There are several categories
of people who can benefit from a stress test:
People with chest pain: Because chest pain
can be caused by many things, a stress test can help a doctor
decide whether the pain is due to heart disease or something
else. For example, if someone is able to exercise for up
to 12 minutes on a treadmill without getting any chest pain
and with no irregularities appearing on the ECG, then the
chances are very low that there is any heart disease.
People with heart disease or angina (chest
pain due to reduced blood flow in the heart): In people
with these conditions, a stress test can help determine
whether an additional test, such as an angiogram, is needed
to evaluate the heart more thoroughly. If a person with
heart disease or angina is able to exercise for up to 10
to 12 minutes, then an angiogram may not be needed.
People who have had a heart attack: Sometimes a
very easy stress test is done even within the first week
following a heart attack. Many people will show a good result,
indicating that they are ready to begin treatment with medication.
However, if someone has pain or shows irregularities on
the ECG during the stress test, then further assessment
of the heart is needed using an angiogram.
People with disease of the heart valves: A
stress test can confirm a person's capacity to do exercise.
However, if this capacity is very low, further assessment
using an angiogram may be needed, and valve surgery may
be considered.
People who are suspected of having an irregular
heartbeat (an arrhythmia): In some people, a stress
test can help diagnose the presence of an arrhythmia.
People with heart disease who have had surgery, or who are
taking other treatment such as drugs, vitamins
or minerals, or who are participating in a cardiac rehabilitation
or exercise program: A stress test can be used to measure
the effectiveness of the surgery or other treatment by monitoring
exercise capacity. A stress test may also measure improvement
from a cardiac rehabilitation exercise program.
People who are at high risk of getting heart disease:
This includes people with diabetes, high blood pressure,
or high cholesterol levels, or those with family members
who have had heart disease before the age of 50. Even if
a person in one of these high-risk categories has no symptoms,
a stress test is still recommended before the age of 50
to detect any early signs of heart disease so that it can
be treated.
People whose occupations involve a lot of physical exertion,
e.g., firefighters: Even if these people do not
have a family history of heart disease, a stress test is
advisable over the age of 40.
Sedentary adults who want to begin an exercise program:
It is recommended that men over 35 years of age and women
over 40 who want to start exercising should take an exercise
test to assess their current exercise capacity and to rule
out the presence of early heart disease
Everything You Need
to Know About Stress Tests
Stress tests are commonly
used for the diagnosis and prognosis of coronary artery
disease. They can also help you and your doctor chose the
best treatment before and after a heart attack. They are
a non-invasive way to answer very important questions about
the past, present and future of your heart.
Who Needs a Stress
Test?
A stress test is useful if you are at risk for coronary
artery disease and a heart attack, have symptoms which may
be due to a blocked coronary, or if you’ve had a heart
attack and need to decide about further treatment.
What are the Different
Types of Stress?
The “stress” portion of a stress test can be
achieved with exercise, as on a treadmill, or with a pharmacologic
means. The choice of which test is appropriate for you depends
on many variables. You and your doctor should review your
medical history and your desire and ability to perform each
of the different kinds of stress test.
The naming of the different
stress tests creates some significant confusion for both
patients and medical staff. This article clarifies the differences
and similarities among the tests.
Who Should Not Have
a Stress Test (the Contraindications)?
The stress test can yield very valuable information for
you and your doctor. However, in some cases, the risks of
a stress test outweigh the benefits. You and your doctor
need to carefully discuss possible contraindications before
proceeding. You should explore your own medical history
and bring any concern to your doctor’s attention before
the stress test.
Imaging the Heart:
An Important Part of the Stress Test
Every stress test includes an ECG, or electrocardiogram,
used to monitor your heart rate and rhythm as well as evaluating
for changes due to decreased blood flow to heart muscle
(ischemia). A stress test is often complemented with by
taking pictures of the heart (imaging). The two commonly
used imaging techniques are nuclear and echocardiographic.
How Do I Prepare for
a Stress Test?
Depending on the type of stress and type of imaging you
will have, you’ll be asked to abstain from certain
medications, foods, beverages, and activities. It’s
critical that you understand these instructions, as not
following them precisely can make the test much less useful.
What Happens During
a Stress Test?
Stress tests can last from a less than half an hour to several
hours. They may require you to walk or run on a treadmill
or simply lay still on a table. Some types of imaging place
you on your back while others, on your side.
