Macquarieheart.com.au

MACQUARIE HEART
Suite 203, Level 2
2 TECHNOLOGY PLACE
MACQUARIE UNIVERSITY NSW 2109
Phone +61 2 9887 8888
+61 2 9887 8885
EXERCISE STRESS ECHOCARDIOGRAM TEST
INFORMATION SHEET

PREPARING FOR YOUR EXERCISE STRESS TEST
Your doctor has asked you to undertake an Exercise Stress Echocardiogram Test. This is an important
test in helping your doctor reach a diagnosis for you. This information sheet provides general guidance
on how the test is conducted.
• Please read this form and provide the referral form your doctor gave you.
• Please list your medicines.
• Stay on your usual medications unless you are told otherwise by the doctor.
If this test is being performed to establish a diagnosis, you may need to stop taking certain drugs (e.g.
beta blockers, Verapamil and Diltiazem) 48 hours before your test. If this is a follow up test, you would
normally stay on all your current medications. Please check with your doctor prior to stopping any of
your medications.
• Wear loose, comfortable clothing and walking shoes or joggers. You will be walking on a treadmill
and it is important to wear clothes which will be suitable for activity involving exertion and that are in
two pieces, i.e. shorts/ trousers, skirt and shirt.
• Only have a light breakfast if your test is in the morning or a light lunch if your test is in the
afternoon. It is much easier to walk when your stomach is not full. It is preferable that you do not eat
for 2 hours before your test.
• Please notify the Macquarie Heart Staff prior to the test if you are diabetic or have any other serious
medical conditions.
THE PURPOSE OF THE TEST
Exercise testing measures your capacity to exercise the heart, lungs and blood vessels. The test
is carried out to assist in making a diagnosis of patients with suspected heart disease.
HOW THE TEST WORKS
Testing consists of walking on a treadmill, the speed and gradient of which are increased every three
minutes. An echocardiogram (heart ultrasound) will be performed prior to the test and at the end.
Throughout the test a doctor will be present and your pulse, blood pressure and electrocardiography
will be monitored. If there is any change in any of these observations that concern the attending doctor,
the test may be stopped. The test will also be stopped if you become tired or breathless, or if you
develop chest pain or other symptoms. Your pulse, blood pressure, electrocardiogram and
echocardiogram will be monitored for some time after the test has been stopped. If at any time during
the test you are feeling unwell in any way, tell the doctor immediately. At the end of the test you will
be disconnected from the ECG machine and all electrodes. However on completion of the test we will
ask you to take a seat in our waiting room for a further 10-15 minutes before you leave.
INTERVENTIONAL CARDIOLOGY│DIAGNOSTICS│ DEVICES│HEART FAILURE│ARRHYTHMIAS│PRE OP ASSESSMENT MACQUARIE HEART
Suite 203, Level 2
2 TECHNOLOGY PLACE
MACQUARIE UNIVERSITY NSW 2109
Phone +61 2 9887 8888
+61 2 9887 8885
EXERCISE STRESS ECHOCARDIOGRAM TEST
CONSENT FORM

Before proceeding with the test we need your signed consent. Before signing the consent form,
please feel free to ask any questions you have about the exercise stress test and about any risks.
The information below outlines the potential risks of the test.
RISKS OF THE TEST.
While every effort is made to minimize the risks of the procedure, there is a very small but definite risk
of complications.
Serious complications include the possibility of a major disturbance of heart rhythm requiring
resuscitation, the development of heart failure or prolonged angina (heart pain), or the development of
a heart attack. The risk of one of these occurring is approximately 2 or 3 in 10,000 tests. Unfortunately,
there is also a very small risk of death occurring as a result of the exercise test. The chance of this in
the average patient is approximately 1 in 10,000, although the risks are higher in patients who are
already known to have severe coronary disease.
A doctor is present for the test and the pulse, blood pressure and electrocardiogram are monitored.
Emergency equipment and trained personnel are available to deal with any complications that may
arise.
SIGNED CONSENT

I have read he information sheet and this form and I have had the opportunity to ask questions. I
understand the test which I will undergo, and I have been made aware of the risks involved. I consent
to participate in this Exercise Stress Echocardiography Test.
Name ____________________________________ DOB: …. /…. / ….
Or Sticker
Signature of patient: ………………………… Witness: …………………………
Date ……………….Date …………………………….
INTERVENTIONAL CARDIOLOGY│DIAGNOSTICS│ DEVICES│HEART FAILURE│ARRHYTHMIAS│PRE OP ASSESSMENT

Source: http://macquarieheart.com.au/wp-content/uploads/2013/MUH-STRESS-ECHO-CONSENT-FORM-2013.pdf