We’ve all seen a patient running on a treadmill during a stress test in a medical TV drama. But not everybody needs a stress test – and they’re hardly dramatic.
What is a stress test?
A stress test is a test in which a patient’s heart is stressed under medical supervision to see if it can tolerate the stressful condition. Once a physician refers a patient to a cardiology clinic, it’s up to the patient and physician to determine what type of test is most appropriate.
Two main factors determine whether a patient may get a stress test ordered by their primary care physician or cardiologist: (1) patient profile and (2) symptoms. A stress test is not meant for everybody, but rather the necessity is based on a combination of patient profile and symptoms.
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What kind of patient profile may lead to a stress test referral?
People who have a higher risk of developing heart disease. That includes:
- A family history of heart disease.
- Ethnic minorities, elderly people, men and people of lower socio-economic status.
- Patients with risk factors including, but not limited to, high cholesterol, diabetes, high blood pressure (hypertension), obesity and tobacco use.
What types of symptoms may lead to a stress test referral?
The most common symptoms for referral are chest pain or shortness of breath with or without exertion. Less common symptoms that could suggest blood vessel blockages include dizziness, light-headedness, weakness, vomiting and a racing heartbeat.
The stress test is used to reveal any issues with blood flow caused by a range of conditions such as blockages in arteries (atherosclerotic coronary artery disease), high blood pressure and risk of congestive heart failure.
What are the three types of stress tests?
- Exercise stress test: An exercise stress test using a treadmill and an electrocardiogram (EKG) is the simplest form of a stress test. The patient runs or walks on the treadmill to the best of their ability with a gradual step-up in the exercise while their heart is monitored by the EKG.
- Exercise stress test with cardiac imaging: A routine treadmill stress test can be enhanced with the inclusion of cardiac imaging. This can be done with the use of an echocardiogram (an ultrasound of the heart) before and after the stress test. Similarly, a nuclear stress test can be done, which involves an intravenous tracer (a small amount of radioactive material) and recording cardiac activity with a nuclear camera.
- Pharmacologic stress test: If a patient is unable to exercise on a treadmill due to arthritis or another medical condition, the stress test can be done with the use of certain medications administered through an IV. These medications can mimic the effect of exercise in the body by increasing blood flow. This is followed by either an echocardiogram or a nuclear imaging.
What are the three possible outcomes and next steps of stress tests?
- Normal: A normal, or negative, test means you have a highly unlikely chance of developing a heart attack in the next year. In this case, the patient's symptoms look noncardiac, so they can continue to focus on lifestyle improvements. But if symptoms persist, they should go back to see the cardiologist they were referred to.
- Abnormal: An abnormal, or positive, stress test leads to next steps specific to the patient’s needs and the complexity of their results. A cardiologist may recommend medications, such as baby aspirin, to help reduce the risk of heart attack. Underlying risk factors like high cholesterol, high blood pressure or diabetes are assessed. After optimization of medical treatment, further evaluation can be done with cardiac catheterization and angiography to assess for potential blockages in the arteries of the heart. This is discussed with the patient and the family in detail prior to proceeding.
- Equivocal: This outcome is rare, but if the stress test is not completely negative or positive, the physician will reassess the patient’s condition. If the suspicion for underlying heart disease is high, then a cardiologist will do an angiography, as mentioned above, using X-ray imaging to look at the heart's blood vessels.
Take small and sustainable steps to a better you
Looking to make some lifestyle tweaks? Sudden, drastic changes are both daunting and unsustainable, so consider positive steps that you can actually stick to, even if they take some work. Consider adopting a daily stress-reducing ritual like showering at the end of the day to “wash away” the stress, or start small with new fitness goals like jogging 5 minutes a day before you push for longer.
How long does it take to get stress test results?
Results are available within 24 hours of the test. However, if the stress test is very abnormal at the time of the test itself, then usually the technician gets the cardiologist into the room right away to discuss any concerns with the patient.
What do you do while you’re waiting for test results?
Hold off on any strenuous physical workouts, but you can continue routine household activities.
Should you worry about getting a stress test?
Don’t show up for your stress test stressed out about it. A stress test is a very low-risk and safe procedure. The chances of having any complication during the stress test are less than 1% (0.01%, or 1 in 10,000). That’s why it’s always done under supervision of a certified technician, with a cardiologist in the building or facility.
Haven’t been ordered a stress test but think you need one?
There is no general rule of thumb when it comes to ordering a stress test. If you have concerns, talk to your physician.