A stress echo is an echocardiogram performed before and after exercise and is usually done on a treadmill. The patient is hooked up to a 12 lead ECG and some pre exercise pictures are then taken mainly concentrating on the heart muscle of the left ventricle. Then the patient does a regular stress test where he walks on a treadmill at an incline. Every three minutes the pace and incline increase. The test is stopped when a target heart rate is reached or some sort of symptoms occur. Immediately after exercise more pictures of the heart muscle are taken while the heart rate is still high. Sometimes stress echos are done using medication to speed up the heart if the patient is unable to walk on a treadmill. In my experience a stress echo would not show an infected heart valve or a small growth in the endocardiaum better than a normal echo. The best way to evaluate for an infected valve (endocarditis) is a slightly invasive procedure called a transesophageal echocardiogram (a small echo probe is put down your throat while asleep). Stress echos are primarily used to evaluate left ventricular wall motion and to help rule out or document the presence of coronary artery disease.