What is a stress test?
A stress test shows how your heart works during physical activity, revealing problems with blood flow in your heart.
ARC offers three basic types of stress testing: exercise stress tests, nuclear stress tests, and stress echocardiograms. An exercise stress test involves walking on a treadmill while monitoring your heart rhythm and blood pressure. A nuclear stress test and a stress echocardiogram both include an exercise stress test with the added component of heart imaging.
You may hear stress tests referred to by different names, such as exercise stress test, treadmill test, stress EKG, stress ECG, nuclear stress test, and stress echocardiogram.
Why get a stress test?
Your doctor or advanced practice clinician (APC) may recommend a stress test if you have signs or symptoms of coronary artery disease. They may also guide treatment decisions, measure the effectiveness of treatment, or determine the severity if you've already been diagnosed with a heart condition.
Symptoms of coronary artery disease may include:
- Angina, a type of chest pain or discomfort
- Excessive fatigue
- Exercise intolerance
- Irregular heartbeat (arrhythmia)
- Shortness of breath
Other reasons to check your heart health may include if you:
- Have an abnormal imaging test indicating coronary artery disease (e.g. calcium score)
- Are at a higher risk for heart disease due to health problems such as diabetes, family history of heart disease, and/or previous heart problems
- Are being treated for heart disease
- Are planning to start an exercise program
- Have had a heart attack in the past
- Have had recent heart surgery
A stress test is generally safe, and complications are rare. But, as with any medical procedure, there is a risk of complications you may want to discuss with your physician or APC. All cardiology tests at ARC are supervised, with a cardiologist on-site.
What to expect during a stress test?
Stress tests will range from 30 minutes to 2 hours, depending on the type of test ordered. The most commonly ordered test is the exercise stress test, which takes around 30 minutes. All cardiology tests at ARC are supervised, with a cardiologist on-site.
Note: You may be asked to stay if your test shows highly abnormal results. This means you will be seen faster to ensure that you’re closely supervised and given the best treatment plan.
Exercise stress test
- A health care provider places several electrodes (small sensors that stick to the skin) on your arms, legs, and chest.
- The electrodes are attached by wires to an electrocardiogram (EKG) machine, which records your heart's electrical activity.
- You will then walk on a treadmill, starting slowly and then gradually increasing in pace and incline until you reach your target heart rate set and/or reach your maximum exercise tolerance as determined by our staff supervising the test.
Stress echocardiogram
- Resting images using an ultrasound machine are acquired before walking on the treadmill.
- You might require an intravenous line if echocardiographic images are suboptimal to allow the administration of contrast.
- After these images are taken, you exercise on a treadmill to your maximum effort or target heart rate. When this occurs, you quickly transfer to the imaging bed so more images can be acquired at peak heart rates.
- The images acquired at rest and exercise are processed and reviewed by your cardiologist later. An ARC cardiologist is always present at the site during the stress echo to ensure the optimal images are acquired.
Nuclear stress test
- Nuclear stress tests typically take longer than other stress tests. You can expect a 30-minute to 2-hour test.
- A health care provider inserts an intravenous (IV) line into your arm containing a small amount of radioactive tracer. The tracer makes it possible for the health care provider to view images of your heart. It takes 15 to 40 minutes for the heart to absorb the radiotracer.
- You then sit upright in a chair with a camera that takes images of your heart at rest.
- The rest of the test is like an exercise stress test. You first get hooked up to an EKG machine, then asked to walk on a treadmill.
- When your heart is working at its hardest, you'll get another injection of the radioactive tracer, again waiting 15 to 40 minutes for your heart to absorb the tracer.
- You are then placed back on the chair with the camera, which takes more images of your heart at high heart rates.
- After these images are processed, which takes at least one day, a cardiologist interprets them.
Chemical stress tests
- This is a stress test where medication is used to simulate exercise for those patients unable to exercise or unlikely to be able to walk long enough to reach target heart rates.
- Same steps as the tests above but instead of walking on a treadmill, after initial images, you receive a medication (Regadenoson). After injection, you will either walk slowly or rest in a chair while the medication circulates, about 15 to 30 minutes, after which the second set of images will be acquired.
Note: The radioactive tracer will naturally leave your body through your urine. Drinking lots of water will help remove it faster.