Contraindications to Stress Echocardiography

General Contraindications

• The American Heart Association recommends that stress echocardiography is contraindicated in patients with acute coronary syndrome or high-risk unstable angina, with a strength of evidence level of A 2, 3
• The American College of Cardiology recommends that stress echocardiography is contraindicated in patients with decompensated heart failure, severe or symptomatic aortic stenosis, uncontrolled cardiac arrhythmias, severe systemic arterial hypertension (≥200/110 mmHg), acute aortic dissection, acute pericarditis or myocarditis, acute pulmonary embolism, and severe pulmonary hypertension, with a strength of evidence level of A 1, 2, 3

Specific Contraindications for Dobutamine Stress Echocardiography

• The American College of Cardiology recommends that dobutamine stress echocardiography is contraindicated in patients with critical aortic stenosis, hemodynamically significant left ventricular outflow tract (LVOT) obstruction, hypokalemia, uncontrolled congestive heart failure, and uncontrolled dysrhythmias, with a strength of evidence level of B 1, 4, 5

Specific Contraindications for Vasodilator Stress Echocardiography

• The American College of Cardiology recommends that vasodilator stress echocardiography is contraindicated in patients with second or third-degree atrioventricular block (without permanent pacemaker), significant arrhythmias, significant hypotension (SBP <90 mmHg), known or suspected bronchoconstrictive or bronchospastic disease, recent use of dipyridamole or dipyridamole-containing medications, and use of methylxanthines (e.g., aminophylline, caffeine) within 12 hours, with a strength of evidence level of B 1, 3, 4, 6