“When does an echo test and stress test show a heart problem?”

This question should be directed to your primary care doctor or cardiologist who can evaluate the differential diagnosis for chest pain in a young male. Many are non-surgical and can be managed with medicine. If your tests were negative, then you should entertain other causes.

I hope that helps.

An echocardiogram of the heart is basically an ultrasound that can examine the function and size of the walls of the heart, the 4 valves of the heart, and the overall efficiency of the heart. Some of the information obtained in this study will be whether or not you have normal heart function (an ejection fraction is calculated); normal valvular function (no leaking or tight valves); normal wall thickness (no walls that are too thin or too thick); and normal wall motion (no walls that are not moving well). A normal echo is a very good thing! A stress test adds increased demand to the heart by making it work harder and it checks the wall motions as well. It can pick up when the heart isn't able to handle the stress. A normal stress test is a very good thing!! There are other tests that your cardiologist may recommend if you continue to have chest pain.

These tests are pwrformed on people with stable angina to rule in or out major heart issues. These tests are not performed during times of pain. They are non invasive tests to better judge if there is any coronary artery disease, and how the heart looks overall. The definitive test is a cardiac cath, but if your cardiac enzymes were normal, and the non invasive tests are normal too, there is an extremely low likelihood that your chest pain is from yoyr heart Coronary spasm could occur and minic CAD, also severe acid reflux may mimic CAD and so can esophageal spasm.

And Echo test will show you whether or not there is muscle dysfunction in the heart and a stress test will show you if the coronary arteries are the cause of the muscle dysfunction.

Donna Mendes, MD

At first glance, a 37 year old man would not be normally expected to have coronary artery disease but there are exceptions and outliers. Generally speaking, a stress test is to see if under a physiologic stress of increased work by the heart to exercise or a pharmacological induced stress in people who cannot exercise, the heart demonstrates ischemia, which is an inability to increase blood flow to the heart to meet the increased demand. If this test is negative then one can generally rule out significant coronary artery disease. There are three kinds of stress tests - treadmill, nuclear medicine, and a dobutamine stress echocardiogram. All have their advantages and limitations but if one of these is done And Is negative, one can generally rule out coronary artery disease as a cause.

The standard echocardiogram is to evaluate cardiac function and valvular function and structure. If that’s normal, then one can exclude this as a cause of symptoms.

The one thing that these tests do not evaluate is rhythm disorders which are usually episodic and if this is suspected then one needs to have an ambulatory monitor which is worn for a period of time, sometimes even 30 days and if one develops symptoms, then that time is correlated with the rhythm to see if they are linked.

Gastrointestinal symptoms can mimic cardiac symptoms as well. And to true other question that you posed the stress test and echo are done at baseline not when one has symptoms- that’s not necessary. The rhythm monitoring is done to see if, when symptoms develop, there is a coincident abnormal rhythm such as an abnormal fast heart rate.

Hope that answers the question adequately.

Niren Angle, MD, RVT, FACS