Exercise Stress Tests (EST) - Heartbt | Heart Disease | Heart Surgery | Chest Pains | Bypass

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Exercise Stress Tests (EST)

Non-Invasive Tests

Coronary Artery Disease

Exercise Stress Testing (EST) is an invaluable tool for examining the heart and blood vessels system's response to exercise. It provides important diagnostic and prognostic information that the doctor use to effectively evaluate and manage patients with heart disease.

When performed on patients by trained physicians, EST is a safe procedure that poses minimal risks and can provide a wealth of information.

The most common reason is to evaluate the cause of chest pain. Because chest pain can come from areas other than the heart, such as the esophagus or the chest wall, a stress test is helpful in determining the likelihood of whether or not you have heart disease. Sometimes you may be asked to have a stress test in the absence of chest pain. This is done if it is suspected that you are at an increased risk of having coronary artery disease. You may be at increased risk if you smoke; diabetic; hypertensive or elevated levels of cholesterol; or if one of your parents or siblings had a heart attack at a young age (family history).

Stress tests are commonly performed in patients who have already suffered heart attacks as well. This allows doctors to assess the patient’s risk of having another heart attack. The test is also helpful in determining the effectiveness of medical therapy in preventing chest pain and limiting ischemia (a reduction in blood flow and oxygen to the heart muscle). Stress tests can also aid in the diagnosis and management of arrhythmias, which are abnormal and potentially harmful heart rhythm.

Equipment requirements for exercise stress testing include a bicycle ergometer or treadmill, a monitor system, resuscitation trolley and a defibrillator. A Doctor and a Clinical Technologist (Cardiac) or a person trained in Basic Cardiac Life Support (BCLS), although someone with Advanced Cardiac Life Support (ACLS) skills is preferred.  

A patient who needs to have an EST may wear soft-soled shoes suitable for walking and comfortable clothes.
On the day of the test a technologist will gently clean 10 small areas on your chest and place electrodes (small, flat, sticky patches) on these areas. The electrodes are attached to an electrocardiograph monitor (ECG ) that charts your heart's electrical activity during the test.

Before you start exercising, the technician will perform an ECG, to measure your heart rate at rest and will take your blood pressure.
You will begin to exercise by walking on a treadmill or pedaling a stationary bicycle.

The rate of exercise, or degree of difficulty will gradually increase. You will be asked to exercise until you feel exhausted.

At regular intervals, the lab technician will ask how you are feeling and take your blood pressure. Please tell them if you feel chest, arm or jaw pain or discomfort, short of breath, dizzy, lightheaded or any other unusual symptoms. It is normal for your heart rate, blood pressure, breathing rate and perspiration to increase during the test. Of course, you should also tell them if you feel too tired to go on, so they can turn off the treadmill. The lab technician will watch for any symptoms or changes on the ECG monitor that suggest the test should be stopped.

After you have finished exercising, you will be asked to lie down for several minutes. Once your heart rate, blood pressure and ECG return to its baseline, the test is concluded.   

Stress Test Safety

In order to minimize these risks, cardiologists avoid stressing people who have ongoing chest pain, advanced heart failure, or severe valvular heart disease, as these patients may be more likely to suffer a complication. Although we understand that it is highly unlikely that an emergency will occur during a stress test, we always prepare ourselves for this occurrence. The stress lab is stocked with emergency medications, a defibrillator, and breathing equipment, just in case a heart attack does occur.  

Test Interpretation

The physician conducting the test will be able to give you the preliminary results before you leave the exercise laboratory. However, the official result may take a few days to complete. The results of the test may help confirm or rule out a diagnosis of heart disease. In patients with known coronary artery disease (prior heart attack, known coronary blockages, previous treatment with angioplasty, stents or bypass surgery, etc.), the study will help confirm that the patient is in a stable state, or that a new blockage is developing. The results may influence your physician's decision to change your treatment or recommend additional testing such as cardiac catheterization, Echo Stress test, or a nuclear stress test.  

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