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Exercise stress test
Exercise ECG; ECG - exercise treadmill; EKG - exercise treadmill; Stress ECG; Exercise electrocardiography; Stress test - exercise treadmill; CAD - treadmill; Coronary artery disease - treadmill; Chest pain - treadmill; Angina - treadmill; Heart disease - treadmill
An exercise stress test is used to measure the effect of exercise on your heart.
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 patches 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 (about every 3 minutes), you will be asked to walk (or pedal) faster and on an incline or with more resistance. It is like walking fast or jogging up a hill.
While you exercise, the activity of your heart is measured with an electrocardiogram ( ECG ). Your blood pressure readings are also taken.
ECG
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
The test continues until:
- You reach a target heart rate .
-
You develop
chest pain
or a change in your blood pressure that is concerning.
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
Read Article Now Book Mark Article - ECG changes suggest 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 to 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
Wear comfortable shoes and loose clothing to allow you to exercise.
Ask your 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 must not eat, smoke, or drink beverages containing caffeine or alcohol for 3 hours (or more) before the test. In most cases, you will 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. This produces 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 symptoms during the test:
- Chest discomfort
-
Dizziness
Dizziness
Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...
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Palpitations
Palpitations
Palpitations are feelings or sensations that your heart is pounding or racing. They can be felt in your chest, throat, or neck. You may:Have an unpl...
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Shortness of breath
Shortness of breath
Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air
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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 getting worse or is happening more often.
Angina
Angina is a type of chest discomfort or pain due to poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). Th...
Read Article Now Book Mark Article - You have had a heart attack.
-
You have had angioplasty or
heart bypass surgery
.
Heart bypass surgery
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to go around a blockage to reach your heart.
Read Article Now Book Mark Article - 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
).
Aortic valve
The aorta is the main artery that carries blood out of the heart to the rest of the body. Blood flows out of the heart and into the aorta through th...
Read Article Now Book Mark ArticleMitral valve stenosis
Mitral stenosis is a disorder in which the mitral valve does not fully open. This restricts the flow of blood.
Read Article Now Book Mark Article
There may be other reasons why your provider asks for this test.
Normal Results
A normal test will most often mean that you were able to exercise as long as or longer than most people of your age and gender. You also did not have symptoms or concerning changes in blood pressure or your ECG.
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 people.
What Abnormal Results Mean
Abnormal results may be due to:
-
Abnormal heart rhythms
during exercise
Abnormal heart rhythms
An arrhythmia is a disorder of the heart rate (pulse) or heart rhythm. The heart can beat too fast (tachycardia), too slow (bradycardia), or irregul...
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Changes in your ECG that may mean there is a blockage in the arteries that supply your heart (
coronary artery disease
)
Coronary artery disease
Stable angina is chest pain or discomfort that most often occurs with activity or emotional stress. Angina is due to poor blood flow through the blo...
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When you have an abnormal exercise stress test, you may have other tests performed on your heart such as:
- Cardiac catheterization
-
Nuclear stress test
Nuclear stress test
Thallium stress test is a nuclear imaging method that shows how well blood flows into the heart muscle, both at rest and during activity.
Read Article Now Book Mark Article -
Stress echocardiography
Stress echocardiography
Stress echocardiography is a test that uses ultrasound imaging to show how well your heart muscle is working to pump blood to your body. It is most ...
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Risks
Stress tests are generally safe. Some people may have chest pain or may faint or collapse. A heart attack or dangerous irregular heart rhythm is rare.
People who are more likely to have such complications are often already known to have heart problems, so they are not given this test.
References
Balady GJ, Morise AP. Exercise testing. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 13.
Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 71.
Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol . 2014;64(18):1929-1949. PMID: 25077860 www.ncbi.nlm.nih.gov/pubmed/25077860 .
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol . 2014;63(25 Pt B):2935-2959. PMID: 24239921 www.ncbi.nlm.nih.gov/pubmed/24239921 .
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Exercise
(In-Depth)
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Stress
(Alt. Medicine)
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Post-traumatic stress disorder
(Alt. Medicine)
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Coronary artery disease
(In-Depth)
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Obesity
(Alt. Medicine)
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Diabetes - type 2
(In-Depth)
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Urinary incontinence
(In-Depth)
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Angina
(Alt. Medicine)
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Carpal tunnel syndrome
(In-Depth)
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Diabetes
(Alt. Medicine)
Review Date: 4/20/2015
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
