Stress Echocardiographic Study Report
Name: Patient ID: Sonographer:
Exam Date: Exam Number: Prior Study:
DOB: Age: Yrs Gender:
Height: inches Weight: lb BSA: m
Referring Physician: Interpreting Physician:
TREADMILL, EKG, AND ECHO DATA SUMMARY Echo exam quality:
Exercise Protocol EKG Data
Protocol: Worst-case ST Slope: ST Level:
Total minutes: Pre-exercise EKG:
Reason for stopping: Exercise EKG:
Heart Rate and Blood Pressure EKG SUMMARY
Resting blood pressure: / 1. No significant ST changes with exercise.
Baseline heart rate: Target heart rate: 2. No CP with exercise.
Percent of Max HR: % Predicted Max HR: 3. Exercise capacity was good.
Blood pressure at peak exercise: / 4. Normal heart rate response to exercise.
Maximum heart rate achieved:
5. Normal blood pressure response to exercise.
Rate pressure product:
6. No arrhythmias were observed.
Rest Echo Study: Normal wall motion and systolic thickening of all left ventricular segments. No resting wall motion
abnormalities. Resting ejection fraction is %.
Immediate Post-Exercise Echo Study: Increased wall motion and systolic thickening of all left ventricular segments
with decrease in end-systolic dimensions. (Visual estimate) No immediate post exercise abnormalities noted.
REST Score: 1.0 IMPOST Score: 1.0
1 Normal 1 Hyperkinetic
2 Hypokinetic 3 Akinetic/
2 Hypokinetic (Mild) 4 Dyskinetic
2 Hypokinetic (Moderate) 5 Dilated and Thinned
2 Hypokinetic (Severe) x Not Visualized
2 Hypokinetic (Borderline)
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