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 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.
About every 3 minutes you will be asked to walk (or pedal) faster.
You will also have to walk on a steeper angle or pedal with more resistance in on a bike. This 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.
The test continues until:
You reach a target heart rate.
You develop chest pain or a change in your blood pressure that is concerning.
ECG changes show that your heart muscle is not getting enough oxygen.
Your heart rhythm changes.
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
You must not eat, smoke, or drink beverages containing caffeine or alcohol for 3 hours (or more) before the test.
Wear comfortable shoes and loose clothing to allow you to exercise.
Ask your health care 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 will usually 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. You may feel mild burning or stinging when the electrode sites are prepared.
You will have a blood pressure cuff on your arm that will be inflated every few minutes. This will produce a tight, squeezing feeling.
Baseline measurements of heart rate and blood pressure will be taken before exercise starts.
Sometimes, people experience some of the following during the test:
Chest discomfort
Dizziness
Palpitations
Shortness of breath
Why the Test is Performed
Reasons why you may have an exercise stress test include:
You are having chest pain and the test is done to check for narrowing of the arteries.
Your angina is becoming more severe or is happening more often.
You have had a heart attack.
You have had angioplasty or heart bypass surgery.
You are going to start an exercise program and you have heart disease or risk factors, such as diabetes
Your health care provider needs to look for heart rhythm changes that may occur during exercise.
You need further testing for heart valve problem (such as aortic valve or mitral valve stenosis).
There may be other reasons why your health care provider asks for this test.
Normal Results
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 patients.
What Abnormal Results Mean
Abnormal results may be due to:
Abnormal heart rhythms during exercise
Changes in your ECG that may mean there is a blockage in the arteries that supply your heart (coronary artery disease)
When you have an abnormal exercise stress test, you may have other tests performed on your heart such as:
Cardiac catheterization
Nuclear stress test
Stress echocardiography
Risks
Stress tests are mostly safe. Some patients may have chest pain or may faint or collapse. A heart attack or dangerous irregular rhythm is rare.
Complications are more likely in people who are already known to have a weak heart. This test is not given in these cases.
Alternative Names
Exercise ECG; ECG - exercise treadmill; EKG - exercise treadmill; Stress ECG; Exercise electrocardiography; Stress test - exercise treadmill
References
Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 71.
Chaitman BR. Exercise stress testing. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 14.
Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.
