Cardiac imaging · London
Stress echocardiogram - private in London.
A functional test of the heart under load. Consultant-supervised throughout, typically 60 to 90 minutes at the clinic, with a verbal result before you leave and a full report within a working day or two.
What it is
An ultrasound of the heart, imaged before and after stress.
A stress echocardiogram is a two-part test. First, a resting transthoracic echo captures how each wall of the left ventricle moves, how the valves behave and what the pumping fraction is. Then the heart is stressed, either by exercise on a treadmill or supine bicycle, or with a short infusion of dobutamine if you cannot exercise. Images are re-acquired at peak stress and compared, side by side, with the baseline.
The point of the exercise is simple: coronary artery disease often looks unremarkable at rest. Ask the heart for more blood flow and any segment fed by a narrowed artery starts to underperform, thickening less or moving out of time with its neighbours. Those inducible wall motion abnormalities are what the consultant is looking for. In valve disease the logic runs in parallel, with gradients and regurgitation measured across the workload rather than in a resting snapshot.
Who it is for
The right patient for a stress echo.
Guidelines from NICE and the British Society of Echocardiography position it as a first-line functional test in stable chest pain and a workhorse in valve and cardiomyopathy assessment.
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Stable chest pain assessment
Typical or atypical angina in a patient with low-to-intermediate pre-test probability of coronary artery disease. Positive study prompts angiography, negative study is reassuring.
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Valve disease under load
Low-flow low-gradient aortic stenosis, exertional mitral regurgitation, and asymptomatic severe regurgitation where symptoms and function under stress guide surgery.
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Cardiomyopathy and contractile reserve
Hypertrophic cardiomyopathy for latent gradients, dilated cardiomyopathy for reserve, and pre-cardiotoxic chemotherapy baselines.
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Patients unfit for CCTA
Heavy calcification, arrhythmia that will not settle for CT gating, contrast allergy or renal impairment. A functional answer without radiation or iodinated contrast.
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Pre-operative risk stratification
Intermediate-risk non-cardiac surgery in a patient with functional capacity limits, particularly vascular surgery.
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Unexplained breathlessness
Pinning down whether exertional dyspnoea is ischaemic, valvular, or driven by exercise-induced pulmonary hypertension.
Types of stress echo
Four stressors, matched to your case.
Exercise is preferred wherever mobility, joints and breathing allow. Pharmacological stress fills the gap for the rest.
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Treadmill exercise stress echo
Images taken at rest, then immediately after a Bruce-protocol treadmill test. Best physiological picture when you can exercise.
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Supine bicycle stress echo
You pedal while lying tilted on the couch, so the sonographer can image throughout each stage rather than only at peak.
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Dobutamine stress echo
A short infusion that raises heart rate and contractility for patients unable to exercise. Atropine may be added to reach target rate.
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Dipyridamole stress echo
A vasodilator alternative, now rarely used in UK practice for echo but sometimes chosen in specific valve or coronary reserve questions.
Preparation
A calm morning, then a working test.
Plan for 60 to 90 minutes at the clinic including consent, resting images, stress, recovery imaging and a quick verbal debrief with the cardiologist.
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Eat a light meal two to three hours beforehand. A full breakfast blunts exercise tolerance.
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Avoid caffeine and caffeinated tea for 24 hours. It interacts with the stress response, particularly for dobutamine studies.
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Hold beta-blockers only if your cardiologist has told you to, usually for 24 to 48 hours. Never stop them unprompted.
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Wear loose exercise clothing and trainers. A sports bra for women helps with electrode placement.
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Bring a list of your medications, any previous cardiology reports and, if available, a resting ECG.
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Skip body lotion or oil on the chest that morning so the ultrasound probe and ECG dots make good contact.
What it detects
Function that only reveals itself under load.
A resting echo describes the plumbing at idle. A stress echo tells you whether it holds up when the demand climbs.
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Inducible wall motion abnormalities
Segments that contract normally at rest but stiffen or thin with stress point to a significant coronary stenosis in that territory.
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Ejection fraction response
A normal heart augments EF with stress. A blunted or falling EF suggests multi-vessel disease or a cardiomyopathy.
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Valve gradient dynamics
Aortic and mitral gradients change under load. Useful in low-flow low-gradient aortic stenosis and exertional mitral regurgitation.
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Pulmonary artery pressures
Exercise-induced pulmonary hypertension is picked up here and often missed on a resting scan.
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Contractile reserve
How much extra squeeze the heart has in reserve. Guides prognosis in cardiomyopathy and pre-valve surgery planning.
Cost in London
£550 to £950, all in.
A consultant cardiologist supervises the study end to end, which is why stress echo sits above a resting scan on the fee list.
| Study | Indicative range | Duration | Report turnaround |
|---|---|---|---|
| Exercise treadmill stress echo | £550-£800 | 60-75 min | 1-3 days |
| Supine bicycle stress echo | £650-£900 | 60-90 min | 1-3 days |
| Dobutamine stress echo | £700-£950 | 75-90 min | 1-3 days |
| Stress echo with contrast enhancement | + £150-£250 | +10 min | 1-3 days |
Fees include the cardiologist, sonographer, echocardiographic contrast where clinically needed, and the written report. Bupa, AXA, Vitality, Aviva, WPA, Cigna and Healix cover stress echo when medically indicated and pre-authorised.
Where it is done
The London panel we introduce to.
Five consultant-led cardiac units where stress echo is a routine daily list, not an occasional add-on.
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Royal Brompton (private patients)
National reference centre for cardiac imaging.
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HCA Wellington Hospital
Large private cardiac unit in St John's Wood.
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Cromwell Hospital (Bupa)
Kensington. Same-week slots for insured patients.
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One Welbeck Heart Health
Purpose-built cardiac centre off Harley Street.
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London Cardiovascular Clinic
City and Devonshire Place sites, consultant-led throughout.
Compared to CCTA and CMR
Functional, not anatomical - and often complementary.
Different questions, different tools. A good cardiologist chooses the study that answers your specific one, and combines them where the answer is genuinely uncertain.
Stress echocardiogram
Functional. Asks whether the heart muscle underperforms when demand rises. No radiation, no iodinated contrast, real-time valve information at load. Depends on image quality and, for exercise studies, on your ability to reach target heart rate.
Coronary CT angiography
Anatomical. Maps the coronary arteries directly and rules out significant disease with a very high negative predictive value. Ideal first test in low pre-test probability. Limited by heavy calcification and arrhythmia. Learn more on our CCTA guide.
Cardiac MRI (stress CMR)
Best-in-class tissue characterisation and highly sensitive stress perfusion imaging with adenosine. Reserved for equivocal studies, cardiomyopathy work-up and viability questions. Details on our cardiac MRI page.
Related pages
Around the same clinical question.
Frequently asked
Six questions we hear most.
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How fit do I need to be for an exercise stress echo?
You need to reach around 85 per cent of your age-predicted maximum heart rate, roughly six to nine minutes on the Bruce protocol. If your knees, hips or breathing will not allow that, a dobutamine or bicycle study is arranged instead. Your cardiologist decides on the day.
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Is dobutamine stress echo safe?
Yes, in the hands of a consultant cardiologist with a resuscitation-trained team, which is the standard on our panel. Serious complications are rare, well under one in a thousand. You may feel palpitations, flushing or a brief headache. The infusion is stopped the moment target heart rate or any concerning change appears.
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Can I have a stress echo if I have asthma?
Well-controlled asthma is not a barrier to exercise or dobutamine stress echo. Bring your inhaler. Severe or brittle asthma needs a discussion with the cardiologist first, particularly if beta-blocker rescue might be required.
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Do I need to stop my beta-blocker beforehand?
Often yes, for 24 to 48 hours, because beta-blockers blunt the heart-rate response and can mask ischaemia. Only stop if your cardiologist tells you to. Never stop a beta-blocker prescribed after a heart attack or for an arrhythmia without asking.
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Will my insurer cover it?
Bupa, AXA, Vitality, Aviva, WPA, Cigna and Healix all cover stress echo when medically indicated and pre-authorised. Screening in an asymptomatic patient is usually self-pay. We handle pre-authorisation before you arrive.
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How quickly do I get the results?
The cardiologist supervising the study gives you a verbal summary before you leave. A written report follows in one to three working days and is sent to your GP or referring consultant with your consent.
Book a private stress echo
Tell us what is going on. We will do the rest.
A short, confidential form. Within one working day we match you to the right cardiologist on our London panel, confirm insurer pre-authorisation and book you in - often within the same week.