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Exercise Stress
Test
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What is the
test?
The exercise stress test, also known as the
treadmill test or exercise tolerance test, indicates
whether your heart gets enough blood flow and
oxygen when it's working its hardest, such as
during exercise. Often, stress tests are given
to people with chest pain or other symptoms who
appear to have coronary artery disease, based
on a medical exam and EKG. In addition, these
tests are sometimes used for other purposes,
from assessing the effectiveness of heart disease
treatment to gauging the safety of a proposed
exercise program.
Stress tests are among the best tools for diagnosing
heart disease, and some research suggests that
they may also be useful in estimating disease
risk in people who don't have symptoms but have
risk factors such as high cholesterol. If you
are over age 40 and are at risk for coronary
artery disease because you smoke or have high
blood pressure or other risk factors, ask your
doctor if you should have this test.
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How
do I prepare for the test?
Wear comfortable, loose-fitting clothing and
athletic shoes. Let the doctor performing the
test know if you think that you won't be able
to walk on a treadmill for any health reason,
such as arthritis. Also let the doctor know if
you have diabetes; since exercise can lower blood
sugar, he or she may want to check your blood
sugar level before the test begins, to be sure
it is not too low (see
"Diabetes alert," below). It's also important
to tell the doctor or other health professional
in the testing room if you've had any chest pain
or pressure on the day of the test. Try to avoid
eating a large meal right before the test, which
could make exercising uncomfortable.
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What
happens when the test is performed?
First you have an EKG both while lying down
and standing up. Your blood pressure is taken.
Several plasticcoated wires, or leads, are taped
to your arms and one leg so that your heart's
electrical pattern can be detected while you
exercise.Your blood pressure and heart rate also
are monitored during the test. You are asked
to walk on a treadmill for about 10 minutes.
The speed and steepness of the treadmill will
increase several times while you exercise. Let
the person who is monitoring you know immediately
if you feel chest pain or heaviness, shortness
of breath, leg pain or weakness, or other unusual
symptoms, or if you think you can't continue
exercising.After the exercise period is completed,
your blood pressure will be checked again.
A variation of this test uses a radionuclide
to visualize parts of the heart that are not
getting enough blood. This test is called either
an exercise-thallium test or exercise-MIBI test
(depending on the radionuclides used). If you
have this test, you will probably need to repeat
it on a day when you have not been exercising
hard, for the sake of comparison.
An exercise stress test strongly suggests coronary
artery disease if walking on the treadmill produces
symptoms such as chest discomfort, shortness
of breath, or dizziness, and these symptoms are
accompanied by EKG changes that indicate inadequate
blood flow to parts of the heart. A test is considered
normal if you can perform a normal amount of
exercise without symptoms or EKG changes. Many
people have chest discomfort but no EKG changes,
or vice versa. In these cases, the exercise test
is of less help, and the result will be interpreted
as consistent with coronary artery disease, but
not conclusive. Further testing may then be required.
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What
risks are there from the test?
If you have cardiac disease, you might develop
chest pain during the test. Because this is a
sign that your heart isn't getting enough oxygen
and could be in danger of damage, it's important
that you alert the medical staff immediately
so that the test can be stopped. While many people
worry that an exercise stress test could be dangerous
to someone with heart disease, it is extremely
safe if doctors examine patients beforehand to
make sure that they are healthy enough for it.
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Must
I do anything special after the test is over?
If your blood pressure becomes unusually high,
or if it suddenly drops during exercise, a nurse
will recheck your blood pressure a few minutes
after the test and may continue to monitor your
EKG. If you develop chest pain, you might be given
some nitroglycerin tablets to relieve the pain
and lower the demand on your heart by dilating
your blood vessels.
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How
long is it before the result of the test is
known?
It usually takes several days for the doctor
to completely evaluate the printout of your heart's
electrical pattern.
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