Even if you’ve never had one yourself, you are probably familiar with the cardiac stress test, in which a person is hooked up to electrodes and asked to walk or jog on a treadmill under medical supervision. It’s a familiar trope in cinema, in which we see the aspiring athlete/aging astronaut/stressed-out executive put through the paces before the serious conversation with the white-coated medical professional.
That’s a fair representation of what an exercise stress test looks like. Health care providers order such tests to look for weakness or abnormalities in the way the heart pumps under stress.
But it may surprise you to learn that physicians don’t regard the stress test as routine. In fact, most physician groups, from the American College of Cardiology to the Society for Vascular Medicine, advise against giving the test to people who don’t show symptoms of heart problems or are in low heart-risk categories. One of the reasons is that they worry about false positives, which can lead to unnecessary treatment, not to mention undue stress.
“The latest recommendations point out that a careful review of the medical literature failed to find any convincing evidence that resting or exercise ECG provided useful information for preventing CVD events in asymptomatic adults,” states an editorial in the August 2018 edition of JAMA Cardiology.
The stress test has its place
Stress tests are commonly ordered by physicians who want a clearer picture of your heart’s strength. The American Heart Association says the test may be called for when a physician seeks to:
- Diagnose coronary artery disease
- Diagnose the causes of chest pain, shortness of breath or lightheadedness
- Recommend a safe level of exercise
- Check the effectiveness of procedures done in patients with coronary artery disease
- Predict the likelihood of risk of a heart attack or other serious heart problems.
So, when is the right time to have an exercise stress test? If you have symptoms of heart problems or have an elevated risk for a serious heart condition and your physician recommends it — that’s when you should have a cardiac stress test.
If you or someone you care about experiences symptoms that could signal heart problems, see your health care provider. You can find a Providence provider in our online directory.
Washington: Providence Heart & Vascular; Providence Spokane Heart Institute; Swedish Heart & Vascular Institute; Kadlec Regional Medical Center
Oregon: Providence Heart & Vascular Institute
California: Providence Saint John’s Health Center; Providence Little Company of Mary Medical Center Torrance, Providence Saint Joseph Medical Center; St. Joseph Hospital Heart and Vascular Center; St. Jude Medical Center; St. Mary Medical Center – Heart and Vascular Center; Heart Institute at St. Joseph Hospital – Humboldt
Alaska: Providence Heart & Vascular Center
Montana: International Heart Institute
Health Break – Heart disease prevention, from Providence International Heart Institute, MT:
Read more helpful heart and vascular health articles like this one. Subscribe to our blog and you’ll never miss a health update:
More reading
New blood pressure guidelines trigger rethinking of heart risk
How to be heart healthy at any age
Heart attack? It might feel different if you’re a woman
“Cardiac exercise stress testing: What it can and cannot tell you,” by the Harvard Medical School.
“Screening for Cardiovascular Disease Risk with Electrocardiography,” offers the latest recommendation by the U.S. Preventive Services Task Force, published by JAMA in June 2018.
The American Heart Association’s resource page explains the mechanics of the exercise stress test.
This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
Overview
What is a stress test?
A stress test is a very commonly performed test to learn:
- How well your heart pumps blood.
- Whether your heart is receiving an adequate blood supply.
- How you perform on physical activity (riding a treadmill or stationary bike) compared with other people your age and sex.
- If your symptoms (chest discomfort, shortness of breath, feeling like your heart is racing or even dizziness) can be reproduced while performing physical activity.
This makes it easier to identify and evaluate certain heart issues, such as:
- Issues with your muscle or valves.
- Adequate blood supply to your heart muscle.
- Electric stability of your heart at rest and during exercise.
Cardiac stress tests help healthcare providers determine whether you need additional — often more invasive — testing to confirm a diagnosis or if treatment might lower your heart attack risk and make you feel better.
How does a stress test work?
A heart stress test starts by making your heart pump harder and faster. For many people, this includes walking on a treadmill or riding a stationary bicycle. That’s why the test is often called an exercise stress test.
Healthcare providers assess your response to the increased workload by measuring:
- Blood pressure.
- Heart rate.
- Oxygen levels.
- Electrical activity in your heart.
- How hard your heart is working compared with others your age and sex.
Why might I need a stress test?
You may need this test to detect heart problems like:
People with high-risk occupations (like pilots or professional athletes) may also need stress tests.
Who should have a cardiac stress test?
This test may be right for you if you have symptoms of heart disease, like:
- Angina, which is chest pain or discomfort due to poor blood flow to the heart.
- Arrhythmia, which is a rapid or irregular heartbeat.
- Shortness of breath (dyspnea).
- Feeling lightheaded or dizzy.
Stress tests are also for people with a heart disease diagnosis who:
- Would like to start exercising.
- Are undergoing treatment and healthcare providers need to determine how well it’s working.
- Face a higher risk of complications due to a personal or family history of heart disease.
- Have diabetes or other underlying conditions that increase your risk of heart disease.
- Require non-cardiac surgery and healthcare providers need to assess your risk of complications.
Providers may also do stress tests in people without known heart disease or symptoms to assess their risk for heart disease and heart attacks, especially if they have other risk factors like diabetes, high blood pressure, high cholesterol or a family history of premature heart disease.
What are the different types of stress tests?
There are many methods for assessing heart function while it’s hard at work. All cardiac stress tests involve checking your heart rate, blood pressure, oxygen levels and electrical activity. But there are some differences.
Stress test types include:
Exercise stress test
This is the most common and basic heart stress test. It involves walking on a treadmill or riding a stationary bicycle. A well-trained exercise physiologist usually tailors the speed and elevation of the treadmill to your ability to walk and your overall fitness.
If you can’t exercise, you receive medications that make your heart pump harder and faster or dilate the artery supplying blood to your heart (coronary arteries). An electrocardiogram (EKG) captures your heart’s electrical activity. Exercise stress tests check for signs of coronary artery disease.
Exercise stress echocardiogram
An exercise stress echocardiogram is similar to the basic stress test but provides more detail. Healthcare providers perform an echocardiogram (ultrasound of your heart) before and at peak exercise. This cardiac imaging test uses sound waves to evaluate blood flow through your heart as well as the pumping chambers of your heart (muscle) and valve functions.
You might need a stress echocardiogram if the results of your initial stress test are unclear. This study enables healthcare providers to observe blood flow through the heart’s chambers as well as the effects of exercise.
Nuclear stress test
This advanced heart stress test uses safe levels of a radioactive substance and a cardiac imaging scan to assess heart function. A healthcare provider takes pictures of your heart before (at rest) and after you exercise. A cardiologist compares the amount of blood flow to the muscle of your heart at rest and after stress. A decrease in blood flow signal usually indicates a blockage in one or multiple arteries in your heart.
Nuclear cardiac stress tests can:
- Determine the severity of blockage of coronary artery disease.
- Assess whether previous treatments, such as stents or bypass surgery are working as they should.
- Help you avoid more invasive heart tests, such as cardiac catheterization.
- Show whether your heart is healthy enough for non-cardiac surgery or exercise.
Cardiac rehabilitation stress test
If your healthcare provider recommends cardiac rehabilitation, the program may include stress testing. Rehabilitation is a medically supervised exercise program that helps people with heart disease become more physically active.
Cardiac rehabilitation stress testing includes:
- Entrance stress test: Helps the rehabilitation team develop an exercise program that’s appropriate for your capabilities.
- Exit stress test: Enables the team to measure your progress and create a long-term exercise program after you complete rehabilitation.
Who should not have an exercise stress test?
Cardiac stress testing isn’t for everyone. You might not need the test if you have:
- A coronary artery disease diagnosis, have undergone treatment and not had new symptoms for years and are doing well on medical therapy.
- No history of risk factors for coronary artery disease or coronary disease or symptoms.
- A low risk of heart disease, including people who do not smoke, are physically active and eat a heart-healthy diet.
The test is also not for people with heart conditions that make stress testing unsafe (contraindications). These include:
- Aortic dissection.
- Endocarditis, pericarditis or myocarditis (heart muscle inflammation).
- Recent heart attack.
- Severe aortic stenosis (aortic valve narrowing).
- Uncontrolled abnormal heart rhythm (arrhythmia).
- Ongoing chest pain.
Why is exercise stress test eligibility important?
Your healthcare provider may decide not to have you undergo stress tests or repeat “routine” stress tests to help you avoid unnecessary costs and treatments. An unindicated stress test may show results that prompt healthcare providers to recommend additional testing you don’t need. Some of these tests, including a coronary angiogram, carry a higher risk of complications than stress tests.
Cardiologists consider your overall health in determining whether a heart stress test is right for you. This determination includes your:
- Age.
- Family history of heart disease.
- Sex.
- Health history.
- Level of physical activity.
- Symptoms.
- Risk factors like smoking, diabetes, high blood pressure and high cholesterol.
What’s important to know about exercise stress testing in women?
People designated female at birth (DFAB) tend to experience heart disease differently than designated male at birth (DMAB). This makes it challenging to detect early-stage heart disease. In general, healthcare providers tailor their stress testing and method of imaging during stress testing based on your sex and age to obtain optimal results and minimize radiation and unclear test results.
Is cardiac stress testing safe?
If there are no contraindications, exercise stress tests are safe. Very few people experience complications. Trained healthcare providers, typically an exercise physiologist and a cardiologist, are present during your test in the rare event that you have a complication. They assess your performance, data and symptoms throughout the tests and immediately provide emergency treatment if it’s needed. You also have the option of stopping the stress test at any time if you become anxious or uncomfortable.
