If your doctor orders a stress test, there’s no need to be concerned, even if you’ve suffered a prior heart attack. This simple, straightforward test is a safe way to evaluate the blood supply to your heart and how well your heart pumps.
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There are several variations of a stress test that may be ordered for different reasons. The most common reason is to look for the presence and extent of coronary artery disease (CAD) in someone who is experiencing symptoms.
“In general, the test allows us to differentiate between healthy heart muscle and muscle that has been damaged by heart attack and whether the blood supply to areas of muscle is compromised,” says cardiologist Michael Rocco, MD.
What to expect during the standard stress EKG
The basic, no-frills stress test is known as a stress EKG. The patient is wired with a standard 12-lead EKG, then walks on a treadmill. As the speed and incline of the treadmill are gradually increased, their heart’s response is monitored.
“There are characteristic changes to an EKG that indicate blood flow problems and rhythm abnormalities,” says Dr. Rocco. “We also look at blood pressure response and symptoms.”
The test — which can also be done with a stationary bicycle — is commonly done to look for the presence of CAD. It can also be used on high-risk patients prior to starting an exercise or cardiac rehabilitation program, and after the program has been completed to assess progress.
Stress echo imaging
Sometimes, the heart is imaged before and after a stress test. The addition of imaging helps diagnose CAD in situations where an EKG alone is less likely to be accurate; for example, in patients who take digoxin, and in women.
In this test, echocardiography is used to image the heart before and after the patient walks on a treadmill.
“This enables us to see the motion of the heart. If we spot an area of the heart muscle that looks normal at rest, but does not contract normally after exercise, this indicates there’s a problem with blood flow to that area,” says Dr. Rocco.
Nuclear stress imaging
Instead of echocardiography, a stress imaging test can be done using a nuclear tracer injected intravenously. The tracer, which is not iodine-based and will not cause an allergic reaction, is taken up by the heart and reveals the pattern of blood flow to the muscle.
“An abnormality that appears after the heart is stressed by exercise suggests that the flow of blood to that area is compromised. An abnormality present both before and after exercise generally indicates scar tissue or prior heart attack,” he says.
Pharmacologic stress tests
In order for a stress test to be useful, the patient must be able to achieve a high heart rate (85% of predicted maximum). In someone who is very elderly or has a medical condition that prevents this extent of exercise, medications can be given intravenously to achieve the desired result.
One of these is adenosine, a medication that increases coronary blood flow. “It doesn’t really mimic exercise, but it does tell us how well blood perfuses the heart muscle during the stimulation,” says Dr. Rocco.
Alternatively, dobutamine can be given. This drug mimics exercise somewhat by increasing heart rate, blood pressure and the force of contractility. When the heart is imaged with echocardiography, the cardiologist looks for abnormalities in wall motion or EKG that indicate the presence of CAD.
Cardiopulmonary exercise stress test
This is a special type of stress test ordered to evaluate heart failure or a potential heart transplant recipient, or to determine whether shortness of breath is caused by heart or lung disease.
It is performed on a treadmill or cycle with EKG, but a breathing apparatus is used to measure oxygen use and carbon dioxide production.
What happens next after my stress test?
Cardiologists combine the information provided by a stress test with a patient’s medical history and symptoms to make decisions about the need for further testing or management.
“Not every abnormal stress test requires additional testing. Some patients simply need to modify their risk factors,” says Dr. Rocco. “However, if the abnormality occurs at a low level of exercise, affects a large segment of heart muscle, or the pattern suggests multivessel disease, we will often proceed with cardiac catheterization.”
This article originally appeared in Cleveland Clinic Heart Advisor.
The statics are staggering enough. Heart disease claims 800,000 American lives every year. In 2017, that equated to roughly 1 in every 3 deaths. On average, one person dies of cardiovascular disease every 40 seconds. The United States isn’t alone—globally 31 percent of all deaths are due to some type of heart disease, according to the American College of Cardiology. Now, imagine those figures are more than mere numbers. Imagine that they represent someone you know and love. Or perhaps they even represent you. That thought places everything in a completely different perspective, doesn’t it?
What are the risk factors for heart disease?
Smoking, obesity and a sedentary lifestyle can all contribute to your risk. Having just one risk factor doubles your chances of having heart disease, according to the National Heart, Lung and Blood Institute.
You are at risk if:
- You are diabetic or have prediabetes.
- You are a smoker or you are regularly exposed to secondhand smoke, according to the Centers for Disease Control.
- You have high blood pressure.
- You have high cholesterol or high triglycerides.
- You are overweight or obese.
- You eat an unhealthy diet.
- You fail to get enough exercise.
- If you are a woman, who takes birth control pills and smokes, you are at a very high risk for heart disease.
- You are consistently under stress or suffer from depression.
- You’ve been diagnosed with sleep apnea.
- You have a family history of heart disease.
If you have had chest pain or any symptoms of heart disease, your doctor may wish for you to take a stress test. This is also commonly called the “treadmill test.” We’re here to take you through every step of this non-invasive procedure and give you an idea of what to expect.
What happens during a heart stress test?
First, and most important, one of our internal medicine physicians at Raleigh Medical Group will take time to speak to you about the test, your symptoms, and any information you need to prepare for the test. This will give you a chance to ask any questions. We believe it is vital to not only offer the highest quality medical care, but to also listen and give our patients time to address their concerns. We want to provide you with any education you need to help you live a healthier life.
Be sure your doctor has up-to-date information on the medications you are taking. It’s also important to let him or her know if you take any herbal supplements or drink alcohol. Continue taking your regular medication as prescribed unless your doctor tells you otherwise. Occasionally, some medications that keep your heart rate low are held prior to treadmill testing.
Be sure to follow your doctor’s instructions before the test. Sometimes patients are asked to refrain from eating, smoking or drinking for several hours. You should also wear comfortable clothes and walking or running shoes.
Next, you will be hooked up to a piece of heart monitoring equipment called an EKG. This will
will evaluate your heart rate and rhythm. Your blood pressure will be carefully monitored during all stages of the test.
The nurse or technician will do baseline reads and EKGs prior to starting your study. You will then be asked to walk slowly on the treadmill, which may be tilted to mimic the elevation of a small hill. Gradually, you will be asked to walk faster as more incline is added. This allows the physician to see how your heart reacts when it is asked to work hard, such as during exercise.
Additionally, your physician may also add an echocardiogram to your treadmill test. In some instances, this is a more helpful test as it allows the technician to provide measurements of your heart and check how well it moves during exercise. Your physician will determine which type of treadmill test is best for you.
Finally, after the test, we’ll take the results and create an effective health care plan specifically designed for you.
Remember, if at any time you feel you need to stop the test, all you have to do is speak with one of our professionals who will be with you during the entire procedure. It will be important to let your physician know if you experience any symptoms during the study.
Would you like more information? You can download a useful guide on stress tests from the American Heart Association.
Should you worry about your heart stress test?
In short, no. We’ve outlined three reasons that we hope will ease your anxiety.
1. A HEART STRESS TEST IS NON-INVASIVE.
The stress/exercise test doesn’t involve anesthesia or any type of injections. The electrodes used to monitor your heart rate are simply affixed to your chest with a special type of tape. This allows them to be easily removed after the examination. It’s a painless procedure.
2. SOMEONE IS IN THE ROOM WITH YOU DURING THE TEST.
If you’ve had the shortness of breath, chest pain or a previous heart attack, you may be nervous or uneasy. Perhaps you’re wondering if you will be able to complete the test or if you’ll be too exhausted on the treadmill. Don’t worry. Our health care professionals will be right there to address any concerns and to assist you in case an emergency arises.
3. IGNORANCE IS NOT BLISS.
Perhaps one of the most worrisome aspects of a stress test is the underlying fear that the physician will find something wrong with your heart. For this reason, many people opt to keep their “head in the sand” because they’d rather live in ignorance than face the facts. That could be a fatal mistake.
Your stress test may display perfectly normal results. If it doesn’t, we’re going to help you. We’re dedicated to guiding you through every step of the process, and we want you to know that you have a health care team that will provide unwavering support. Often, medication and lifestyle changes are all that is needed to start on the road to improvement.
We want all our patients to live a healthier life, and we want to be active partners in your care. We offer the services of a dietitian to help you make smart food choices. In addition, we offer a variety of medical screenings and vaccinations. We tailor our treatments to provide the finest personalized health care for each stage of your adult life.
