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  • Gregg M. Yamada, MD FACC

Part 1: Echo and Stress Test

My posts are intended to provide you with useful information to supplement what a cardiologist will discuss with you. Rather than be blindsided, if you have a general idea of what to expect, it removes a lot of the angst you may have. Education allows you to be an active participant in your care, rather than a passive listener. The 'ask your doctor' series provides answers to common patient questions.

Question: Why Did My Cardiologist Order a Stress Test and an Echocardiogram?

There are two baseline tests that which cardiologists recommend regardless of the condition being evaluated:


We must be certain that the structure and function of your heart is normal. The TST and Echo provide this foundation.

  • A normal stress test indicates you do not need a coronary stent or a bypass surgery. You may have CAD, but the blockages are not serious when the TST is negative.

  • A normal echo indicates that the heart muscle is strong, the chamber sizes are normal, and the valves are working properly. You may have some degree of valvular regurgitation or stenosis, but that may be quite safe.

There are far superior tests for evaluating the structure and function of your heart, but a stress test and an echo are all that are typically allowed by insurance carriers.

The Importance of a Normal Stress Test and Echo

Once we know that your heart is generally healthy, it is unlikely that you have a dangerous or life-threatening cardiac condition.

  • For example, it would be unexpected for a patient to have a negative TST and echo, only to suddenly pass away 6 months later. Consider a TST and Echo to be a low-level screening for serious heart conditions. I will teach you some exceptions at your visit.

  • If you have complaints such as chest pain/discomfort, shortness of breath, fatigue—symptoms that may represent angina (symptoms of a blocked coronary artery)—a negative TST and echo indicates these are non-cardiac complaints.

  • If you experience palpitations, dizziness/fainting a negative TST and echo indicates that the arrhythmia is most likely benign (safe). A cardiac monitor may also be placed to document any arrhythmia.

Types of Stress Tests and Echocardiograms

There are various versions of stress tests from less accurate to most accurate.

These include:

  • Non-imaging stress tests

  • Stress echo and less commonly a dobutamine stress echo

  • Nuclear stress test:

  • Stress MRI

In Part 2 of this series, I will discuss how cardiologists determine the appropriateness of diagnostic testing with reference to Appropriate Use Criteria or AUC guidelines.

Note: Understanding your heart condition is not difficult. Patients become frustrated and confused when doctors don’t explain things clearly. If you don’t understand what your doctor is talking about, then you won’t be able to ask meaningful questions. I hope that my posts provide you with a framework that you can build upon to become an active participant in your healthcare.

Stay Healthy!

Gregg Yamada MD FACC


FYI: Wherever possible I try to embed (hover your pointer over colored words) links to quality cardiology websites so you can read further about topics I discuss. I hope this saves you time.

Disclaimer: I hope you find my medical blogs to be pertinent, interesting, thought provoking, and even humorous. The information provided is educational and should not be taken as medical advice. I am a doctor, but I am not your doctor. Please schedule an appointment with your doctor to discuss these issues and to determine what is right for you.

© 2020. Gregg M. Yamada, MD FACC. All rights reserved.



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