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Exercise stress test
Definition
An exercise stress test is a screening tool used to test the effect of exercise on your heart.
Alternative Names
Exercise ECG; ECG - exercise treadmill; EKG - exercise treadmill; Stress ECG; Exercise electrocardiography; Stress test - exercise treadmill
How the Test is Performed
This test is done at a medical center or health care provider's office.
The technician will place 10 flat, sticky patches called electrodes on your chest. These are attached to an ECG monitor that follows the electrical activity of your heart during the test.
You will walk on a treadmill or pedal on an exercise bicycle. Slowly (usually every 3 minutes), you will be asked to walk (or pedal) faster and on an incline. It is like walking fast or jogging up a hill.
While you exercise, the activity of your heart is measured with an electrocardiogram (ECG), and your blood pressure readings are taken.
The test continues until:
- You reach a target heart rate
- You develop chest pain or a change in your blood pressure that is concerning
- ECG changes show that your heart muscle is not getting enough oxygen
- You are too tired or have other symptoms, such as leg pain, that keep you from continuing
You will be monitored for 10 - 15 minutes after exercising, or until your heart rate returns to baseline. The total time of the test is around 60 minutes.
How to Prepare for the Test
You must not eat, smoke, or drink beverages containing caffeine or alcohol for 3 hours (or more) before the test.
Wear comfortable shoes and loose clothing to allow you to exercise.
Ask your health care provider if you should take any of your regular medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.
Tell your doctor if you are taking sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil (Levitra) and have taken a dose within the past 24 to 48 hours.
You will usually be asked to avoid caffeine for 24 hours before the test. This includes:
- Tea and coffee
- All sodas, even ones that are labeled caffeine-free
- Chocolates
- Certain pain relievers that contain caffeine
How the Test Will Feel
Electrodes (conductive patches) will be placed on your chest to record the heart's activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.
The blood pressure cuff on your arm will be inflated every few minutes, producing a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before exercise starts.
You will start walking on a treadmill or pedaling a stationary bicycle. The pace and incline of the treadmill (or the pedaling resistance) will slowly be increased.
Sometimes, people experience some of the following during the test:
- Chest discomfort
- Dizziness
- Palpitations
- Shortness of breath
Why the Test is Performed
Reasons why an exercise stress test may be performed include:
- You are having chest pain (to check for coronary artery disease -- narrowing of the arteries that feed the heart muscle)
- Your angina is becoming more severe or is happening more often
- You have had a heart attack
- You have had angioplasty or heart bypass surgery
- You are going to start an exercise program and you have heart disease or certain risk factors, such as diabetes
- To identify heart rhythm changes that may occur during exercise
- To further test for a heart valve problem (such as aortic valve or mitral valve stenosis)
There may be other reasons why your health care provider asks for this test.
Normal Results
The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.
It may be hard to interpret the results of an exercise-only stress test in some patients.
What Abnormal Results Mean
Abnormal results may be due to:
- Abnormal heart rhythms during exercise
- Changes in your ECG that may mean there is a blockage in the arteries that supply your heart (coronary artery disease)
When you have an abnormal exercise stress test, you may have other tests performed on your heart:
Risks
Stress tests are generally safe. Some patients may have chest pain or may faint or collapse. A heart attack or dangerous irregular rhythm is rare.
Persons who are likely to have such complications are usually already known to have a weak heart, so they are not given this test.
References
Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 71.
Chaitman BR. Exercise stress testing. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 14.
Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
