Stress Test and Procedure
Overview
Stress tests, sometimes called exercise stress tests, check how the heart responds when working harder. During these tests, a healthcare professional often has a person walk on a treadmill or use a stationary bike while monitoring heartbeat, blood pressure, and breathing.
| What Is Measured During a Stress Test? |
|---|
| Heart rate |
| Blood pressure |
| Breathing |
| Blood flow in the heart |
If someone cannot exercise, a healthcare provider gives a special medication that makes the heart react as if exercising. Doctors use stress testing to:
- Detect coronary artery disease or irregular heart rhythms (arrhythmias).
- Evaluate which treatments are suitable.
- See how well a treatment is working.
- Measure the seriousness of a heart condition.
Why People Need Cardiac Stress Tests
A cardiac stress test helps doctors find out how the heart reacts when it is made to work harder. This test is important for several reasons:
- Finding Blocked Arteries: The test checks for coronary artery disease, which happens when there are blockages or narrowing in blood vessels that supply the heart. These problems can lower blood flow and may cause chest pain or even a heart attack.
- Spotting Heartbeat Problems: Sometimes, the heart beats too fast, too slow, or skips beats. Stress tests, such as exercise stress testing or stress ECG, help identify these abnormal rhythms.
- Checking Treatment Results: People who are already getting heart care might need a stress test. It lets the healthcare provider see if medications or other treatments are helping.
- Surgery Preparation: Before some surgeries, like heart valve procedures or transplants, a stress test can show if a patient’s heart is strong enough for an operation.
Cardiac stress tests include several methods:
| Type of Test | How It Works |
|---|---|
| Exercise Stress Test | Walking on a treadmill or riding a bike. |
| Drug (Pharmacologic) Stress Test | Medicines make the heart work harder if a patient cannot exercise. |
| Nuclear Stress Test | A small amount of radioactive substance creates images of blood flow. |
| Stress Echocardiography | Ultrasound creates moving pictures of the heart during stress. |
Common conditions where a stress test might be needed:
- Angina
- Heart arrhythmia
- Dilated cardiomyopathy
- Valve problems (like mitral or tricuspid regurgitation)
- Prior heart attack
- Congenital heart disorders
- Low blood pressure issues (hypotension)
Possible Risks
Exercise stress tests are usually safe, but there are some risks to know about. Some people may feel chest pain, shortness of breath, or even dizziness and lightheadedness during or right after the test. Most side effects stop soon after the test ends.
- Low blood pressure
- Physical limitations can make it hard for some to complete the test
- Detection of underlying coronary artery disease (CAD)
In rare cases, people can have irregular heart rhythms (arrhythmias) or a heart attack.
Getting Ready for the Test
Eating, Drinking, and Medicines
- Do not eat, drink, or use tobacco for a set time before the test. Skip caffeine the day before and on the test day.
- Some medications, including herbal supplements, may need to be paused—ask your provider if you should take them before the test.
- Bring inhalers if used for asthma or breathing issues, and inform the staff about them.
- Complete any required consent form before arriving.
Clothing and What to Bring
- Wear loose, comfortable clothes and sneakers suitable for walking on a treadmill. Avoid tight or formal clothing.
- Pack personal items such as an ID, insurance card, and any necessary medications in a small bag.
What You Can Expect
Before the exercise starts, the healthcare team gathers important information. They often ask about the patient’s medical history and usual exercise habits. A doctor or nurse listens to the lungs and heart using a stethoscope to spot any concerns that could affect the test.
Next, the patient changes into comfortable clothing and may need to remove jewelry or accessories. An ECG technician places soft, sticky electrodes on the chest. In some cases, small sections of body hair are shaved to help the electrodes stick properly. These electrodes connect to wires, which link to an electrocardiogram (ECG) monitor.
This setup tracks the heart’s electrical activity throughout the procedure. A blood pressure cuff wraps around one arm. Sometimes, an oxygen tube or mask is also used to measure oxygen uptake. This allows the healthcare team to check blood pressure and oxygen levels at different times during the test.
What Happens While You’re Tested
During the test, the patient typically uses a treadmill or a stationary bike. The test may also be called a treadmill test or exercise ECG. The first few minutes start with a gentle pace. As the test progresses, the speed or resistance increases to make the heart work harder.
Throughout the session, the ECG electrodes measure and record the heart’s electrical activity in real time. This lets the team watch for heart rhythm changes or signs of a problem. The blood pressure cuff checks blood pressure several times.
Breathing may also be monitored—some patients may breathe into a tube so the team can measure how much oxygen the body uses. Some tests use an echocardiogram or ultrasound to look at the heart’s structure before and after exercise.
In special cases, nuclear medicine images or a cardiac catheterization provide more detailed information. The healthcare provider carefully watches for signs that the exercise should stop, such as:
- Chest pain
- Shortness of breath
- Irregular heartbeat
- High or low blood pressure
- Dizziness
- Extreme tiredness
The goal is often to reach a target heart rate. If symptoms become serious or the test measurements show a problem, the test will stop sooner. If the patient cannot use the treadmill or bike, the provider gives medication through an IV to mimic the effects of exercise on the heart.
What Happens Once the Test Finishes
As soon as the exercise portion ends, the patient stands still for a short moment and may then lie down. The healthcare team continues to monitor heart rate, breathing, and blood pressure to check how the body recovers from physical stress.
Once monitoring ends, most people can return to normal daily activities unless the medical team gives other advice. The staff removes the electrodes and blood pressure cuff, wrapping up the test process. The team uses results from the ECG, blood pressure readings, and other measurements to help guide next steps in care.
Outcomes
Stress test results provide important details that guide the next steps in care. If the results are normal, the healthcare team may decide that no further testing is needed. If the findings suggest possible coronary artery disease, a coronary angiogram might be ordered to check for blockages in the heart’s arteries.
If symptoms continue or get worse despite normal results, additional tests may be recommended—such as a nuclear stress test or a stress test with an echocardiogram—for clearer imaging.
Possible Next Steps After a Stress Test
- Normal Result: No further action needed
- Signs of Artery Disease: Coronary angiogram
- Ongoing or Worsening Symptoms: More detailed stress tests
