Stress Test Health Article

Definition

A stress test is primarily used to identify coronary artery disease. It requires patients to exercise on a treadmill or exercise bicycle while their heart rate, blood pressure, electrocardiogram (ECG), and symptoms are monitored.

Purpose

The body requires more oxygen during exercise than rest. To deliver more oxygen during exercise, the heart has to pump more oxygen-rich blood. Because of the increased stress on the heart, exercise can reveal coronary problems that are not apparent when the body is at rest. This is why the stress test, though not perfect, remains the best initial, noninvasive, practical coronary test.

The stress test is particularly useful for detecting ischemia (inadequate supply of blood to the heart muscle) caused by blocked coronary arteries. Less commonly, it is used to determine safe levels of exercise in people with existing coronary artery disease.

Precautions

The exercise stress test carries a very slight risk (one in 100,000) of causing a heart attack. For this reason, exercise stress tests should be attended by health care

professionals with immediate access to defibrillators and other emergency equipment.

Patient are cautioned to stop the test should they develop any of the following symptoms:

• an unsteady gait
• confusion
• skin that is grayish or cold and clammy
• dizziness or fainting
• a drop in blood pressure
• angina (chest pain)
• cardiac arrhythmias (irregular heart beat)

Description

A technician affixes electrodes to the patient's chest, using adhesive patches with a special gel that conducts electrical impulses. Typically, electrodes are placed under each collarbone and each bottom rib, and six electrodes are placed across the chest in a rough outline of the heart. Wires from the electrodes are connected to an ECG, which records the electrical activity picked up by the electrodes.

The technician runs resting ECG tests while the patient is lying down, then standing up, and then breathing heavily for half a minute. These baseline tests can later be compared with the ECG tests performed while the patient is exercising. The patient's blood pressure is taken and the blood pressure cuff is left in place, so that blood pressure can be measured periodically throughout the test.

The patient begins riding a stationary bicycle or walking on a treadmill. Gradually the intensity of the exercise is increased. For example, if the patient is walking on a treadmill, then the speed of the treadmill increases and the treadmill is tilted upward to simulate an incline. If the patient is on an exercise bicycle, then the resistance or "drag" is gradually increased. The patient continues exercising at increasing intensity until he or she reaches the target heart rate (generally set at a minimum of 85% of the maximal predicted heart rate based on the patient's age) or experiences severe fatigue, dizziness, or chest pain. During the test, the patient's heart rate, ECG, and blood pressure are monitored.

Sometimes other tests, such as echocardiography or thallium scanning, are used in conjunction with the exercise stress test. For instance, recent studies suggest that women have a high rate of false negatives (results showing no problem when one exists) and false positives (results showing a problem when one does not exist) with the stress test. They may benefit from another test, such as exercise echocardiography. People who are unable to exercise may be injected with drugs, such as adenosine, which mimic the effects of exercise on the heart, and then given a thallium scan. The thallium scan or echocardiogram are particularly useful when the patient's resting ECG is abnormal. In such cases, interpretation of exercise induced ECG abnormalities is difficult.

Preparation

Patients are usually instructed not to eat or smoke for several hours before the test. They should be advised to inform the physician about any medications they are taking, and to wear comfortable sneakers and exercise clothing.

Aftercare

After the test, the patient should rest until blood pressure and heart rate return to normal. If all goes well, and there are no signs of distress, the patient may return to his or her normal daily activities.

Complications

There is a very slight risk of myocardial infarction (a heart attack) from the exercise, as well as cardiac arrhythmia (irregular heart beats), angina, or cardiac arrest (about one in 100,000).

Results

A normal result of an exercise stress test shows normal electrocardiogram tracings and heart rate, blood pressure within the normal range, and no angina, unusual dizziness, or shortness of breath.

A number of abnormalities may appear on an exercise stress test. Examples of exercise-induced ECG abnormalities are ST segment depression or heart rhythm disturbances. These ECG abnormalities may indicate deprivation of blood to the heart muscle (ischemia) caused by blocked coronary arteries. Stress test abnormalities generally require further diagnostic evaluation and therapy.