When to consider an exercise stress test

5:09 AM, Aug 20, 2018

Heart disease is the leading cause of death for men and women in the United States.

We know that in the United States close to 50 percent of Americans have at least one major risk factor for heart disease. Those factors include high blood pressure, high cholesterol, and tobacco use.

Dr. Thomas Alexander, a cardiologist with the Corpus Christi Medical Center, says patients who need to consider this test often show signs of discomfort.

“Chest pain can be from multiple things,” Dr. Thomas Alexander said. “It can come from the chest wall, can be from the lungs, it could be from the muscles around the heart. So the way we evaluate a patient may include a stress test with or without imaging.”

The test is performed on a treadmill or by riding a stationary bike.

“A regular treadmill is when you get someone on and just walk them and then start running on the treadmill with speed increments. We check their heart rate, and we monitor their EKG at the same time,” Alexander said. “In some patients, we need a nuclear imaging. We do the stress test we mentioned and then we inject a radioactive device that actually measures the radioactive content in the heart which comes out in pictures.”

Doctors do not recommend a yearly stress test, except for those patients who are at high risk of having heart disease.

“The goals are: 1, to evaluate if you have blockages; 2, is it safe to exercise; 3, some patients get regular heartbeats, and you get someone with complaints of fast heartbeats when they exercise; a stress test may bring out arrhythmias,” Alexander said.

A good result from your stress test doesn’t mean you’re in the clear, Alexander said. Plus the warning signs of a heart attack should be clear.

“Anyone who has persistent chest pain associated with shortness of breath, left arm pain, should call 911, and come to the hospital,” he said.

An exercise stress test shows how your heart works during physical activity. Because exercise makes your heart pump harder and faster, an exercise stress test can reveal problems with blood flow within your heart.

A stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored. Or you’ll receive a drug that mimics the effects of exercise.

Your doctor may recommend a stress test if you have signs or symptoms of coronary artery disease or an irregular heart rhythm (arrhythmia). The test may also guide treatment decisions, measure the effectiveness of treatment or determine the severity if you’ve already been diagnosed with a heart condition.

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 problem.

Why it’s done

Your doctor may recommend a stress test to:

  • Diagnose coronary artery disease. Your coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. Coronary artery disease develops when these arteries become damaged or diseased — usually due to a buildup of deposits containing cholesterol and other substances (plaques).
  • Diagnose heart rhythm problems (arrhythmias). Heart arrhythmias occur when the electrical impulses that coordinate your heart rhythm don’t function properly, causing your heart to beat too fast, too slowly or irregularly.
  • Guide treatment of heart disorders. If you’ve already been diagnosed with a heart condition, an exercise stress test can help your doctor find out how well treatment is working. It may also be used to help establish the treatment plan for you by showing how much exercise your heart can handle.Your doctor may use a stress test to help determine the timing of cardiac surgery, such as valve replacement. In some people with heart failure, stress test results may help the doctor determine whether you need a heart transplant or other advanced therapies.
  • Your doctor may recommend a test with imaging, such as a nuclear stress test or echocardiographic stress test, if an exercise stress test doesn’t pinpoint the cause of your symptoms.

During a stress test

A nurse or technician will place sticky patches (electrodes) on your chest, legs and arms. Some areas may need to be shaved to help them stick. The electrodes have wires connected to an electrocardiogram machine, which records the electrical signals that trigger your heartbeats. A cuff on your arm checks your blood pressure during the test. You may be asked to breathe into a tube during the test to show how well you’re able to breathe during exercise.

If you’re not exercising, your doctor will inject the drug into your IV that increases blood flow to your heart. You might feel flushed or short of breath, just as you would if you were exercising. You might get a headache.

You’ll probably exercise on a treadmill or stationary bike, starting slowly. As the test progresses, the exercise gets more difficult. You can use the railing on the treadmill for balance. Don’t hang on tightly, as this may skew the results.

You continue exercising until your heart rate has reached a set target or until you develop symptoms that don’t allow you to continue. These signs and symptoms may include:

  • Moderate to severe chest pain
  • Severe shortness of breath
  • Abnormally high or low blood pressure
  • An abnormal heart rhythm
  • Dizziness
  • Fatigue
  • Certain changes in your electrocardiogram

You and your doctor will discuss your safe limits for exercise. You may stop the test anytime you’re too uncomfortable to continue exercising.

Results

If the information gathered during your exercise stress test shows your heart function to be normal, you may not need any further tests.

However, if the results are normal and your symptoms continue to worsen, your doctor might recommend a nuclear stress test or another stress test that includes an echocardiogram before and after exercise or medications to increase blood flow to your heart. These tests are more accurate and provide more information about your heart function, but they are also more expensive.

If your stress test results suggest that you might have coronary artery disease or show an arrhythmia, your doctor will use the information to develop a treatment plan. You may need additional tests, such as a coronary angiogram.

If you had a stress test to help determine treatment for a heart condition, your doctor will use the results to plan or change your treatment.

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