The Physicians at the Kingston Heart Clinic usually order this test. The test is an alternative to Treadmill Exercise Echocardiography. It has the advantage that the Echocardiographer is able to record ultrasound images during exercise rather than after the completion of exercise.
It is used for Patients who are experiencing symptoms of chest discomfort, shortness of breath or palpitations (irregular heart beat). Often these symptoms are related to physical activity. At the Kingston Heart Clinic most of these tests are actually perfomed in patients with valvular heart disease. The test is most useful in Patients with heart valve disease where blood flow across the heart valves can be recorded during exercise.
Prior to the Supine Bicycle Exercise Echocardiography an Allied Heath Professional will take a brief history including medication history and symptoms, ask you about your risk factors (High blood pressure, Cholesterol level, Smoking, Diabetes, etc…) and then explain the test to you. You will then be examined to make sure there is no reason to cancel the test. Once this is completed you will be asked to read and sign a consent form. The staff will answer any questions relating to the consent form.
The Registered Nurse will then prepare the skin so the Electrocardiogram (ECG) can monitor your heart rhythm continuously throughout the test without interference. For Men this involves both shaving the skin and then gently roughening the skin with special sandpaper. For Women the skin still has to be gently roughed. Ten electrodes are then applied to the chest. The electrodes are placed in a position so the Echocardiographer can take good quality images of the heart.
During your Supine Bicycle Exercise Echocardiography test there are always 2 experienced Physicians immediately available. One of these Physicians is experienced in the interpretation of Echocardiography. All resuscitation equipment and emergency medications are readily available. There are 2 Health Professionals present throughout the test, an RN and an ECHO technologist. The staff takes yearly Basic Cardiac Life Support (BCLS) certification. All RNs are ACLs certified. The Kingston Heart Clinic has performed just over 2,000 bicycle tests.
Before the test your blood pressure and ECG will be recorded. The Echocardiographer will then acquire the resting ultrasound images of the heart. The bicycle bed is a special bed to which you will be snuggly strapped. Your feet are firmly attached by special shoes, which also form the bicycle pedals. The Bed is able to rotate 45 degrees to your left. The pedal distance can be adjusted for individual comfort before cycling commences.
During cycling you will be instructed to look at a light, which will be green, if you are cycling at the correct speed. A white light means you have to speed up and a red light means you have to slow down. You will be instructed to either speed up or slow down by the Allied Health Professional. The workload of the bicycle will progressively increase during the test.
Cycling at a 45-degree angle can be difficult. The Allied Health Professionals supervising the test will give you all the encouragement you will need.
During the test you will be asked, how you are feeling and your blood pressure will be recorded every 3 minutes. Your heart rhythm is monitored continuously and an ECG is taken every 3 minutes as a permanent record for the Physician to review. If you are experiencing any difficulties this must be related this to the Registered Nurse.
The Supine Bicycle Exercise Echocardiogram test is a heart rate limited and symptom limited test. The target heart rate is 85% of your maximum predicted heart rate (220-Age in years) plus an extra 10 beats per minute. The test will stop if you develop symptoms or if you achieve this target heart rate, whichever occurs first. The test will also be stopped if you tell the Registered Nurse to stop. The Registered Nurse may also stop the test. Once you reach your target heart rate or if you are near the end of your ability to exercise the Echocardiographer will record ultrasound images while you are still cycling. If need be the workload on the bicycle can be reduced so you can still cycle while the ultrasound images are being acquired.
At the completion of the test your clinical condition, blood pressure, heart rhythm and ECG will be monitored until everything returns to baseline. Once this has occurred a final set of ultrasound images are obtained.
At the Kingston Heart Clinic all Supine Bicycle Stress ECOs are interpreted by the supervising Physician and a formal written report will then be mailed and received by your Doctor within 10 days. Tests which are significantly abnormal are interpreted immediately and FAXed to the referring Physician. If necessary, the patient will be interviewed and advice and/or drug therapy initiated.
Frequently, echocontrast, DEFINITY will be used to enhance the ECHO images. There are some side effects (serious ~1%, total~9%, including backpain, headache, nausea and flushing).