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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[Dec 15, 2017] Understanding chronic stress

Notable quotes:
"... Some studies have even suggested t hat unhealthy chronic stess management, such as overating "comfort" foods, has contributed to the growing obesity epidemic ..."
"... Stress in America ..."
"... Studies have also illustrated the strong link between insomnia and chronic stress. ..."
"... Stress in America ..."
"... Taking one small step to reduce your stress and improve your emotional health, such as going on a daily walk, can have a beneficial effect. Being active is a small but powerful change you can make to manage stress. ..."
"... Health Psychology ..."
"... Annals of the New York Academy of Sciences ..."
"... Review of Psychology ..."
"... Emotional Longevity: what really determines how long you live. ..."
"... Annals of the New York Academy of Sciences ..."
"... Journal of Psychosomatic Research ..."
"... Public Health Nutrition ..."
"... Annals of the New York Academy of Sciences ..."
apa.org

Stress is often described as a feeling of being overwhelmed, worried or run-down. Stress can affect people of all ages, genders and circumstances and can lead to both physical and psychological health issues. By definition, stress is any uncomfortable "emotional experience accompanied by predictable biochemical, physiological and behavioral changes." 1 Some stress can be beneficial at times, producing a boost that provides the drive and energy to help people get through situations like exams or work deadlines. However, an extreme amount of stress can have health consequences and adversely affect the immune, cardiovascular, neuroendocrine and central nervous systems. 2

How stress harms your health

In addition, an extreme amount of stress can take a severe emotional toll. While people can overcome minor episodes of stress by tapping into their body's natural defenses to adapt to changing situations, excessive chronic stress, which is constant and persists over an extended period of time, can be psychologically and physically debilitating. Unlike everyday stressors, which can be managed with healthy stress management behaviors, untreated chronic stress can result in serious health conditions including anxiety, insomnia, muscle pain, high blood pressure and a weakened immune system. 3 Research shows that stress can contribute to the development of major illnesses, such as heart disease, depression and obesity. 4

Some studies have even suggested t hat unhealthy chronic stess management, such as overating "comfort" foods, has contributed to the growing obesity epidemic. 5

Yet, despite its connection to illness, APA's Stress in America survey revealed that 33 percent of Americans never discuss ways to manage stress with their healthcare provider.

Chronic stress can occur in response to everday stressors that are ignored or poorly managed, as well as to exposure to traumatic events. The consequences of chronic stress are serious, particularly as it contributes to anxiety and depression. People who suffer from depression and anxiety are at twice the risk for heart disease than people without these conditions. 6 Additionally, research has shown that there is an association between both acute and chronic stress and a person's abuse of addictive substances. 7

Managing your stress

Studies have also illustrated the strong link between insomnia and chronic stress. 8

According to APA's Stress in America survey, more than 40 percent of all adults say they lie awake at night because of stress. Experts recommend going to bed at a regular time each night, striving for at least seven to eight hours of sleep and eliminating distractions such as television and computers from the bedroom. Many Americans who experience prolonged stress are not making the lifestyle changes necessary to reduce stress and ultimately prevent health problems.

Improving lifestyle and behavioral choices are essential steps toward increasing overall health and avoiding chronic stress. The key to managing stress is recognizing and changing the behaviors that cause it, but changing your behavior can be challenging. Taking one small step to reduce your stress and improve your emotional health, such as going on a daily walk, can have a beneficial effect. Being active is a small but powerful change you can make to manage stress.

Physical activity increases your body's production of feel-good endorphins, a type of neurotransmitter in the brain, and helps in treating mild forms of depression and anxiety. 9 In addition, eating a healthy diet and enhancing both the amount and quality of your sleep may be beneficial. But remember, if a high stress level continues for a long period of time, or if potential problems from stress continue to interfere with activities of daily living, it is important to reach out to a licensed mental health professional, such as a psychologist. Research has shown that chronic stress can be treated with appropriate interventions such as lifestyle and behavior change, therapy, and in some situations, medication. 10

A psychologist can help you ovecome the barriers that are stopping you from living a healthy life, manage stress effectively and help identify behaviors and situations that are contributing to your consistently high stress level.

Special thanks to Mary K. Alvord, PhD, Karina W. Davidson, PhD, Jennifer F. Kelly, PhD, ABPP, Kevin M. McGuiness, PhD, MS, ABPP-CH, and Steven Tovian, PhD, ABPP, who assisted with this article.
References
  1. Baum, A. (1990). "Stress, Intrusive Imagery, and Chronic Distress," Health Psychology , Vol. 6, pp. 653-675.
  2. Anderson, N.B. (1998). "Levels of Analysis in Health Science: A Framework for Integrating Sociobehavioral and Biomedical Research," Annals of the New York Academy of Sciences , Vol. 840, pp. 563-576.
  3. Baum, A. & Polsusnzy, D. (1999). "Health Psychology: Mapping Biobehavioral Contributions to Health and Illness." Annual Review of Psychology , Vol. 50, pp. 137-163.
  4. Ibid.
  5. Dallman, M. et al. (2003). "Chronic stress and obesity: A new view of 'comfort food.'" PNAS, Vol. 100, pp. 11696-11701.
  6. Anderson, N.B. & Anderson, P.E. (2003). Emotional Longevity: what really determines how long you live. New York: Viking.
  7. Sinha, R. (2008). "Chronic Stress, Drug Use, and Vulnerability to Addiction." Annals of the New York Academy of Sciences , Vol. 1141, pp. 105-130.
  8. Vgontzas, A.N. et al. (1997). "Chronic insomnia and activity of the stress system: a preliminary study." Journal of Psychosomatic Research , Vol. 45, pp. 21-31.
  9. Fox, K.R. (1999). "The influence of physical activity on mental well-being." Public Health Nutrition , Vol. 2, pp. 411-418.
  10. McEwen, B.S. (2004). "Protection and Damage from Acute and Chronic Stress: Allostasis and Allostatic Overload and Relevance to the Pathophysiology of Psychiatric Disorders." Annals of the New York Academy of Sciences , Vol. 1032, pp. 1-7.
The full text of articles from APA Help Center may be reproduced and distributed for noncommercial purposes with credit given to the American Psychological Association. Any electronic reproductions must link to the original article on the APA Help Center. Any exceptions to this, including excerpting, paraphrasing or reproduction in a commercial work, must be presented in writing to the APA. Images from the APA Help Center may not be reproduced.

[Dec 15, 2017] Neoliberalism undermines workers health not only via the financial consequences of un/under employment and low wages, but also through chronic exposure to stress due to insecurity

Neoliberalism as "Die-now economics." "Embodiment into lower class" or "the representation as a member the lower class" if often fatal and upper mobility mobility is artificially limited (despite all MSM hype it is lower then in Europe). So just being a member of lower class noticeably and negatively affects your life expectancy and other social metrics. Job insecurity is the hazard reserved for lower and lower middle classes destructivly effect both physical and mental health. Too much stress is not good for humans. Neoliberalism with its manta of competition uber alles and atomization of the workforce is a real killer. also the fact that such article was published and the comments below is a clear sign that the days of neoliberalism are numbered. It should go.
Notable quotes:
"... In our new book , we draw on an extensive body of scientific literature to assess the health effects of three decades of neoliberal policies. Focusing on the social determinants of health -- the conditions of life and work that make it relatively easy for some people to lead long and healthy lives, while it is all but impossible for others -- we show that there are four interconnected neoliberal epidemics: austerity, obesity, stress, and inequality. They are neoliberal because they are associated with or worsened by neoliberal policies. ..."
"... Neoliberalism operates through labor markets to undermine health not only by way of the financial consequences of unemployment, inadequate employment, or low wages, as important as these are, but also through chronic exposure to stress that 'gets under your skin' by way of multiple mechanisms. Quite simply, the effects of chronic insecurity wear people out over the life course in biologically measurable ways . ..."
"... Oh, and "beyond class" because for social beings embodiment involves "social production; social consumption; and social reproduction." In the most reductive definition of class -- the one I used in my crude 1% + 10% + 90% formulation -- class is determined by wage work (or not), hence is a part of production (of capital), not social consumption (eating, etc.) or social reproduction (children, families, household work ). So, even if class in our political economy is the driver, it's not everything. ..."
"... "Neoliberalism sees competition as the defining characteristic of human relations. It redefines citizens as consumers, whose democratic choices are best exercised by buying and selling, a process that rewards merit and punishes inefficiency. It maintains that "the market" delivers benefits that could never be achieved by planning. ..."
"... Attempts to limit competition are treated as inimical to liberty. Tax and regulation should be minimised, public services should be privatised. The organisation of labour and collective bargaining by trade unions are portrayed as market distortions that impede the formation of a natural hierarchy of winners and losers. Inequality is recast as virtuous: a reward for utility and a generator of wealth, which trickles down to enrich everyone. Efforts to create a more equal society are both counterproductive and morally corrosive. The market ensures that everyone gets what they deserve." ..."
"... As opposed to being champions of "self-actualization/identity" and "absolute relativism", I always got the impression that they were both offering stark warnings about diving too deeply into the self, vis-a-vis, identity. As if, they both understood the terrifying world that it could/would create, devoid of common cause, community, and ultimately empathy. A world where "we" are not possible because we have all become "I". ..."
"... Wonks like Yglesias love to mock working class concerns as "economic anxiety," which is at once belittling (it's all about f-e-e-e-lings ..."
"... "we have measurable health outcomes from political choices" So True!!! ..."
Dec 12, 2017 | www.nakedcapitalism.com

...Neoliberal epidemics are particular pathways of embodiment. From Ted Schrecker and Clare Bambra in The Conversation :

In our new book , we draw on an extensive body of scientific literature to assess the health effects of three decades of neoliberal policies. Focusing on the social determinants of health -- the conditions of life and work that make it relatively easy for some people to lead long and healthy lives, while it is all but impossible for others -- we show that there are four interconnected neoliberal epidemics: austerity, obesity, stress, and inequality. They are neoliberal because they are associated with or worsened by neoliberal policies. They are epidemics because they are observable on such an international scale and have been transmitted so quickly across time and space that if they were biological contagions they would be seen as of epidemic proportions.

(The Case-Deaton study provides an obvious fifth: Deaths of despair. There are doubtless others.) Case in point for one of the unluckier members of the 90%:

On the morning of 25 August 2014 a young New Jersey woman, Maria Fernandes, died from inhaling gasoline fumes as she slept in her 13-year-old car. She often slept in the car while shuttling between her three, low-wage jobs in food service; she kept a can of gasoline in the car because she often slept with the engine running, and was worried about running out of gasoline. Apparently, the can accidentally tipped over and the vapours from spilled gasoline cost her life. Ms Fernandes was one of the more obvious casualties of the zero-hours culture of stress and insecurity that pervades the contemporary labour market under neoliberalism.

And Schrecker and Bambra conclude:

Neoliberalism operates through labor markets to undermine health not only by way of the financial consequences of unemployment, inadequate employment, or low wages, as important as these are, but also through chronic exposure to stress that 'gets under your skin' by way of multiple mechanisms. Quite simply, the effects of chronic insecurity wear people out over the life course in biologically measurable ways .

... ... ...

Oh, and "beyond class" because for social beings embodiment involves "social production; social consumption; and social reproduction." In the most reductive definition of class -- the one I used in my crude 1% + 10% + 90% formulation -- class is determined by wage work (or not), hence is a part of production (of capital), not social consumption (eating, etc.) or social reproduction (children, families, household work ). So, even if class in our political economy is the driver, it's not everything.

nonclassical , December 11, 2017 at 8:30 pm

L.S. reminiscent of Ernst Becker's, "The Structure of Evil" Ė "Escape from Evil"? (..not to indicate good vs. evil dichotomy) A great amount of perspective must be agreed upon to achieve "change" intoned. Divide and conquer are complicit, as noted .otherwise (and as indicated by U.S. economic history) change arrives only when all have lost all and can therefore agree begin again.

There is however, Naomi Klein perspective, "Shock Doctrine", whereby influence contributes to destabilization, plan in hand leading to agenda driven ("neoliberal"=market fundamentalism) outcome, not at all spontaneous in nature:

"Neoliberalism sees competition as the defining characteristic of human relations. It redefines citizens as consumers, whose democratic choices are best exercised by buying and selling, a process that rewards merit and punishes inefficiency. It maintains that "the market" delivers benefits that could never be achieved by planning.

Attempts to limit competition are treated as inimical to liberty. Tax and regulation should be minimised, public services should be privatised. The organisation of labour and collective bargaining by trade unions are portrayed as market distortions that impede the formation of a natural hierarchy of winners and losers. Inequality is recast as virtuous: a reward for utility and a generator of wealth, which trickles down to enrich everyone. Efforts to create a more equal society are both counterproductive and morally corrosive. The market ensures that everyone gets what they deserve."

Amfortas the Hippie , December 11, 2017 at 4:20 pm

Well done, as usual.

On Case-Deason: Sounds like home. I keep the scanner on(local news) ems and fire only since 2006(sheriff got a homeland security grant). The incidence of suicide, overdose and "intoxication psychosis" are markedly increased in the last 10+ years out here in the wilderness(5K folks in whole county, last I looked). Our local economy went into near depression after the late 90's farm bill killed the peanut program then 911 meant no hunting season that year(and it's been noticeably less busy ever since) then drought and the real estate crash(we had 30 some realtors at peak..old family land being sold off, mostly). So the local Bourgeoisie have had less money to spend, which "trickles down" onto the rest of us.:less construction, less eating out even at the cheap places, less buying of gas, and on and on means fewer employees are needed, thus fewer jobs. To boot, there is a habit among many employers out here of not paying attention to labor laws(it is Texas ) the last minwage rise took 2 years to filter out here, and one must scrutinize one's pay stub to ensure that the boss isn't getting squirrelly with overtime and witholding.
Geography plays into all this, too 100 miles to any largish city.

... ... ...

Rosario , December 11, 2017 at 10:55 pm

I'm not well versed in Foucault or Lacan but I've read some of both and in reading between the lines of their writing (the phantom philosophy?) I saw a very different message than that often delivered by post-modern theorists.

As opposed to being champions of "self-actualization/identity" and "absolute relativism", I always got the impression that they were both offering stark warnings about diving too deeply into the self, vis-a-vis, identity. As if, they both understood the terrifying world that it could/would create, devoid of common cause, community, and ultimately empathy. A world where "we" are not possible because we have all become "I".

Considering what both their philosophies claimed, if identity is a lie, and the subject is always generated relative to the other, then how the hell can there be any security or well being in self-actualization? It is like trying to hit a target that does not exist.

All potentially oppressive cultural categorizations are examples of this (black, latino, gay, trans, etc.). If the identity is a moving target, both to the oppressor and the oppressed, then how can it ever be a singular source of political action? You can't hit what isn't there. This is not to say that these groups (in whatever determined category) are not oppressed, just that formulating political action based strictly on the identity (often as an essential category) is impossible because it does not actually exist materially. It is an amalgamation of subjects who's subjectivity is always relative to some other whether ally or oppressor. Only the manifestations of oppression on bodies (as brought up in Lambert's post) can be utilized as metrics for political action.

... ... ...

Lambert Strether Post author , December 11, 2017 at 11:20 pm

I thought of a couple of other advantages of the "embodiment" paradigm:

Better Framing . Wonks like Yglesias love to mock working class concerns as "economic anxiety," which is at once belittling (it's all about f-e-e-e-lings *) and disempowering (solutions are individual, like therapy or drugs). Embodiment by contrast insists that neoliberalism (the neoliberal labor market (class warfare)) has real, material, physiological effects that can be measured and tracked, as with any epidemic.

... ... ...

oaf , December 12, 2017 at 7:11 am

"we have measurable health outcomes from political choices" So True!!!

Thank you for posting this.

[Oct 16, 2016] Stress Test for Heart Disease

... ... ...

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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