Stress testing measures heart function under “stress” to diagnose or rule out heart conditions. Tests include exercise ECG and echocardiogram, with vital signs monitored. Patients should wear comfortable clothes, avoid eating for 12 hours, and express discomfort. A stress test does not always indicate heart problems, but early detection is beneficial.
There are a couple of definitions for stress testing, including actual tests people can take to assess their emotional stress levels. Most commonly in medicine, stress testing refers to measuring heart function when the heart is working hard or under “stress.” This shouldn’t be thought of as negative stress on the heart, but simply means a demand on the heart to work harder through exercise or an injection of a drug.
There are a number of reasons why doctors, and often cardiologists, order a stress test. These could be to rule out or govern conditions such as an increased risk of heart attack, abnormal heart rhythms or the presence of diseased coronary arteries. Sometimes patients have symptoms such as difficulty breathing or heart pain that are not easily explained, and the test might be used to diagnose a cause or to rule out the heart as the cause of the symptoms.
There are several variations of the stress test. In the exercise electrocardiogram (ECG) test, people will use a treadmill or bicycle to raise their heart rate while the ECG is closely monitored for any irregular signs. The test usually begins with a reading of the resting ECG, and then a person will continue to wear ECG monitoring stickers as they begin to exercise.
Typically the exercise portion of this test isn’t that long, although it might seem long if people don’t exercise regularly. Generally most people elevate their heart rate to the desired area in about 10 minutes and ECG readings will be taken when this occurs. Occasionally this test ends with an echocardiogram or ultrasound of the heart, but this is not always the case.
An echocardiogram stress test is a little different and can be done in a number of ways. This looks at pictures of the heart when it’s working and usually starts with the administration of drugs such as dobutamine or adenosine. These drugs take the place of exercise and make your heart beat very fast, as if you were exercising, which can be an unpleasant sensation, although fortunately short-lived. Both an ECG and an echocardiogram can be performed, and as with exercise testing, vital signs such as blood pressure are closely monitored.
Because there are so many possible variations of the stress test, it’s difficult to educate people about what to expect or how they should prepare. The best education usually comes from the cardiologist who performs the test. In general it could be said that if the test involves physical activity, people should wear comfortable clothes and shoes suitable for a workout. If an echo is involved, women will be asked to remove their bras, so wearing one that is easy to remove makes sense. Most tests ask people not to eat for 12 hours before testing, and it may be wise to schedule these tests for early in the morning to avoid daytime fasting.
Another area cardiologists should fully explain to patients is that they can and should express discomfort. If the test suddenly involves sharp pain, even if not related to the heart, patients may stop. Most will have the option of doing other forms of stress testing if the exercise is uncomfortable or too difficult to do.
The last thing people might want to know is whether an order for a stress test always means a diagnosis of heart problems. It is not so. Many people have these tests and they are proven to be in excellent shape. However, if the test does reveal heart problems, people can take comfort in the fact that detecting heart problems early is much more favorable when it comes to treatment outcomes.
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