An exercise stress test is a type of test that can help diagnose the risk of heart disease or acute myocardial infarction while exercising. It allows physicians to detect any abnormal responses to physical activity, such as difficulty breathing, chest pain, abnormal heart rhythms, or changes in the heart’s electrical activity. These abnormal responses indicate an inadequate blood supply to the heart muscles during exercise.
Exercise stress tests are done for a variety of reasons. The most common one is to detect a narrowing or blockage in one or more coronary arteries. This network of blood vessels supplies the heart muscle with oxygen and nutrients. When the heart is at rest, even an artery that is almost completely blocked may have enough blood flow to meet the needs of the section of heart muscle it supplies. But make the heart work harder, and the clogged vessel may not be able to handle the extra rush of blood needed by the hard-working muscle. This mismatch in demand and supply can cause angina — pressure or pain in the chest, jaw, left arm, or elsewhere that comes on with exercise or other stress and disappears with rest. An exercise stress test can document low blood flow (ischemia) in the coronary arteries. It should be part of the work-up for anyone having angina or who might be a candidate for artery-opening angioplasty. Stress tests are also used to reveal hidden rhythm problems, assess some valves, gauge the safety of an exercise program, and monitor the effectiveness of treatment.
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-Allows for correlation of symptoms with activity
-Allows doctors to assess rhythm, rate, and blood pressure in response to activity
-Exercise tolerance determined
-Limited sensitivity and specificity
-Does not localize ischemia
-No estimate of Left ventricular function
The test will take approximately 1 hour to complete. A member of the healthcare team will briefly check the patient’s medical history, focusing on current symptoms and a family history of heart disease. A nurse will place electrode patches on the patient’s chest to measure the patient’s heart rhythm and heart rate via wires attached to an electrocardiograph monitor. During the test, the healthcare team will monitor the patient’s blood pressure and ECG at all times. The patient will be asked to start out by walking slowly on a treadmill. The degree of difficulty and incline on the machine will gradually increase approximately every 3 minutes. Once the patient has reached the target heart rate, or if they are exhausted and cannot continue, a healthcare team member will stop the treadmill.
You will expected to follow the recommended preparations before the procedure. -Do not consume any food or drinks 2 hours prior to the test – especially greasy foods, tea, coffee and alcoholic beverages. -Consult the doctor in advance regarding any medications planned to be taken before the test, as certain medications can interfere with the results of the test. -Bring your list of medications, along with the specified dosages. -Wear comfortable shoes and loose clothing suitable for exercise. Patients must inform the medical personnel immediately if they require the treadmill to be slowed or stopped, or experience the following: -Chest pain, burning sensation or tightness in the chest -Nausea or dizziness -Exhaustion
Once the test is complete, medical personnel will continue to monitor the patient’s blood pressure and heart rate until the levels return to normal. If the doctor suspects any abnormalities, they may conduct further testing or propose alternative testing methods in order to acquire more definitive results. After the test, the patient may eat, take their medication, and go about their activities as usual – unless instructed not to do so by a doctor.
-Irregular heartbeat -Syncope (fainting) – which can cause injury if the patient collapses -Acute myocardial infarction (heart attack)
What kinds of information can the stress test show?
Different bits of data collected during an exercise stress test can point to problems inside the heart. 1. ECG. Changes in the ECG are key signs that part of the heart muscle isn't getting as much oxygenated blood as it needs. This is often indicated by an elevation or depression in part of the ECG called the ST segment (see figure). 2. Heart rate. Two possible indicators of ischemia or trouble in the heart's electrical system are if the heart fails to beat as fast as it should with strenuous exercise or it takes too long to slow down after exercise. 3. Blood pressure. When the cardiovascular system is healthy, systolic blood pressure (the pressure generated when the heart contracts) increases with exercise, and can easily reach 200. If it doesn't climb much above 120, or begins falling, it can indicate an overworked left ventricle or a valve or rhythm problem. 4. Rhythm changes. The appearance of nonstandard heart rhythms can suggest coronary artery disease, cardiomyopathy, or an inherited heart problem. The most ominous is ventricular tachycardia, an exceptionally rapid beating of the heart's lower chambers. 5. Recovery. In many people, the ECG shows brief alterations in the rhythm of the ventricles (the lower chambers of the heart) or the atria (the upper chambers) as the heart recovers after exercise. These erratic beats don't indicate ischemia, but they have been linked with later cardiac problems.
What other tests can be performed if the exercise stress test provides insufficient data?
For most people, a standard stress test is sufficient. Others need more precise information, and some cannot exercise. Variations and alternatives include: - Nuclear stress test. A radioactive tracer is injected into the bloodstream as you exercise to measure blood flow to the heart muscle. -Stress echocardiography - A clinician uses an ultrasound probe to record images of your heart before and after you exercise. These images can identify parts of the heart that aren't receiving enough blood. -Pharmacological stress test. Instead of exercise, a heart-stimulating drug such as dobutamine or adenosine is used to make the heart work harder.