Stress testing

Preparation

  • Donít eat or drink anything except water for 4 hours before the test.
  • Donít drink or eat anything with caffeine for 12 hours before the test.

If you use an inhaler for your breathing, bring it to the test.

You may also be asked to stop taking other heart drugs on the day of your test. If you have questions about your meds, ask your doctor. Donít discontinue any drug without checking with him first.

What If I Have Diabetes?

If you take insulin to control your blood sugar , ask your doctor how much you should take the day of the test. Often, youíll take only half of your usual morning dose and eat a light meal 4 hours before.

If you take pills to control your blood sugar, donít take your medication until after the test is over.

Donít take your diabetes medication and skip a meal before the test.

If you have a glucose monitor, bring it with you. Youíll want to check your blood sugar levels before and after your exercise stress test. If you think that your blood sugar is low, tell the lab personnel right away.

Plan to eat and take your blood sugar medication after your stress test.

How long it last

Although the appointment lasts about 60 minutes, the exercise time is usually between 7 and 12 minutes.

What Is Stress Testing

NHLBI, NIH

Stress testing provides information about how your heart works during physical stress. Some heart problems are easier to diagnose when your heart is working hard and beating fast.

During stress testing, you exercise (walk or run on a treadmill or pedal a stationary bike) to make your heart work hard and beat fast. Tests are done on your heart while you exercise.

You might have arthritis or another medical problem that prevents you from exercising during a stress test. If so, your doctor may give you medicine to make your heart work hard, as it would during exercise. This is called a pharmacological (FAR-ma-ko-LOJ-ih-kal) stress test.

Overview

Doctors usually use stress testing to help diagnose coronary heart disease (CHD). They also use stress testing to find out the severity of CHD.

CHD is a disease in which a waxy substance called plaque (plak) builds up in the coronary arteries. These arteries supply oxygen-rich blood to your heart.

Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can mostly or completely block blood flow through an artery. This can lead to chest pain called angina (an-JI-nuh or AN-juh-nuh) or a heart attack.

You may not have any signs or symptoms of CHD when your heart is at rest. But when your heart has to work harder during exercise, it needs more blood and oxygen. Narrow arteries can't supply enough blood for your heart to work well. As a result, signs and symptoms of CHD may occur only during exercise.

A stress test can detect the following problems, which may suggest that your heart isn't getting enough blood during exercise:

During a stress test, if you can't exercise for as long as what is considered normal for someone your age, it may be a sign that not enough blood is flowing to your heart. However, other factors besides CHD can prevent you from exercising long enough (for example, lung disease, anemia, or poor general fitness).

Doctors also may use stress testing to assess other problems, such as heart valve disease or heart failure.

Standard Exercise Stress Test

A standard exercise stress test uses an EKG (electrocardiogram) to detect and record the heart's electrical activity.

An EKG shows how fast your heart is beating and the heart's rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart.

During a standard stress test, your blood pressure will be checked. You also may be asked to breathe into a special tube during the test. This allows your doctor to see how well you're breathing and measure the gases that you breathe out.

A standard stress test shows changes in your heart's electrical activity. It also can show whether your heart is getting enough blood during exercise.

Imaging Stress Test

As part of some stress tests, pictures are taken of your heart while you exercise and while youíre at rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats.

  1. One type of imaging stress test involves echocardiography (echo). This test uses sound waves to create a moving picture of your heart. An exercise stress echo can show how well your heart's chambers and valves are working when your heart is under stress.

    A stress echo also can show areas of poor blood flow to your heart, dead heart muscle tissue, and areas of the heart muscle wall that aren't contracting well. These areas may have been damaged during a heart attack, or they may not be getting enough blood.
     

  2. Other imaging stress tests use radioactive dye to create pictures of blood flow to your heart. The dye is injected into your bloodstream before the pictures are taken. The pictures show how much of the dye has reached various parts of your heart during exercise and while you're at rest.

    Tests that use radioactive dye include a thallium or sestamibi stress test and a positron emission tomography (PET) stress test. The amount of radiation in the dye is considered safe for you and those around you. However, if you're pregnant, you shouldn't have this test because of risks it might pose to your unborn child.

Imaging stress tests tend to detect CHD better than standard (nonimaging) stress tests. Imaging stress tests also can predict the risk of a future heart attack or premature death.

An imaging stress test might be done first (as opposed to a standard exercise stress test) if you:

Who Needs Stress Testing?

You may need stress testing if you've had chest pains, shortness of breath, or other symptoms of limited blood flow to your heart.

Imaging stress tests, especially, can show whether you have coronary heart disease (CHD) or a heart valve problem. (Heart valves are like doors; they open and shut to let blood flow between the heart's chambers and into the heart's arteries. So, like CHD, faulty heart valves can limit the amount of blood reaching your heart.)

If you've been diagnosed with CHD or recently had a heart attack, a stress test can show whether you can handle an exercise program. If you've had percutaneous coronary intervention, also known as coronary angioplasty, (with or without stent placement) or coronary artery bypass grafting, a stress test can show how well the treatment relieves your CHD symptoms.

You also may need a stress test if, during exercise, you feel faint, have a rapid heartbeat or a fluttering feeling in your chest, or have other symptoms of an arrhythmia (an irregular heartbeat).

If you don't have chest pain when you exercise but still get short of breath, your doctor may recommend a stress test. The test can help show whether a heart problem, rather than a lung problem or being out of shape, is causing your breathing problems.

For such testing, you breathe into a special tube. This allows a technician to measure the gases you breathe out. Breathing into the tube during stress testing also is done before a heart transplant to help assess whether you're a candidate for the surgery.

Stress testing shouldnít be used as a routine screening test for CHD. Usually, you have to have symptoms of CHD before a doctor will recommend stress testing.

However, your doctor may want to use a stress test to screen for CHD if you have diabetes. This disease increases your risk of CHD. Currently, though, no evidence shows that having a stress test will improve your outcome if you have diabetes.


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[Oct 16, 2016] Stress Test for Heart Disease

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Your doctor uses the test to:

What Happens During the Exercise Stress Test?

First, a technician will gently clean 10 small areas on your chest and place small, flat, sticky patches called electrodes on them. They'll be attached to an electrocardiogram monitor -- called an EKG -- that charts your heart's electrical activity during the test.

Before you start exercising, the technician will perform an EKG to measure your heart rate at rest. He'll also take your blood pressure.

You will begin to exercise by walking on a treadmill or pedaling a stationary bicycle. The incline or resistance will gradually increase. You will be asked to exercise until you feel exhausted. If medication is used, or it is a nuclear stress test, an IV will be inserted in your arm in order to have the medication administered.

At regular intervals, the lab personnel will ask how you are feeling. Tell them if you feel:

It's normal for your heart rate, blood pressure, breathing rate, and perspiration to increase during the test. The lab personnel will watch for anything on the EKG monitor that suggests the test should be stopped.

After the test, you'll walk or pedal slowly for a couple of minutes to cool down. Your heart rate, blood pressure, and EKG will continue to be monitored until the levels begin returning to normal.

Although the appointment lasts about 60 minutes, the exercise time is usually between 7 and 12 minutes.

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