• Cardiac Stress Test

    (Exercise Stress Test; Exercise Tolerance Test)

    Definition

    A cardiac stress test is a recording of the heart's activity during exercise. The heart is monitored using electrodes to record its electrical activity. Heart activity is also measured by looking at changes in blood pressure and pulse during the test.

    Reasons for Test

    During physical activity, your body needs higher levels of oxygen. It gets oxygen from the blood. During exercise, the heart has to work harder to get blood to your organs. A cardiac stress test is used to see if your heart works well, even when it is working hard. The test is most often done to:
    • Evaluate whether complaints of chest pain are related to your heart
    • Determine if arteries to your heart have blockages or narrowing (coronary heart disease [CHD])
    • Identify an irregular heart rhythm, or see if you pass out during or after exercise
    • Monitor your heart's response to treatment or procedures
    • Determine a safe level of activity before the start of an exercise plan
    • Plan rehabilitation after a heart attack
    EKGs Revealing Cardiac Muscle Damage
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    Possible Complications

    A cardiac stress test has minimal risk. Complications can include:
    • Developing chest pain
    • Developing an irregular heart rhythm
    • Having a heart attack, but this is extremely rare
    Technicians will be alert for any signs of heart or lung problems. Immediate action will be taken if complications happen. A doctor, most often a cardiologist, will be available during the stress test as well.

    What to Expect

    Prior to Test

    • Your doctor may do a physical exam. Your medicines will be reviewed. Some medicines should not be taken before the test.
    • Your doctor may need to examine your heart. This can be done with:
    In the time leading up to your procedure:
    • Do not eat or drink products with caffeine for 12-24 hours before the test.
    • Do not eat or drink anything except water for four hours before the test.
    • Do not smoke for several hours before the test.
    • Wear comfortable clothing and walking shoes or exercise sneakers.
    • Bring a list of your current medicines to the test.
    • If you have diabetes, bring your glucose monitor to the test.

    Description of Test

    EKG electrodes will be attached to your chest. The electrodes are small, sticky patches with wires. Your resting blood pressure and EKG readings will be taken.
    The cardiac stress test is done on a treadmill or a stationary bike. You will slowly start walking or riding. At regular intervals, the speed and elevation will be increased. Your EKG, blood pressure, heart rate, and symptoms will be closely monitored.
    The test may be stopped early if you feel extremely tired, get chest pain, have trouble breathing, or if you have any symptoms that suggest heart problems. Significant changes in the EKG will also stop the test. After exercise is complete, your blood pressure, heart rate, and EKG will be monitored until levels return to normal.
    Your doctor may also order a blood flow imaging exam. This is called a nuclear stress test. A small amount of radioactive chemical will be injected into a vein when you are exercising at your peak. Scans will be taken while you lie in different positions under a special camera. The images will help identify areas of the heart that may not be receiving enough oxygen. After you have rested for about an hour, a second set of images will be taken.
    A stress echocardiogram may also be done. This is an ultrasound, which takes pictures of the heart before and right after exercise.

    After Test

    You may resume normal activities.

    How Long Will It Take?

    The exercise portion of the test generally takes less than 15 minutes. Your entire appointment will last about an hour. A nuclear stress test may take up to 3-4 hours.

    Will It Hurt?

    Exercise testing normally causes no pain.

    Results

    A cardiologist will review the test results and send a report to your doctor. The report is often sent within 24 hours.
    One or more of the following are considered a positive stress test:
    • EKG changes that show low oxygen supply to the heart
    • You develop chest pain or trouble breathing, especially if associated with EKG changes
    • Nuclear stress test results that show areas of your heart that are not receiving enough oxygen during exercise
    • Failure to properly increase heart rate and/or blood pressure during exercise
    A positive test may mean CHD, but not all patients who test positive have CHD. Your doctor will decide if further testing or treatment is needed based on the results of your test.

    Call Your Doctor

    After the test, call your doctor if any of the following occurs:
    • Chest pain
    • Pounding in the chest
    • Dizziness or lightheadedness
    • Feeling extremely tired or having trouble breathing
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Family Physicians http://www.familydoctor.org

    American Heart Association http://www.heart.org

    Heart Rhythm Society http://www.hrsonline.org

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca

    Heart and Stroke Foundation of Canada http://www.heartandstroke.com

    References

    Darrow M. Ordering and understanding the exercise stress test. Am Fam Physician. 1999:59(2):401-410. Available at: http://www.aafp.org/afp/1999/0115/p401.html. Accessed January 23, 2013.

    Exercise stress test. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Exercise-Stress-Test%5FUCM%5F307474%5FArticle.jsp. Updated January 2, 2013. Accessed January 23, 2013.

    Tierny LM, McPhee SJ, et al. Current Medical Diagnosis and Treatment. 45th ed. New York, NY: McGraw-Hill; 2006.

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