ABSTRACT
Stress echocardiography “combines the most difficult part of echocardiography, the assessment of wall motion abnormalities, with the most boring part of cardiology, the performance of stress tests” (A. E. Weyman). Training therefore is of paramount importance in this particular field, perhaps even more so than in other subspecialties of echocardiography. Stress echocardiography is an advanced technique and requires experience in transthoracic echocardiography, because the recognition of range and limits of normalcy is critical in interpreting stress echo images. The trainee should learn to properly acquire the images, to handle the software for storage and display of recorded images, and to systematically interpret the stress test comparing baseline and stress images segment by segment. Typical errors such as acquisition of nonstandard cross sections due to time pressure, false triggering due to ECG artifacts, or arrhythmias leading to uninterpretable cine-loops, etc., should be recognized and corrected. Importantly, the trainee must learn to recognize large inducible wall motion abnormalities that should lead to termination of the study.
