Concierge cardiology · London
Cardiac stress testing, the modern menu — treadmill ECG, stress echo, stress cardiac MRI and CT-FFR.
Modern cardiac stress testing goes beyond the classic exercise treadmill. Options include exercise or dobutamine stress echocardiogram, stress cardiac MRI (adenosine), CT coronary angiography with FFR, and myocardial perfusion imaging (MPI).
Why patients choose us
- 01
The right test, not just any stress test
We match you to the right modality — treadmill ECG, stress echo, stress cMRI or CT-FFR — based on your pre-test probability and clinical picture.
- 02
Consultant cardiologist reporting
A consultant cardiologist supervises the test and issues the report, with LVEF, ischaemic burden and a clear next step.
- 03
Independent, and free to you
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
The six things worth knowing first.
Cardiac stress testing has moved on. These are the facts that shape which test the cardiologist recommends — and what a good report looks like.
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Definition
An assessment of coronary flow and cardiac function under physiological or pharmacological stress.
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The modern menu
Treadmill ECG, stress echocardiogram, stress cardiac MRI, CT coronary angiography with FFR, and myocardial perfusion imaging (MPI).
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Chosen by patient factors
Modality is chosen by pre-test probability of coronary artery disease, exercise capacity, body habitus and previous imaging.
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NICE CG95 favours imaging
NICE Chest pain of recent onset (CG95) favours imaging-based stress tests over exercise ECG alone.
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CT-FFR — the emerging standard
CT coronary angiography with FFR is emerging as the non-invasive gold-standard for stable chest pain.
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Complements angiography
Stress testing complements invasive coronary angiography — it helps decide who benefits from a catheter lab visit at all.
Indicative pricing
What private cardiac stress testing costs in London.
Indicative ranges across our partner cardiology units. Send the details and we quote firm figures across two or three options.
In short
A stress echocardiogram in our network: £650–£1,100, with findings often the same day.
| Test | Indicative range | Typical duration | Report turnaround |
|---|---|---|---|
| Exercise treadmill ECG | £350–£550 | 45 min | Same-day |
| Stress echocardiogram (exercise or dobutamine) | £650–£1,100 | 60 min | Same-day |
| Stress cardiac MRI (adenosine) | £1,200–£1,900 | 75 min | 24–48 hr |
| CT coronary angiography with FFR (HeartFlow) | £1,400–£2,400 | 45 min | 3–5 days |
| Myocardial perfusion imaging (MPI / SPECT) | £1,500–£2,200 | Half-day | 48–72 hr |
| Full ischaemia work-up (consult + stress test + follow-up) | £1,800–£3,500 | Half-day | Same-week |
Prices vary by modality, clinic, whether a consultant cardiology consultation is bundled, and whether contrast or a radiotracer is used. We come back with a firm quote within one working day.
The problem
The wrong stress test is worse than none.
A treadmill ECG in the wrong patient produces false reassurance or false alarm. Modality choice — set by a consultant cardiologist against your pre-test probability — is the whole game.
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Stable chest pain?
We route to an imaging-based stress test per NICE CG95, not a plain treadmill ECG.
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Can’t exercise easily?
Dobutamine stress echo or adenosine stress cardiac MRI — pharmacological stress with the same endpoints.
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Previous equivocal test?
CT-FFR or PET perfusion for a definitive answer without going to the catheter lab.
Preparation and journey
From consultation to structured report — what happens, in order.
A consultant cardiologist runs the plan from first message to signed report.
Phase 1 · Before your test
Consultation and preparation
Phase 2 · On the day
Physician-supervised stress test
Phase 3 · After
Structured report
- 01
Before
Cardiology consultation
A consultant cardiologist reviews your history, risk factors and any prior imaging, and confirms which stress modality fits you best.
- 02
Before
Withhold beta-blockers if requested
You may be asked to hold beta-blockers, rate-limiting calcium-channel blockers or nitrates for 24–48 hours — only if the cardiologist advises it.
- 03
Before
Fast 4–6 hours (imaging-based tests)
A light fast for 4–6 hours before stress echo, stress cMRI, CT-FFR and MPI. Water, essential medications and insulin as advised.
- 04
On the day
IV cannula for stress echo / MRI / MPI
A small cannula is placed for contrast, stress agents (dobutamine, adenosine, regadenoson) or radiotracer.
- 05
On the day
Modified Bruce or symptom-limited protocol
For exercise tests, a modified Bruce or symptom-limited treadmill/bike protocol — you exercise until target heart rate, symptoms or a stopping criterion.
- 06
On the day
Continuous ECG and BP monitoring
Continuous 12-lead ECG, blood pressure and rhythm monitoring throughout, with a physician-led safety team present.
- 07
After
Structured report with LVEF and ischaemia
A structured consultant report: LVEF, wall-motion or perfusion findings, ischaemic burden, exercise capacity and a concrete next step.
Typical end-to-end: 3–7 days. Urgent cases: same day.
What it shows
The findings a cardiac stress test can put a number on.
Cardiac stress testing quantifies inducible ischaemia and function under load. These are the specific findings a good report describes.
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Exercise-induced ischaemia
ST-segment shift or reproducible angina at a defined workload.
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Regional wall-motion abnormality (stress echo)
A previously normal segment becoming hypokinetic under stress — a specific marker of ischaemia.
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Perfusion defect (MPI, stress MRI)
A territory of myocardium under-perfused at stress but normal at rest — inducible ischaemia.
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Ischaemic burden % of myocardium
The percentage of left ventricle affected — the key number for deciding on revascularisation.
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CT-FFR pressure drop across a stenosis
A computed pressure ratio that flags haemodynamically significant coronary stenoses without a catheter.
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Exercise capacity in METs
Objective fitness — a strong independent predictor of cardiovascular outcome.
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Chronotropic response
How your heart rate rises with workload — chronotropic incompetence carries prognostic weight.
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Red flag: sustained VT, hypotension or ST-elevation — terminate test and admit
Any of these ends the test immediately and triggers same-day cardiology admission.
The modern menu
Not all cardiac stress tests are the same.
What each option on the modern menu is actually for.
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Exercise treadmill ECG
The classic test — 12-lead ECG during a Bruce protocol. Best in low-to-intermediate risk patients who can exercise.
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Exercise stress echocardiogram
Echo images before and immediately after exercise — detects inducible wall-motion abnormalities.
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Dobutamine stress echocardiogram
Pharmacological stress with dobutamine for patients who cannot exercise. Same wall-motion endpoints.
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Stress cardiac MRI (adenosine)
Adenosine perfusion cMRI — the highest spatial resolution non-invasive ischaemia test.
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CT coronary angiography with FFR
CTCA plus computational fluid dynamics (HeartFlow) — anatomy and physiology in one visit.
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Myocardial perfusion imaging (MPI / SPECT)
Radiotracer perfusion imaging at rest and stress — well-validated ischaemic burden quantification.
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PET myocardial perfusion
Higher-accuracy perfusion imaging with quantitative myocardial blood flow — for complex or previously equivocal cases.
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Invasive coronary angiography with FFR
The catheter-lab gold-standard — reserved for high pre-test probability or after a positive non-invasive test.
Next steps
What follows a stress test — the treatment options.
The report is not the end of the story. This is the range of next steps that a stress-test result opens up, from reassurance to revascularisation.
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Reassurance if normal
A negative high-quality stress test carries a strong negative predictive value — often the answer is genuine reassurance.
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Optimal medical therapy for CAD
Antiplatelet, statin, beta-blocker, ACE-inhibitor and anti-anginal therapy where indicated.
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Invasive coronary angiography (± FFR)
For a positive test with meaningful ischaemic burden — a diagnostic catheter procedure with pressure-wire assessment.
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PCI (percutaneous coronary intervention)
Stent implantation for flow-limiting lesions confirmed at angiography.
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Coronary artery bypass graft (CABG)
Surgical revascularisation for multi-vessel or left-main disease, or complex anatomy.
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Cardiovascular risk reduction
Blood-pressure control, lipids, glucose, weight, smoking cessation and exercise prescription.
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Cardiac rehabilitation
A supervised programme after ACS, PCI or CABG — one of the most evidence-based cardiology interventions.
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Structured cardiology follow-up
A planned review pathway — repeat imaging, symptom review and titration of therapy.
Our vetted London network
A small panel of cardiology units, we picked them.
Partners across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every cardiology unit in our network.
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Consultant cardiologists with cardiac imaging accreditation
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On-site resuscitation team and defibrillator during every stress test
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Modern echo, cMRI or CT platform with current-generation software
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Onward invasive-cardiology pathway if significant ischaemia is found
Red flags and safety
The findings that change the plan immediately.
A well-run stress test is very safe — serious complications are around 1 in 10,000. These are the specific findings that terminate the test or escalate care.
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Sustained VT / VF during test
Sustained ventricular tachycardia or fibrillation — the test is terminated and resuscitation begun immediately.
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Marked ST-elevation
ST-elevation on the exercise ECG suggests transmural ischaemia — activation of the acute coronary pathway.
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Hypotension
A fall in systolic blood pressure with exercise is a high-risk finding and stops the test.
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Angina at low workload
Chest pain at low METs points to significant ischaemia and warrants prompt angiography.
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Very high ischaemic burden (> 10%)
More than 10% of the left ventricle ischaemic on imaging is the threshold above which revascularisation improves prognosis.
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High-risk perfusion defect
Large or multi-territory perfusion defects — a marker of left-main or three-vessel disease.
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Reduced LVEF post-stress
A drop in ejection fraction with stress suggests extensive ischaemia and needs urgent review.
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Uncontrolled hypertension
Severe uncontrolled hypertension is a contraindication — stabilise before proceeding.
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Recent ACS (relative contraindication)
Acute coronary syndrome in the preceding days is a relative contraindication — timing and modality need cardiology sign-off.
Reading your report
A cardiac stress test report can look intimidating. It isn’t.
Whatever the finding, a structured cardiology report keeps to the same four parts.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication and cardiovascular risk
Your details, symptoms, risk factors and pre-test probability — the frame for interpreting the numbers.
- 02 Technique
Modality, protocol and stress achieved
Which test, which stress agent or protocol, heart rate and BP response, and whether target workload was reached.
- 03 Findings
LVEF, wall motion, perfusion and ischaemic burden
Left ventricular function, regional wall motion, perfusion territories and quantified ischaemic burden.
- 04 Impression
The conclusion: read this first
Negative, low-, intermediate- or high-risk study, and the concrete next step — medical therapy, angiography or reassurance.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about cardiac stress testing.
Quick answers on modality choice, CT-FFR, medication holds, timing, safety and what happens if the test is positive.
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Which cardiac stress test should I actually have?
That depends on your pre-test probability of coronary disease, whether you can exercise properly, body habitus and any prior imaging — NICE CG95 favours imaging-based tests over a plain exercise ECG for most stable chest pain. In London a private cardiologist will typically start with CT coronary angiography with FFR or a stress echo, moving to stress cardiac MRI or MPI where the picture is unclear.
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What is CT-FFR (HeartFlow) and why is it emerging as the gold-standard?
CT coronary angiography with FFR combines anatomical imaging of the coronary arteries with a computed pressure ratio (fractional flow reserve) across each stenosis. It gives anatomy and physiology in one non-invasive visit and increasingly replaces both exercise ECG and diagnostic catheter angiography for stable chest pain.
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Do I need to stop my beta-blocker before a stress test?
Sometimes. For a diagnostic exercise or stress echo the cardiologist may ask you to hold beta-blockers, rate-limiting calcium-channel blockers or nitrates for 24–48 hours. Never stop cardiac medication without specific advice — we confirm the plan with the reporting cardiologist first.
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How long does a cardiac stress test take?
A treadmill ECG takes about 45 minutes end-to-end. Stress echo runs around 60 minutes. Stress cardiac MRI is roughly 75 minutes. CT-FFR is a 45-minute scan with a report a few days later. MPI is a half-day because rest and stress imaging are separated.
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Is a cardiac stress test safe?
Very. Serious complications are rare — around 1 in 10,000 — and every test is supervised by a physician with resuscitation equipment on hand. Sustained VT, marked ST-elevation, hypotension or angina at low workload terminate the test immediately.
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What happens if the test is positive?
A positive stress test with meaningful ischaemic burden usually leads to invasive coronary angiography with pressure-wire (FFR) assessment. Flow-limiting lesions are treated with PCI (stent) or, for multi-vessel or left-main disease, CABG. Everyone gets optimal medical therapy and cardiovascular risk reduction alongside.
Sources
Clinical references behind this guide.
- NICE. Chest pain of recent onset: assessment and diagnosis (CG95).
- European Society of Cardiology. Guidelines on chronic coronary syndromes.
- American Heart Association. Stress testing scientific statements.
- British Cardiovascular Society. Position statements and guidance.
Last reviewed 2026-07-30. Next review 2027-07-30. Reviewed by Pulse Atlas Editorial Board (). Approx 7 min read.
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In practice, in London
The London pathway for cardiac stress testing
With cardiac stress testing, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The NHS route for cardiac stress testing is thorough, but the queue is real. Most patients we speak with have been told to expect anywhere from a handful of weeks to several months, depending on their local trust and how the referral is graded. Going private in London usually collapses that window to a matter of days — often the same week if the diary allows. It isn’t about jumping a queue so much as buying time back while you still have the flexibility to plan around it.
In practice, a private cardiac stress testing appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For cardiac stress testing specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For cardiac stress testing, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.