Pediatric Echocardiography Stress Laboratory

To fully assess the condition of a child’s heart, physicians must observe how it functions under stress. Even a heart that appears clinically normal at rest may reveal dysfunction with exercise. The Echocardiography Stress Laboratory, a new service provided by the Stanford Medicine Children’s Health Echocardiography Laboratory, combines traditional echocardiography with cardiovascular stress testing for assessing children with pulmonary hypertension, abnormal valves, and cardiomyopathies or other conditions predisposing them to systolic or diastolic abnormalities. The lab is equipped with a stationary bicycle that is supine so that providers can perform echocardiograms immediately before and at peak exercise. Additional modalities such as tissue Doppler and strain measurements can be added to stress echo to help detect coronary artery vasculopathy or other conditions affecting function that may not be apparent at rest.

Unlike an ordinary exercise test, stress echo reveals how much right ventricular pressure increases with exercise in pulmonary hypertension, how high the gradient across a stenotic or mechanical valve becomes with stress, how much outflow obstruction increases in hypertrophic cardiomyopathy, and how global systolic or diastolic function is affected by exercise.

Stress echo helps cardiologists zero in on an accurate diagnosis and plan the best possible treatment course for their young patients. It is also a powerful follow-up tool for heart surgery patients, including transplants.

Cardiologist Inger Olson, MD, director of the Echocardiography Stress Laboratory, collaborates with other investigators using exercise testing as a way to study obesity, heart transplantation, pulmonary hypertension, and patients with single ventricles post Fontan procedures.

Examples of conditions assessed in the Echocardiography Stress Laboratory

  • Pulmonary hypertension
  • Mechanical mitral or aortic valves
  • Stenotic aortic and pulmonary valves (e.g., repaired tetralogy of Fallot)
  • Hypertrophic cardiomyopathy
  • Post chemotherapy
  • Post heart transplant
  • Cardiac complications related to Kawasaki disease
  • Cardiac complications related to sickle cell disease

For referring physicians

How to order an exercise echocardiogram

Under "SmartSet Orders" in the Epic clinical software, search for "exercise echo" to find the exercise echocardiogram order set. This includes an order for a focused echocardiogram and a non-metabolic exercise study. For the echocardiogram order, you will need to select one of the options for indications. The test will be done specifically for this indication. You do not need to make any modifications to the exercise order.