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A stress echocardiogram is a heart ultrasound performed before and during exercise — or under pharmacological stress with dobutamine — to detect reduced blood flow to the heart muscle and assess how your heart performs under load. Delivered in Marylebone by BSE-accredited consultant cardiac sonographers, from £550, with a written report within 24 hours. No GP referral required.
New to cardiac imaging? Start with our private echocardiogram overview, or see how stress echo compares to CT coronary angiography and myocardial perfusion imaging.
A resting transthoracic echocardiogram images the heart at rest. A stress echo adds a second set of images captured while the heart is working hard — either during exercise on a treadmill or bicycle, or under the effect of dobutamine, a medicine that makes the heart beat faster and stronger. By comparing resting and stress images side-by-side, the sonographer and reporting cardiologist can identify regions of the heart muscle that fail to contract normally under load, which usually means a coronary artery is not delivering enough blood to that territory.
This makes stress echocardiography a functional test — it looks at how the heart performs, not just how it looks. It is one of the principal non-invasive tests for suspected coronary artery disease and is also used to assess the severity of certain valve problems under stress, to risk-stratify patients before major surgery, and to investigate unexplained exertional breathlessness.
Every stress echo at Sonoworld is performed by a BSE stress-echo-accredited consultant cardiac sonographer, with a consultant cardiologist available on site to supervise pharmacological protocols and review findings.
Stress echocardiography is the investigation of choice when the clinical question is whether the heart muscle is receiving enough blood on demand, or how valve and ventricular function change under load. A resting echocardiogram is often normal in these patients — the abnormality only appears under stress.
| Clinical Question | Why a Stress Echo |
|---|---|
| Chest pain on exertion | Detects inducible ischaemia; functional alternative to CT coronary angiography in the NICE CG95 stable chest pain pathway |
| Unexplained exertional breathlessness | Distinguishes cardiac from non-cardiac breathlessness; assesses pulmonary pressures and valve gradients under load |
| Known coronary artery disease | Monitors disease progression; guides revascularisation decisions; assesses symptoms after angioplasty or bypass |
| Borderline aortic stenosis | Unmasks symptoms and measures gradient change with exercise; informs timing of valve replacement |
| Mitral regurgitation | Exercise-induced worsening of regurgitation or pulmonary pressure can indicate the need for earlier surgery |
| Pre-operative risk assessment | Used before major non-cardiac surgery in patients with cardiac risk factors and limited functional capacity |
| Hypertrophic cardiomyopathy | Identifies exercise-induced left ventricular outflow tract obstruction, which changes treatment |
| Risk stratification after MI | Assesses residual ischaemia and viable myocardium in patients recovering from a heart attack |
The commonest indication. In patients with typical or atypical exertional chest pain and an intermediate probability of coronary disease, stress echo offers a radiation-free functional assessment with sensitivity and specificity comparable to myocardial perfusion imaging.
For heart murmurs and borderline valve disease, stress echo reveals how gradients and regurgitation change with exercise, informing the timing of intervention in line with NICE NG208.
When resting cardiac imaging is unremarkable but symptoms persist on exertion, diastolic stress echocardiography can reveal rising filling pressures with exercise — a pattern consistent with heart failure with preserved ejection fraction (HFpEF).
For patients facing major non-cardiac surgery who have cardiac risk factors or limited exercise tolerance, a pharmacological stress echo provides the functional assessment surgeons need without requiring the patient to exercise.
There are two ways to stress the heart during a stress echocardiogram. Exercise is the default choice whenever the patient is physically able — because it also gives the cardiologist information about functional capacity and symptom reproduction. Dobutamine is used when the patient cannot exercise adequately. The diagnostic accuracy is broadly equivalent; the choice depends on you, not on the clinic.
You walk on a treadmill (Bruce protocol) or pedal a recumbent bicycle while ECG, blood pressure, and symptoms are monitored. The sonographer images the heart immediately before exercise and within 60 seconds of stopping — or continuously during bicycle stress. Effort is the driver; you control how hard you push.
Dobutamine is given through a cannula in stepwise increasing doses, raising your heart rate and the force of contraction. Atropine may be added at the end to reach target heart rate. Images are captured at rest, at low dose, at peak dose, and in recovery. The test is supervised throughout by a consultant cardiologist.
At the time of booking, we ask about your mobility, symptoms, joint and orthopaedic history, and any conditions that limit exercise tolerance (COPD, severe osteoarthritis, peripheral arterial disease). In practice, most patients under 70 with suspected coronary artery disease have exercise stress echo; patients unable to reach 85% of predicted maximum heart rate on exercise are offered dobutamine. If you are unsure which protocol you need, call the clinic and we will discuss it with you before booking.
A stress echocardiogram answers a different clinical question to a resting echo, an ECG, or a CT coronary angiogram. The table below summarises when each test is the right choice so you can arrive at your appointment with a clear idea of what your scan will and will not show.
| Test | What It Shows | Radiation | Best For |
|---|---|---|---|
| Stress echocardiogram | Wall motion and heart function at rest and under load; valve gradients under stress | None | Inducible ischaemia; valve disease under load; exertional breathlessness |
| Resting echocardiogram (TTE) | Heart structure, valves, ejection fraction at rest | None | Heart failure, valve disease, murmurs, cardiomyopathy |
| ECG | Heart rhythm and electrical conduction at rest | None | Arrhythmia, conduction defects, acute chest pain assessment |
| Holter monitor | Continuous rhythm over 24–72 hours | None | Intermittent palpitations, paroxysmal arrhythmia |
| CT coronary angiography | Anatomy of the coronary arteries — narrowings, plaques, calcium | Low-dose X-ray; IV contrast | First-line in low-to-intermediate risk stable chest pain under NICE CG95 |
| Myocardial perfusion imaging | Blood flow to the heart muscle at rest and under stress | Radioactive tracer | Functional ischaemia assessment when stress echo is not possible |
| Cardiac MRI (stress CMR) | Detailed heart anatomy, perfusion, and scar | None (gadolinium contrast) | Complex cases, viability assessment, cardiomyopathy workup |
For a full side-by-side of imaging options, read our echocardiogram comparison guide. If you are not sure which test matches your symptoms, call 020 3633 4902 and we will help you decide.
Preparation for a stress echo is not the same as for a resting echocardiogram. Please read these instructions carefully — some medications may need to be temporarily withheld, and you will need to fast for a short period before the test.
Eat a light meal at least 3 hours before the appointment, then avoid food. You may drink water. Avoid caffeine (coffee, tea, cola, energy drinks, and chocolate) for 12 hours before the test — caffeine can interfere with the response to dobutamine and mimic stress-related symptoms.
Take all regular medications as normal unless we have specifically advised otherwise. This includes blood pressure tablets, statins, diabetes medication, and aspirin.
If your cardiologist has asked us to assess for inducible ischaemia, you may be asked to withhold beta-blockers (for example bisoprolol, atenolol, propranolol) for 24–48 hours before the test, as these blunt the heart-rate response. Do not stop any medication without being told to do so — confirm this with the clinic when booking.
Wear comfortable clothing suitable for exercise if you are booked for an exercise protocol — loose trousers or shorts, a t-shirt, and trainers or flat rubber-soled shoes. Avoid lotions and oils on the chest as they prevent the ECG electrodes from sticking.
You can eat, drink, and drive home as normal after the test. If you have had a dobutamine protocol, the drug wears off within 10–15 minutes and we will only discharge you once your heart rate and blood pressure have returned to baseline. No sedation is used, so there are no post-procedure restrictions.
A stress echo takes longer than a resting echo — typically 60 to 90 minutes in total — because rest images, stress images, and a recovery period are all part of the protocol. Here is what to expect at each stage.
We confirm your symptoms, medications, and any prior cardiac investigations. The sonographer and supervising cardiologist discuss whether an exercise or pharmacological protocol is appropriate. You sign a consent form covering both the scan and, where relevant, the use of dobutamine.
ECG electrodes are placed on your chest and a baseline 12-lead ECG is recorded. A full set of resting echocardiographic images is captured while you lie on your left side. Your resting blood pressure is recorded.
For exercise protocols, you walk on a treadmill at increasing speeds and inclines, or pedal a recumbent bicycle, until target heart rate is reached or you develop symptoms. For dobutamine protocols, the drug is infused in stepwise increasing doses via a cannula, with continuous ECG and blood pressure monitoring.
At peak stress, the sonographer rapidly captures a second full set of echocardiographic images — either during bicycle exercise, within 60 seconds of stopping treadmill exercise, or at peak dobutamine dose. Speed matters: abnormalities can resolve quickly once the heart slows down.
You are monitored until heart rate, blood pressure, and ECG return to baseline. The sonographer and cardiologist review resting and stress images side-by-side and share initial observations with you in plain English. A formal written report follows within 24 hours.
A stress echocardiogram performed in an accredited clinic by an experienced team is a safe test. The British Society of Echocardiography publishes stress echo safety standards, and serious adverse events are rare — large published series report a major complication rate of well under 1 in 1,000 studies. Both protocols are supervised continuously by a clinician trained in cardiac emergencies, and emergency medication and resuscitation equipment are immediately available.
The purpose of stress testing is to provoke symptoms and abnormalities that only appear under load. If you develop chest pain, significant breathlessness, dizziness, or ECG changes, the test is stopped and treatment is given. In the vast majority of cases, any symptoms resolve within minutes of stopping exercise or of the dobutamine wearing off.
Exercise protocols: shortness of breath, leg tiredness, mild chest discomfort at peak effort. Dobutamine protocols: palpitations, a flushed or "warm" feeling, headache, nausea, or transient irregular beats. All typically settle quickly in recovery.
Some cardiac conditions make stress testing unsafe until stabilised. At triage, we will ask about:
Chest pain at rest, worsening chest pain, new breathlessness at rest, collapse, or symptoms of a suspected heart attack need urgent assessment. Do not book a private stress echo — call 999 or go to your nearest A&E. A stress echo is a test for stable, investigative situations, not for an acute cardiac event.
Stress echo appointments are run as scheduled clinic sessions so that consultant cardiologist supervision is always available. Most appointments can be offered within a week. Booking is confirmed immediately.
Choose your preferred date and time on our secure booking page. A member of the clinical team will call you to confirm which protocol (exercise or dobutamine) is suitable for you and to answer any questions about preparation.
Price includes consultant cardiologist supervision, the scan, verbal feedback, and a written report within 24 hours. Insurance patients: please bring your authorisation code. See the full echocardiogram cost breakdown.
Insurance patients are welcome. Sonoworld is recognised by most major insurers including Bupa, AXA Health, Aviva, and Vitality. If you are unsure whether your symptoms warrant a stress echo or a different cardiac investigation, consider pairing it with a heart health screening blood panel — cholesterol, HbA1c, and BNP results complete the picture of cardiovascular risk in a single visit.
A resting echocardiogram images the heart while you are lying still. It is excellent for assessing heart structure, valves, and pumping function at rest. A stress echocardiogram adds a second set of images captured while the heart is working hard — either during exercise or under dobutamine. The comparison between rest and stress images is what allows us to detect inducible ischaemia and assess how valve disease behaves under load. Many patients with suspected coronary artery disease have a normal resting echo; the abnormality only appears with stress.
Plan for 60 to 90 minutes in the clinic. That includes the clinical history, resting ECG and baseline images, the stress phase itself (typically 8–15 minutes of exercise, or 15–25 minutes of dobutamine infusion), recovery monitoring, and a preliminary discussion at the end. The scanning time is short; the clock is mostly spent on safe preparation and recovery.
No — you can self-refer at Sonoworld. However, because stress echo is a test that provokes the heart, the clinical team will review your reason for wanting the test before booking is confirmed. If it becomes clear during that conversation that a different test would be more appropriate (for example a CT coronary angiogram, Holter monitor, or resting echo alone), we will explain that and redirect you. If you have a referral letter, bring it along — it gives the sonographer useful clinical context.
The target is to reach 85% of your age-predicted maximum heart rate — roughly calculated as (220 minus your age) × 0.85. For most patients this is achievable within 8 to 12 minutes on the treadmill. If you know you cannot exercise adequately because of knees, hips, back, COPD, or peripheral arterial disease, a dobutamine stress echo is a fully valid alternative with comparable diagnostic accuracy. Tell us at booking and we will arrange the right protocol from the start.
Dobutamine is a well-established stress agent used in cardiology for decades. In accredited clinics with continuous ECG monitoring and consultant cardiologist supervision, the rate of serious complications in published series is well under 1 in 1,000 studies. Common transient side effects include palpitations, a flushed feeling, headache, nausea, and brief irregular beats — these settle within 10–15 minutes of stopping the infusion. The test is stopped at the first sign of significant chest pain, ECG changes, or a drop in blood pressure.
Only if your referring cardiologist or the clinic has specifically told you to. Beta-blockers (for example bisoprolol, atenolol, propranolol) slow the heart-rate response, which can blunt the diagnostic sensitivity of a stress test for inducible ischaemia. In some cases we ask you to withhold these for 24–48 hours before the test; in others — particularly if the test is for valve disease or after a recent cardiac event — we ask you to continue them as normal. Never stop any cardiac medication without being told to do so.
They answer different questions. A CT coronary angiogram is an anatomical test — it shows the coronary arteries and any narrowings or plaques. A stress echocardiogram is a functional test — it shows whether the heart muscle is receiving enough blood on demand. Under NICE CG95, CT coronary angiography is the first-line test for most patients with stable chest pain. Stress echo is typically used when CT coronary angiography is equivocal, contraindicated, or when functional assessment is specifically required — for example to decide whether a known narrowing is actually causing the symptoms.
A positive stress echo means new wall motion abnormalities appeared in one or more regions of the heart during stress that were not present at rest. This usually indicates inducible ischaemia — a coronary artery that cannot increase blood supply enough to meet the demand of the stressed heart. The next step is usually a discussion with a cardiologist to decide whether coronary angiography (invasive or CT-based) is needed to define the culprit vessel and whether treatment should be medical or interventional.
You will receive verbal feedback from the sonographer and supervising cardiologist immediately after the test. A formal written report — including wall motion scores, haemodynamic response, symptom and ECG response, and clinical interpretation — is typically issued within 24 hours. With your consent, we send a copy directly to your GP or cardiologist.
Yes. No sedation is used and dobutamine wears off within 10–15 minutes. You are kept in the clinic until heart rate, blood pressure, and ECG have returned to baseline, at which point you can drive, return to work, and resume normal activity. If the test is positive and the team has any concerns, we will discuss that with you before you leave.
Yes. Because stress echo sessions require consultant cardiologist supervision, we ask for 48 hours' notice of cancellation or rescheduling where possible. Cancellations made within 24 hours of the appointment may be subject to a fee. Call 020 3633 4902 or email info@sonoworld.co.uk to make changes.
29 Weymouth Street
London W1G 7DB
Nearest stations: Regent's Park (Bakerloo) · Great Portland Street (Circle, H&C, Metropolitan) · Baker Street (Jubilee, Bakerloo, Metropolitan)
Open in Google MapsStress echo clinics run as scheduled sessions — call for the next available slot.
Stress echo assesses the heart under load. These related tests answer the neighbouring questions — rhythm, structure at rest, and vascular disease — and are often used in combination.
Heart structure, valves & function at rest.
Heart rhythm & electrical conduction. 5–10 min.
24–72 hr continuous rhythm recording.
Plaque & narrowing in carotid arteries.
Symptom guides, condition explainers, and follow-up reading from our cardiovascular patient library.
How exertional chest pain is triaged — what warrants a stress echo, a CT coronary, or urgent care.
How cardiologists distinguish cardiac breathlessness from lung, anaemia, or deconditioning causes.
What CAD is, how it develops, and how stress echo fits alongside other non-invasive tests.
What EF means, how it's measured, and how it changes between rest and stress imaging.
How to put together a sensible cardiovascular screening schedule by age and risk factor.
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