An exercise stress test is a test that is done to collect information about how your heart functions during exercise. The test is done while you are walking on a treadmill or using an exercise bike. The goal is to raise your heart rate and "stress" the heart. The heart is evaluated before, during, and after you exercise. An electrocardiogram (ECG) will be used to monitor the heart, and your blood pressure will also be monitored. In some cases, nuclear scanning or an ultrasound of the heart (echocardiogram) will also be done to evaluate your heart.
An exercise stress test is done to look for coronary artery disease (CAD). The test may also be done to:
- Evaluate your limits of exercise during cardiac rehabilitation.
- Check for high blood pressure during exercise.
- Check how well you can exercise after such treatments as coronary stenting or new medicines.
- Check for problems with blood flow to your arms and legs during exercise.
If you have an abnormal test result, this may mean that you are not getting enough blood flow to your heart during exercise. More testing may be needed to understand why your test was not normal.
Tell a healthcare provider about:
- Any allergies you have.
- All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
- Any blood disorders you have.
- Any surgeries you have had.
- Any medical conditions you have.
- Whether you are pregnant or may be pregnant.
What are the risks?
Generally, this is a safe procedure. However, problems may occur, including:
- Pain or pressure in the following areas:
- Jaw or neck.
- Between your shoulder blades.
- Down your left arm.
- Dizziness or lightheadedness.
- Shortness of breath.
- Increased or irregular heartbeats.
- Nausea or vomiting.
- Heart attack (rare).
- Life-threatening abnormal heart rhythm (rare).
What happens before the procedure?
- Follow instructions from your healthcare provider about eating or drinking restrictions.
- You may be told to avoid all forms of caffeine for 24 hours before the test. This includes coffee, tea (even decaffeinated tea), caffeinated sodas, chocolate, cocoa, and certain pain medicines.
- Ask your healthcare provider about:
- Taking over-the-counter medicines, vitamins, herbs, and supplements.
- Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or beta-blocker medicines.
- If you have diabetes, ask how you are to take your insulin or pills. It is common to adjust your insulin dose the morning of the test.
- If you are taking beta-blocker medicines, it is important to talk to your healthcare provider about these medicines well before the date of your test. Taking beta-blocker medicines may interfere with the test. In some cases, these medicines may need to be changed or stopped 24 hours or more before the test.
- If you wear a nitroglycerin patch, it may need to be removed prior to the test. Ask your healthcare provider if the patch should be removed before the test.
- If you use an inhaler for any breathing condition, bring it with you to the test.
- Do not apply lotions, powders, creams, or oils on your chest prior to the test.
- Wear loose-fitting clothes and comfortable walking shoes.
- Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes, for four hours before the test or as told by your healthcare provider. If you need help quitting, ask your healthcare provider.
What happens during the procedure?
- Multiple electrodes will be attached to your chest.
- Multiple wires will be attached to the electrodes. These will transfer the electrical impulses from your heart to the ECG machine. Your heart will be monitored both at rest and while exercising.
- If you are also having an echocardiogram or nuclear scanning, images of your heart will be taken before and after you exercise.
- A blood pressure cuff will be placed around your arm to measure your blood pressure throughout the test. You will feel it tighten and loosen throughout the test.
- You will walk on a treadmill or use a stationary bike. If you cannot use these, you may be asked to turn a crank with your hands.
- You will start at a slow pace or level on the exercise machine. The exercise difficulty will be slowly increased to raise your heart rate. In the case of a treadmill, the speed and incline will gradually be increased.
- You may be asked to periodically breathe into a tube. This measures the gases you breathe out.
- You will be asked how you are feeling throughout the test. You will be asked to rate your level of exertion.
- Tell the staff right away if you feel:
- Chest pain.
- Shortness of breath.
- Too fatigued to continue.
- Pain or aching in your legs or arms.
- You will exercise until you have symptoms or until you reach a target heart rate. The test will also be stopped if you have changes in your blood pressure or ECG readings, or if you develop an irregular heartbeat (arrhythmia).
The procedure may vary among healthcare providers and hospitals.
What happens after the procedure?
- You will sit down and recover from the exercise. Your blood pressure, heart rate, and ECG will be monitored until you recover.
- You may return to your normal schedule, including diet, activities, and medicines, unless your healthcare provider tells you otherwise.
- It is up to you to get your test results. Ask your healthcare provider, or the department that is doing the test, when your results will be ready.
- An exercise stress test is a test that is done to collect information about how your heart functions during exercise.
- This test is done to look for coronary artery disease (CAD).
- During this test, you will walk on a treadmill or use an exercise bike to raise your heart rate.
- It is important to follow instructions from your healthcare provider about eating and drinking restrictions before the test. This may include avoiding caffeine and certain medicines before the test.
This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.
Fletcher G.F., Ades P.A., Kligfield P., et. al.: Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013; 128: pp. 873-934.
Guazzi M., Arena R., Halle M., Piepoli M.F., Myers J., Lavie C.J.: 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation 2016; 133: pp. e694-e711.
Maron B.J., Friedman R.A., Kligfield P., et. al.: Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 2014; 64: pp. 1479-1514.
Myers J., Arena R., Franklin B., et. al.: Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association. Circulation 2009; 119: pp. 3144-3161.
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