Stress echocardiogram note template
Exercise and dobutamine studies use the same template.
- Indication
- Ischaemia evaluation, pre-operative risk stratification, or dyspnoea workup.
- Protocol
- Bruce, modified Bruce or dobutamine. Stages reached, and peak heart rate against predicted.
- Haemodynamics
- Resting heart rate and blood pressure, peak heart rate and blood pressure, and recovery.
- ECG
- Rhythm changes, ST changes and arrhythmias.
- Echo findings
- Resting wall motion, stress wall motion, ejection fraction at rest and at stress, diastolic function.
- Symptoms
- Chest pain, dyspnoea and fatigue during the study.
- Reason for termination
- Target heart rate reached, symptoms, ECG changes, or time.
- Complications
- Arrhythmia, ischaemic event, hypotension or dobutamine reaction during the study, each with its management.
- Impression
- Positive, negative or inconclusive for inducible ischaemia.
- Plan
- Further workup or reassurance, medications and follow-up.
Worked examples
Stress echo · negative exercise study Lee, Andrew · 48M · Synthetic patient
Indication Exertional dyspnoea, assessment for inducible ischaemia. Protocol Exercise, Bruce protocol, 4 stages completed, 12 min. Peak HR 158, 92% of age-predicted maximum. Haemodynamics Rest 68 bpm, 128/78. Peak 158 bpm, 186/84. Recovery to 92 bpm by 3 min. ECG Sinus rhythm throughout, no ST deviation, no arrhythmia. Echo findings Normal wall motion at rest and at peak stress. LVEF 60% at rest, 68% at stress. Normal diastolic function. Symptoms Leg fatigue only. No chest pain. Reason for termination Target heart rate achieved. Complications Nil. Impression Negative for inducible ischaemia at a good workload. Plan Reassurance, investigate dyspnoea along a respiratory pathway, no further cardiac imaging planned.
Stress echo · positive dobutamine study Watts, Norman · 72M · Synthetic patient
Indication Pre-operative risk stratification before vascular surgery in a patient unable to exercise. Protocol Dobutamine to 40 mcg/kg/min with atropine 0.5 mg. Peak HR 142, 96% of age-predicted maximum. Haemodynamics Rest 72 bpm, 136/80. Peak 142 bpm, 148/76. Recovery uneventful. ECG 1.5 mm horizontal ST depression in the anterior leads at peak, resolving in recovery. Brief run of ventricular bigeminy. Echo findings Normal wall motion at rest. New hypokinesis of the mid and apical anterior segments at peak. LVEF 58% at rest, 50% at stress. Impaired relaxation. Symptoms Central chest tightness at peak, settled within two minutes of stopping. Reason for termination Symptoms with ECG changes. Complications Brief run of ventricular bigeminy at peak, self-terminating on stopping the dobutamine. No treatment required. Impression Positive for inducible ischaemia in the left anterior descending territory. Plan Coronary angiography before the vascular procedure. Commence aspirin 100 mg and atorvastatin 40 mg. Timing to be discussed with the vascular team.
