CARDIOLOGISTS IN HEBBAL Stress echocardiography Ischaemic areas of myocardium are known to have reduced contraction compared with normal areas. This can be demonstrated by high-quality echocardiograms. A number of standard views of the heart are obtained and the wall is divided into regions that are assessed for reduced motion. The echo equipment must be designed to store rest images and to present them next to stress images on a split screen so that direct comparison can be made. The stress can be provided by exercise or dobutamine infusion. Exercise echocardiography is difficult to perform because of movement problems and there is quite high inter-reporter variability, but both techniques can approach the accuracy of sestamibi testing in experienced hands. It is not possible to obtain images of adequate quality in all patients.