Exercise Stress Test

A stress test puts stress on the heart using exercise. Dr. Moore’s office utilizes a treadmill for this test. (There are other methods of putting stress on the heart such as to pedal an exercise bike or omitting the exercise using drugs to cause the heart to beat more forcefully and faster as well. This is called a chemical stress. It is used in people who may have mobility issues)

Who needs a stress test?

The stress test is done to help identify causes of symptoms such as chest pain or shortness of breath. As your body works harder during the test, it requires more oxygen, so the heart must pump more blood. The stress test can show if the blood supply is reduced in the arteries that supply the heart, diagnose cardiac arrhythmias (abnormal heart rhythms) and determine the effectiveness of certain heart medications and treatments. It will also show your level of fitness, which will guide your physician in recommending an exercise program specifically for you.  The exercise stress test is typically done in patients who are symptomatic and have a low or intermediate probability of coronary artery disease. Occasionally this test may be done in patients who have no symptoms but have an intermediate to high probability of coronary artery disease IF they have a high-risk occupation such as bus driver or pilot or IF they are about to start an aggressive exercise program. This test is not appropriate for people who are unable to exercise or if their resting EKG is abnormal.

There are other tests that can be done if an exercise stress test is not appropriate for you. These include:

  •             Stress Echo
  •             Cardiac SPECT stress
  •             Cardiac PET stress
  •             Coronary Calcium Score
  •             Coronary CT Angiography
  •             Cardiac MRI (not yet available)

What to expect with your test?

Electrodes will be placed and connected with wires to a computer in order to produce an electrocardiogram (EKG). An EKG and blood pressure (BP) reading are done at rest. A series of EKG’s will also be printed at predetermined intervals during the test. The trained technician will also print out EKG’s if any abnormality is seen during the test. In addition to serial EKG’s during the test, your BP and your perceived level of exertion will be recorded at predetermined intervals during the test. The technician will also ask you about symptoms that may develop during the test such as chest pain, shortness of breath or dizziness. These symptoms will be recorded at the times they occur. At predetermined intervals during the test the treadmill will speed up very gradually and the incline or grade of the treadmill will increase thus increasing the stress (workload) on the heart. You will be asked to keep going until the heart rate reaches between 80% and 90% of the maximum for their age and sex. Some people are not able to achieve their target heart rate due to deconditioning, certain medications or even an abnormality of the pacemaker of the heart (called the sinoatrial node). If symptoms such as shortness of breath or chest pain become too uncomfortable or if significant abnormalities appear on the ECG or blood pressure recordings, or if the person is unable to exercise any further due to fatigue or inability to keep up with the speed of the treadmill, the test is stopped sooner. Once the test has ended several more EKG’s will be printed and your BP will be monitored for the next few minutes. You will be asked about symptoms during this recovery time as well.

What are the risks of the test?

There is very little risk for healthy people who take the test. The risk is equivalent to walking fast or jogging up a hill. A medical professional is always present in the office in the event something unusual happens during a test.

What to expect after the test?

Before you leave the office, your physician will review the entire test looking at all the information gathered. Your physician will be looking at the particular symptoms you exhibited during the test, how long you stayed on the test, how quickly and how much your heart rate and blood pressure increased during the test, the EKG findings during the test including changes that are suspicious for coronary artery disease, the rhythm of your heart, and what happened with your vital signs and EKG’s in the recovery time after the test. The physician will then determine if the test was adequate, meaning your heart rate was high enough and your exercise time was long enough.

If the test result is normal no further testing is required. If the test result is abnormal further testing may be needed – such as a chemical stress or stress echo. The test may not have been a max test due to lack of workload on the heart or lack of increase in the heart rate to an adequate level. If this occurs the doctor would decide if the test was sufficient for the patients situation or if another diagnostic test such as a chemical stress test is necessary.

Who should NOT undergo exercise stress testing?

  • Those persons who are unable to exercise
  • Those persons who have an abnormal resting EKG
  • Those persons that have worsening chest pain felt related to coronary artery disease (unstable angina)
  • Usually those persons who are symptomatic and have a high probability of coronary artery disease
  • Those persons with very high, poorly controlled blood pressure

How to prepare for your test?

  • Wear comfortable clothing and tennis shoes
  • Unless you are told specifically not to eat, eat a snack such as peanut butter crackers or yogurt about 2 hours prior to the test
  • Drink adequate fluids on the day of your test
  • Avoid caffeine or alcohol for 24 hours before the test
  • No smoking within 2 hours of the test
  • No exercise the day of your test