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Stress Test

Stress Test

Definition

Used to evaluate heart function, a stress test requires that a patient exercises on a treadmill or exercise bicycle while his or her heart rate, breathing, blood pressure, electrocardiogram (ECG), and feeling of well being are monitored.

Purpose

When the body is active, it requires more oxygen than when it is at rest, and, therefore, the heart has to pump more 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 helps doctors determine how well the heart handles the increased demands imposed by physical activity. It is particularly useful for evaluating possible coronary artery disease, detecting inadequate supply of oxygen-rich blood to the tissues of the heart muscle (ischemia ), and determining safe levels of exercise in people with existing heart disease.

Precautions

The exercise stress test carries a very slight risk (1 in 100,000) of causing a heart attack. For this reason, the exercise stress test should be attended by a health care professional with a defibrillator and other emergency equipment on standby.

The patient must be aware of the symptoms of a heart attack and stop the test if he or she develops any of the following symptoms:

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

Description

The technician affixes electrodes to specific areas of the patient's chest, using special 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. Then the technician attaches wires from the electrodes 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 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, the speed of the treadmill increases and the treadmill is tilted upward to simulate an incline. If the patient is on an exercise bicycle, the resistance or "drag" is gradually increased. The patient continues exercising at increasing intensity until he or she reaches his or her 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 this time, the patient's heart rate, ECG pattern, and blood pressure are continually monitored.

In some cases, other tests, such as echocardiography or thallium scanning, are also 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 that mimic the effects of exercise on the heart and given a thallium scan, which can detect the same abnormalities that an exercise test can.

Preparation

Patients are usually instructed not to eat or smoke for several hours before the test. They should also tell the doctor about any medications they are taking. They should 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.

Risks

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

Normal 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.

Abnormal results

A number of abnormalities may show up on an exercise stress test. An abnormal electrocardiogram (ECG) may indicate deprivation of oxygen-rich blood to the heart muscle (ST wave segment depression, for example), heart rhythm disturbances, or structural abnormalities of the heart, such as overgrowth of muscle (hypertrophy). If the blood pressure rises too high or the patient experiences distressing symptoms during the test, the heart may be unable to handle the increased workload. Stress test abnormalities usually require further evaluation and therapy.

Resources

ORGANIZATIONS

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

KEY TERMS

Angina Chest pain from a poor blood supply to the heart muscle due to narrowing of the coronary arteries.

Cardiac arrhythmia An irregular heart rate or rhythm.

Coronary arteries Two arteries that branch off from the aorta and supply blood to the heart.

Defibrillator A device that delivers an electric shock to the heart muscle through the chest wall in order to restore a normal heart rate.

False negative Test results showing no problem when one exists.

False positive Test results showing a problem when one does not exist.

Hypertrophy The overgrowth of muscle.

Ischemia Dimished supply of oxygen-rich blood to an organ or area of the body.

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Stress Test

Stress test

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 at 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.

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 reaching 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 such other tests, 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 such drugs, 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.


Risks

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). 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.

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

  • 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)

Normal 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 narrowed or blocked coronary arteries. Stress test abnormalities generally require further diagnostic evaluation and therapy.


Patient education

Patients must be well prepared for a stress test. They should not only know the purpose of the test, but also signs and symptoms that indicate the test should be stopped. Physicians, nurses, and ECG technicians can ensure patient safety by encouraging them to immediately communicate discomfort at any time during the stress test.

Resources

books

Ahya, Shubhada N., Kellie Flood, and Subramanian Paranjothi. The Washington Manual of Medical Therapeutics, 30th edition. Philadelphia: Lippincott Williams & Wilkins, 2001, pp. 96100.

organizations

American Heart Association. 7272 Greenville Avenue, Dallas, TX 75231. (214) 373-6300. <http://www.amhrt.org>.

National Heart, Lung, and Blood Institute. Information Center. PO Box 30105, Bethesda, MD 20824-0105. (301) 951-3260. <http://www.nhlbi.nih.gov>.

Barbara Wexler Lee A. Shratter, M.D.

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stress test

stress test or exercise electrocardiography, in medicine, a test that evaluates the performance of the heart by subjecting it to controlled amounts of physical stress. Such tests, which include walking on a treadmill, measure the heart's reaction to an increased demand for oxygen. The test ends when the patient reaches a predetermined heart rate or experiences chest pain or fatigue. See electrocardiography.

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"stress test." The Columbia Encyclopedia, 6th ed.. . Encyclopedia.com. 20 Aug. 2017 <http://www.encyclopedia.com>.

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"stress test." The Columbia Encyclopedia, 6th ed.. . Retrieved August 20, 2017 from Encyclopedia.com: http://www.encyclopedia.com/reference/encyclopedias-almanacs-transcripts-and-maps/stress-test