater sensitivity and specificity when compared to the simple stress test. In addition, it has the enormous advantage of not using radiation or contrast when compared with other exams such as Scintigraphy, Coronary Angio-CT and MRI.

Among other situations it also evaluates the severity of already known diseases, not only coronary disease, but also diseases of the heart valves, pulmonary hypertension, as well as the evaluation of pathological intraventricular gradients (as the cause of these symptoms) in athletes.

It has a great impact in that it allows the specialist to reach a diagnosis and assess the severity of diseases without the use of radiation and, obviously, a better diagnosis results in a better treatment.

Among the various methods of diagnostic - myocardial perfusion scintigraphy, CT angiography and MRI -magnetic resonance imaging – stress echocardiography is the cheapest, but the biggest advantage (bearing in mind that it allows access to information at least equivalent to other tests) it does not use radiation or contrast. In addition, it is also the fastest exam (it lasts at the most half an hour).