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Stress Testing

Table of Contents

Stress Testing

Exercise Stress Test, Cardiac Stress Test, Treadmill Test, Cardiac Diagnostic Test, Cardiopulmonary Exercise Test, Abbreviated CPX Test

A stress test measures how healthy your heart is and how well it works during physical stress. Some heart problems are easier to identify when your heart is working hard to pump blood throughout your body, such as when you exercise. Read on to understand who needs it and the associated risks.

Stress test

Image by Blue0ctane at English Wikipedia

What Is Stress Test?

Cardiac Stress Test

Image by National Heart Lung and Blood Institute

Cardiac Stress Test

The image shows a patient having a stress test. Electrodes are attached to the patient's chest and connected to an EKG (electrocardiogram) machine. The EKG records the heart's electrical activity. A blood pressure cuff is used to record the patient's blood pressure while he walks on a treadmill.

Image by National Heart Lung and Blood Institute

What Is Stress Test?

A stress test measures how healthy your heart is and how well it works during physical stress. Some heart problems are easier to identify when your heart is working hard to pump blood throughout your body, such as when you exercise.

Your doctor may recommend this test if you have symptoms of a heart problem, such as shortness of breath, chest pain, dizziness, and a rapid or irregular heartbeat. If your doctor does find a problem, the stress test also can help your doctor choose the right treatment plan and determine what types of physical activity are safe for you.

You may do a stress test in your doctor’s office or a hospital. The test usually involves physical exercise such as walking on a treadmill or riding a stationary bicycle. If you are not able to exercise, your doctor will give you medicine that will make your heart work hard and beat faster, as if you were exercising. Your doctor may ask you not to take some of your prescription medicines or to avoid coffee, tea, or any drinks with caffeine on the day of your test, because these may affect your results. Your doctor will ask you to wear comfortable clothes and shoes for the test.

For the stress test, your doctor will put sticky patches called electrodes on your chest and attach a blood pressure cuff to your arm and a pulse monitor to your finger or another part of your body. Your doctor will measure your heart activity and blood pressure before you start the test.

You will slowly start to exercise on a treadmill or stationary bicycle, and then gradually increase the treadmill speed or bicycle resistance until your heart is working at the target heart rate for your age. Most often, a stress test includes an electrocardiogram to measure your heart’s electrical activity and heart rate, and a blood pressure monitor as you exercise. Your doctor may also measure your blood oxygen level. During the test, you will exercise for about 10 to 15 minutes. Your doctor will stop the test if you show any sign of a heart problem or if you are too tired to continue the test. If you are not able to exercise, your doctor will give you medicine over a 10- to 20-minute period through an intravenous (IV) line into one of your blood vessels.

Your doctor may use echocardiography, cardiac MRI, or a nuclear heart scan to take images of your heart during or right after the stress test. These tests will show how well blood is flowing through your heart and how well your heart pumps blood when it beats. If your doctor also wants to see how well your body uses oxygen you may be asked to wear a mask or mouthpiece to measure the gases that you breathe out during the stress test.

After the stress test, your doctor will measure your heart activity and blood pressure to make sure that both measurements are back within the normal range. You should be able to return to your normal activities right away.

Your doctor will carefully monitor you throughout the test to lower the risk of complications caused by the exercise or medicine used to raise your heart rate. Intense exercise during the test can rarely cause some heart problems such as chest pain or irregular heartbeats; these usually go away after exercise. Some stress medicines temporarily lower your blood pressure. If your doctor gives you medicine to make your heart beat harder instead of having you exercise, there is a small risk of developing certain heart problems after the test.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (7)

Types of Stress Testing

Stress test at Beaumont Hospital.

Image by Original uploader was Blue0ctane at en.wikipedia

British Heart Foundation - Your guide to an exercise ECG (stress test), heart disease test

Video by British Heart Foundation/YouTube

What is a Stress Test?

Video by Henry Ford Allegiance Health/YouTube

What to Expect: Nuclear Medicine Stress Test | Cedars-Sinai

Video by Cedars-Sinai/YouTube

Who Needs a Stress Test?

Video by Mayo Clinic/YouTube

Stress Test Animation

Video by Blausen Medical Corporate/YouTube

Mayo Clinic Minute: What is a cardiac stress test?

Video by Mayo Clinic/YouTube

Types of Stress Testing

Original uploader was Blue0ctane at en.wikipedia

3:38

British Heart Foundation - Your guide to an exercise ECG (stress test), heart disease test

British Heart Foundation/YouTube

2:42

What is a Stress Test?

Henry Ford Allegiance Health/YouTube

3:57

What to Expect: Nuclear Medicine Stress Test | Cedars-Sinai

Cedars-Sinai/YouTube

6:28

Who Needs a Stress Test?

Mayo Clinic/YouTube

0:31

Stress Test Animation

Blausen Medical Corporate/YouTube

1:01

Mayo Clinic Minute: What is a cardiac stress test?

Mayo Clinic/YouTube

Stress Tests

Stress Tests

Also called: Cardiac Stress Test, Cardiac Diagnostic Test

Stress tests shows how well your heart works when it's pumping hard. They can find problems with blood flow to your heart muscle and other heart conditions. Reduced blood flow can be a sign of a serious heart disease.

Stress Tests

Also called: Cardiac Stress Test, Cardiac Diagnostic Test

Stress tests shows how well your heart works when it's pumping hard. They can find problems with blood flow to your heart muscle and other heart conditions. Reduced blood flow can be a sign of a serious heart disease.

Stress tests show how well your heart works when it's pumping hard. Some heart diseases are easier to find when your heart is working its hardest to pump blood through your body. So stress tests check your heart while you exercise on a treadmill or stationary bicycle. If you're not able to exercise, medicine can be used to make your heart work harder , as if you were exercising.
There are different types of stress tests. They all check:
- Blood flow in your heart
- Your blood pressure
- The rate and rhythm of your heartbeat
- The strength of the electrical signals that control your heartbeat
Some stress tests also take pictures of your heart at rest and when it's working hard. The pictures provide more detail about how your heart is working.
Stress tests are most often used to find the cause of symptoms that may be from a heart problem.
The tests can help diagnose certain heart conditions, including:
- Coronary artery disease (CAD)
- Angina
- Arrhythmia
- Heart failure
- Heart valve diseases
- Cardiomyopathy
Stress testing is also used:
- To find out how serious a known heart condition is, including the chance that you'll have a heart attack in the future.
- To help make treatment decisions for a heart condition.
You may need a stress test if you have symptoms that could be from a heart condition. Symptoms may include:
- Chest pain or discomfort without a known cause
- Shortness of breath
- Irregular or rapid heartbeat that may feel like a fluttering in your chest
- Feeling dizzy or lightheaded
You may also need a stress test to check your heart health if you:
- Have a heart condition with new or worsening symptoms.
- Are going to have surgery. Your health care provider may want to see if your heart is strong enough for the operation.
- Are being treated for heart disease. The test can show how much treatment is helping, including heart surgery.
- Have a high risk for heart disease. Your risk may be higher than normal if you have a family history of heart disease and/or certain conditions, such as diabetes, that are linked to heart disease.
- Plan to start an exercise program. If you have a heart condition or a high risk for a heart condition, a stress test can show what level of exercise is safe for you. (Always talk with your provider before starting any strenuous, new exercise.)
Stress tests may be done with or without imaging (pictures of your heart). The most common type of test is an exercise stress test. It doesn't include pictures. But the main steps of an exercise stress test are part of all stress tests:
- You'll have a blood pressure cuff on your arm to check your blood pressure.
- Electrodes will be placed on your body for an electrocardiogram test (also called EKG or ECG). Electrodes are small sensors that stick to your skin. Wires connect the electrodes to a computer or an EKG machine that records the electrical activity in your heart during the stress test.
- If you're unable to exercise: An intravenous (IV) line will be inserted into a vein in your arm. You'll get medicine through the IV. The medicine will make your heart work harder for 10 to 20 minutes while an EKG records your heart's electrical activity. Medicine can be used instead of exercise for all types of stress tests.
- If you can exercise: You'll walk on a treadmill or ride a stationary bicycle. On a treadmill, the speed will slowly increase. The treadmill may also tilt so you feel like you're walking uphill. On a bicycle, the resistance will slowly increase, so it's harder to pedal.
  You'll exercise for about 10 to 15 minutes until you reach a target heart rate based on your age and fitness level. But you may stop the test sooner if:
  
  You develop chest pain, shortness of breath, dizziness, fatigue or other symptoms
  The EKG shows a problem with your heart
- After all types of stress tests, you'll be monitored for 10-15 minutes or until your heart rate returns to normal.
Stress tests with pictures include stress echocardiograms, nuclear stress tests, and cardiac (heart) MRI stress tests. These tests have extra steps:
A stress echocardiogram or "echo" takes moving pictures of your heart using doppler ultrasound. The pictures show the size and shape of your heart and blood flow through your heart. Pictures will be taken before and after your heart has worked its hardest. You'll lie on your left side on a table as a provider moves an ultrasound device on your chest. If you exercise on a bicycle, the second set of pictures may be taken while you're pedaling.
A nuclear stress test takes pictures of your heart using a small amount of a radioactive substance called a "tracer" and a special camera that scans your heart. A provider injects the tracer into your bloodstream through an IV line that's placed in a vein. Your heart and blood vessels absorb the tracer, which makes them show up more clearly in the pictures.
Pictures are taken while you lie on a table before and after your heart has worked its hardest. After the test, the tracer naturally leaves your body in your urine (pee). Drinking lots of water will help remove it faster.
A cardiac MRI stress test takes the most detailed pictures of your heart using radio waves, magnets, and a computer. It is a newer test that's mostly used for very serious heart problems. For an MRI stress test:
- A provider may inject dye into your bloodstream through an IV line placed in your arm. Some cardiac MRIs, but not all, use dye to help show very small details on the pictures.
- Pictures of your heart may be taken before and after your heart has worked hard. To take the pictures, you'll lie on a table that slides into a large, tunnel-like MRI machine. You'll hear loud sounds as the machine takes pictures. If you're exercising for the test, you may use a treadmill near the MRI, or you may exercise while lying in the MRI machine using special devices to move your arms or legs.
1. Stress Tests: MedlinePlus Medical Test [accessed on Mar 09, 2023]

Exercise Tolerance Test

Exercise Tolerance Test

Also called: Treadmill Stress Testing, Exercise Stress Test, Cardiopulmonary Exercise Test, CPX Test

Exercise tolerance testing is a form of cardiac stress testing that uses treadmill exercise with electrocardiogram (EKG) and blood pressure monitoring. The test is used to determine a patient’s functional capacity, assess the probability and extent of coronary artery disease (CAD) as well as assess risks, prognosis and effects of therapy.

Exercise Tolerance Test

Also called: Treadmill Stress Testing, Exercise Stress Test, Cardiopulmonary Exercise Test, CPX Test

Exercise tolerance testing is a form of cardiac stress testing that uses treadmill exercise with electrocardiogram (EKG) and blood pressure monitoring. The test is used to determine a patient’s functional capacity, assess the probability and extent of coronary artery disease (CAD) as well as assess risks, prognosis and effects of therapy.

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Use the slider below to see how your results affect your health.
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VO2 max refers to the maximum amount of oxygen that an individual can utilize during intense or maximal exercise. The greater your VO2 max, the more oxygen your body can consume and transport to your organs, muscles, and tissues, enabling you to have better endurance and performance for a given effort.
Related conditions
- Before the test begins, your nurse or doctor will explain it to you. Feel free to ask questions and voice concerns at this time. When you understand what will happen, you will be asked to sign a consent for the test to be performed.
- To monitor your heart during exercise, adhesive patches, called electrodes, will be put on your chest. Your chest will be cleansed with alcohol and shaved in some areas (if necessary) before these electrodes are placed.
- You will be asked about symptoms you have had with exercise in the past. Describe, as completely as you can, any chest discomfort, breathing problems, lightheadedness or dizziness, fluttering in the chest, weakness, fatigue, or anything else you think may be relevant. Also, mention anything you feel while you are being prepared for the test.
- A nurse or doctor will be with you throughout the test. Your heart rate and rhythm and your blood pressure will be checked during the test.
- Generally, the treadmill’s pace and incline will increase every 3 minutes. It is important that you describe anything you feel as you exercise. If you become short of breath, the nurse may ask you to rate it as “mild,” “moderate,” or “severe.” If you have chest discomfort, you will be asked to describe it as best you can and rate it on a scale of 1 to 10 (1 is very mild; 10 is very severe). There is no right or wrong number. This helps your doctor know how you are doing and gives us a better way to compare how you feel before and after the test.
- Keep walking until you are told to stop or until you cannot walk any longer. Let the nurse know when you need to slow down. Keep walk-ing as the treadmill slows. Do not jump off.
- While you rest, your heart will continue to be monitored.
- Inform the doctor or nurse about any temporary or permanent condition that could affect your ability to move, walk, bear weight, or keep your balance. If possible, discuss this when you are first scheduled for the test. It is also important that the doctor and/or nurse conducting the test have this information.
- Carefully follow your doctor’s instructions about medications. Some medications should be stopped for 48 hours before the test; others should not be stopped. If you do not have clear instructions about all your medications (including those for your heart, blood pressure, or other medications), contact your doctor or nurse a few days before the test.
- Avoid caffeine, alcohol, and nicotine 8 hours before the test. Do not eat 2 hours before the test, and do not drink liquids 1 hour before the test. If your exercise test is combined with heart imaging (such as a thallium scan), follow the specific instructions for that test.
- Try to be as well rested as possible. You may need to reschedule the test if you feel unwell (for example, if you have a cold). If you do not feel you can give your maximum exercise effort, contact your nurse or doctor before the test.
- Wear loose, comfortable clothing with a separate top and bottom. Women should wear bras. Wear comfortable, flat shoes that will not slip off while you are walking.
After the procedure:
- You can eat and drink as usual.
- Depending on how you feel, you may go about your normal routine or take it easy if the test tired you.
- Do not take a hot shower for at least an hour after the test. Your blood vessels expand with exercise and need time to return to normal. A hot shower may expand them more, causing low blood pressure and dizziness.
1. Procedures/Diagnostic Tests. Exercise tolerance test. National Institutes of Health Clinical Center. [accessed on Dec 11, 2018]
2. Vilcant V, Zeltser R. Treadmill Stress Testing. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. [accessed on Dec 11, 2018]
3. Am Fam Physician. 2017 Sep 1;96(5):293-299. Exercise Stress Testing: Indications and Common Questions. Garner KK, Pomeroy W, Arnold JJ. [accessed on Dec 11, 2018]
4. Am Fam Physician. 1999 Jan 15;59(2):401-10. Ordering and understanding the exercise stress test. Darrow MD. [accessed on Dec 11, 2018]
5. Harvard Men's Health. Cardiac exercise stress testing: What it can and cannot tell you. [accessed on Dec 11, 2018]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Stress Echocardiography

Stress Echocardiography

Also called: Echocardiography Stress Test, Stress Echo

Stress echocardiography, or echo, is a test that uses sound waves to create moving pictures of your heart. A stress echo is done as part of a stress test. Some heart problems, such as coronary heart disease, are easier to diagnose when the heart is working hard and beating fast.

Stress Echocardiography

Also called: Echocardiography Stress Test, Stress Echo

Stress echocardiography, or echo, is a test that uses sound waves to create moving pictures of your heart. A stress echo is done as part of a stress test. Some heart problems, such as coronary heart disease, are easier to diagnose when the heart is working hard and beating fast.

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Use the slider below to see how your results affect your health.
Your result is Normal.
A normal result means that blood flow through the coronary arteries is probably normal.
Related conditions
1. https://medlineplus.gov/ency/article/007150.htm [accessed on Feb 23, 2022]
2. https://medlineplus.gov/lab-tests/stress-tests/ [accessed on Feb 23, 2022]
3. https://www.nhlbi.nih.gov/health-topics/echocardiography [accessed on Feb 23, 2022]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Types

Ekg

Image by Helge V. Keitel

Ekg

Image by Helge V. Keitel

Types of Stress Testing

The two main types of stress testing are a standard exercise stress test and an imaging stress test.

Standard Exercise Stress Test

A standard exercise stress test uses an EKG (electrocardiogram) to detect and record the heart's electrical activity.

An EKG shows how fast your heart is beating and the heart's rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart.

During a standard stress test, your blood pressure will be checked. You also may be asked to breathe into a special tube during the test. This allows your doctor to see how well you're breathing and measure the gases that you breathe out.

A standard stress test shows changes in your heart's electrical activity. It also can show whether your heart is getting enough blood during exercise.

Imaging Stress Test

As part of some stress tests, pictures are taken of your heart while you exercise and while you’re at rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats.

One type of imaging stress test involves echocardiography (echo). This test uses sound waves to create a moving picture of your heart. An exercise stress echo can show how well your heart's chambers and valves are working when your heart is under stress.

A stress echo also can show areas of poor blood flow to your heart, dead heart muscle tissue, and areas of the heart muscle wall that aren't contracting well. These areas may have been damaged during a heart attack, or they may not be getting enough blood.

Other imaging stress tests use radioactive dye to create pictures of blood flow to your heart. The dye is injected into your bloodstream before the pictures are taken. The pictures show how much of the dye has reached various parts of your heart during exercise and while you're at rest.

Tests that use radioactive dye include a thallium or sestamibi stress test and a positron emission tomography (PET) stress test. The amount of radiation in the dye is considered safe for you and those around you. However, if you're pregnant, you shouldn't have this test because of risks it might pose to your unborn child.

Imaging stress tests tend to detect CHD better than standard (nonimaging) stress tests. Imaging stress tests also can predict the risk of a future heart attack or premature death.

An imaging stress test might be done first (as opposed to a standard exercise stress test) if you:

Can't exercise for enough time to get your heart working at its hardest. (Medical problems, such as arthritis or leg arteries clogged by plaque, might prevent you from exercising long enough.)
Have abnormal heartbeats or other problems that prevent a standard exercise stress test from giving correct results.
Had a heart procedure in the past, such as coronary artery bypass grafting or percutaneous coronary intervention, also known as coronary angioplasty, and stent placement.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (4)

Diagnostic Testing for Heart Disease (Q&A)

Video by Howard County General Hospital/YouTube

Types of Stress Testing

Stress test at Beaumont Hospital.

Image by Original uploader was Blue0ctane at en.wikipedia

British Heart Foundation - Your guide to an exercise ECG (stress test), heart disease test

Video by British Heart Foundation/YouTube

What is a Stress Test?

Video by Henry Ford Allegiance Health/YouTube

6:19

Diagnostic Testing for Heart Disease (Q&A)

Howard County General Hospital/YouTube

Types of Stress Testing

Original uploader was Blue0ctane at en.wikipedia

3:38

British Heart Foundation - Your guide to an exercise ECG (stress test), heart disease test

British Heart Foundation/YouTube

2:42

What is a Stress Test?

Henry Ford Allegiance Health/YouTube

Who Needs It

Man feeling tightness or pain in the chest

Image by https://www.myupchar.com

Man feeling tightness or pain in the chest

An illustration of a man feeling tightness or pain in the chest - a symptom of angina or of a heart attack

Image by https://www.myupchar.com

Who Needs Stress Testing?

You may need stress testing if you've had chest pains, shortness of breath, or other symptoms of limited blood flow to your heart.

Imaging stress tests, especially, can show whether you have coronary heart disease (CHD) or a heart valve problem. (Heart valves are like doors; they open and shut to let blood flow between the heart's chambers and into the heart's arteries. So, like CHD, faulty heart valves can limit the amount of blood reaching your heart.)

If you've been diagnosed with CHD or recently had a heart attack, a stress test can show whether you can handle an exercise program. If you've had percutaneous coronary intervention, also known as coronary angioplasty, (with or without stent placement) or coronary artery bypass grafting, a stress test can show how well the treatment relieves your CHD symptoms.

You also may need a stress test if, during exercise, you feel faint, have a rapid heartbeat or a fluttering feeling in your chest, or have other symptoms of an arrhythmia (an irregular heartbeat).

If you don't have chest pain when you exercise but still get short of breath, your doctor may recommend a stress test. The test can help show whether a heart problem, rather than a lung problem or being out of shape, is causing your breathing problems.

For such testing, you breathe into a special tube. This allows a technician to measure the gases you breathe out. Breathing into the tube during stress testing also is done before a heart transplant to help assess whether you're a candidate for the surgery.

Stress testing shouldn’t be used as a routine screening test for CHD. Usually, you have to have symptoms of CHD before a doctor will recommend stress testing.

However, your doctor may want to use a stress test to screen for CHD if you have diabetes. This disease increases your risk of CHD. Currently, though, no evidence shows that having a stress test will improve your outcome if you have diabetes.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (4)

Heart Tests You Should Know About

Video by Lee Health/YouTube

Diagnostic Testing for Heart Disease (Q&A)

Video by Howard County General Hospital/YouTube

Heart Attack Caused by Ischemia

Thromboembolisms can cause heart attacks. A clot may lodge in one of the heart's coronary arteries (the arteries that supply the heart muscle tissue with blood) and block blood flow. The tissue becomes starved of oxygen (a condition called ischemia) and is damaged or dies.

Image by TheVisualMD

Who Needs a Stress Test?

Video by Mayo Clinic/YouTube

1:49

Heart Tests You Should Know About

Lee Health/YouTube

6:19

Diagnostic Testing for Heart Disease (Q&A)

Howard County General Hospital/YouTube

Heart Attack Caused by Ischemia

TheVisualMD

6:28

Who Needs a Stress Test?

Mayo Clinic/YouTube

Before the Test

Fasting - A Glass of Water on an Empty Plate

Image by Jean Fortunet/Wikimedia

Fasting - A Glass of Water on an Empty Plate

Fasting - A glass of water on an empty plate

Image by Jean Fortunet/Wikimedia

What To Expect Before Stress Testing

Your doctor may ask you not to take some of your prescription medicines or to avoid coffee, tea, or any drinks with caffeine on the day of your test, because these may affect your results. Your doctor will ask you to wear comfortable clothes and shoes for the test.

For the stress test, your doctor will put sticky patches called electrodes on your chest and attach a blood pressure cuff to your arm and a pulse monitor to your finger or other part of your body. Your doctor will measure your heart activity and blood pressure before you start the test.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (4)

Who Needs a Stress Test?

Video by Mayo Clinic/YouTube

Blood Vessels of Male Upper Body anterior view

The cardiovascular system is vast network of arteries, veins and vessels that would extend 60,000 miles if stretched end-to-end, enough to circle the globe 3-4 times. All but about a tiny fraction of this vessel network is invisible to the naked eye. The smallest capillaries (from latin \"hairlike\") are so narrow that red blood cells must pass through in single file. The heart and arteries are more than just mechanical pieces of a transport system, however. The cardiovascular system also reflects and responds to health conditions throughout the body.

Image by TheVisualMD

What to Expect: Nuclear Medicine Stress Test | Cedars-Sinai

Video by Cedars-Sinai/YouTube

Stress Test Animation

Video by Blausen Medical Corporate/YouTube

6:28

Who Needs a Stress Test?

Mayo Clinic/YouTube

Blood Vessels of Male Upper Body anterior view

TheVisualMD

3:57

What to Expect: Nuclear Medicine Stress Test | Cedars-Sinai

Cedars-Sinai/YouTube

0:31

Stress Test Animation

Blausen Medical Corporate/YouTube

During the Tet

Heart Valves

Image by josino

Heart Valves

Blood flow through the valves

Image by josino

What To Expect During Stress Testing

You will slowly start to exercise on a treadmill or stationary bicycle, and then gradually increase the treadmill speed or bicycle resistance until your heart is working at the target heart rate for your age. Most often, a stress test includes an electrocardiogram to measure your heart’s electrical activity as you exercise on a treadmill or on a stationary bicycle. Your doctor may also measure your blood oxygen level, blood pressure, and heart rate. During the test, you will exercise for 10 to 15 minutes. Your doctor will stop the test if you show any sign of a heart problem, or if you are too tired to continue the test.

If you are not able to exercise, your doctor will give you medicine over a 10- to 20-minute period through an intravenous (IV) line into one of your blood vessels.

Your doctor may also take images of your heart during or right after the stress test to see how well blood is flowing through your heart and how well your heart pumps blood when it beats. These pictures can be taken by echocardiography or by injecting a radioactive dye into one of your veins, called a nuclear heart scan. The amount of radiation in the dye is considered safe for you and those around you. However, if you are pregnant, you should not have this test because of risks it might pose to your unborn child.

If your doctor also wants to see how well your lungs are working, you may be asked to wear a mask or mouthpiece to measure the gases that you breathe out during the stress test.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (4)

Mayo Clinic Minute: What is a cardiac stress test?

Video by Mayo Clinic/YouTube

What to Expect: Nuclear Medicine Stress Test | Cedars-Sinai

Video by Cedars-Sinai/YouTube

British Heart Foundation - Your guide to an exercise ECG (stress test), heart disease test

Video by British Heart Foundation/YouTube

Nuclear stress test can detect more than blockages

Video by mcgwebcontent/YouTube

1:01

Mayo Clinic Minute: What is a cardiac stress test?

Mayo Clinic/YouTube

3:57

What to Expect: Nuclear Medicine Stress Test | Cedars-Sinai

Cedars-Sinai/YouTube

3:38

British Heart Foundation - Your guide to an exercise ECG (stress test), heart disease test

British Heart Foundation/YouTube

3:33

Nuclear stress test can detect more than blockages

mcgwebcontent/YouTube

After the Test

Assessing Blood Flow

Image by TheVisualMD

Assessing Blood Flow

Coronary artery disease (CAD)- clogged coronary arteries - can cause angina when blood flow is restricted, or heart attack when flow is severely reduced or completely blocked. If CAD is suspected, the most common initial tests to be given are electrocardiograms (EKGs), chest X-rays, blood tests, and "stress tests". If initial tests confirm the presence of heart disease, then additional tests may be performed. These could include coronary angiograms, echocardiograms, PET scans, and myocardial perfusion scans.

Image by TheVisualMD

What To Expect After Stress Testing

After the stress test, your doctor will measure your heart activity and blood pressure to make sure that both measurements are back within the normal range. You should be able to return to your normal activities right away. If you had a test that involved radioactive dye, your doctor may ask you to drink plenty of fluids to flush it out of your body.

If your stress test shows that your heart is healthy, you may not need further testing or treatment. Your doctor may order other diagnostic tests or imaging tests if the stress test results suggest that you may have a heart condition, if you are physically unable to exercise, or if you continue having symptoms, such as shortness of breath or chest pain.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (4)

Hydrate

Hydrate and complete the cleansing of the kidneys and bladder

Image by TheVisualMD

What is a Stress Test?

Video by Henry Ford Allegiance Health/YouTube

Blood Pressure & Mean Arterial Pressure - MEDZCOOL

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British Heart Foundation - Your guide to an exercise ECG (stress test), heart disease test

Video by British Heart Foundation/YouTube

Hydrate

TheVisualMD

2:42

What is a Stress Test?

Henry Ford Allegiance Health/YouTube

2:16

Blood Pressure & Mean Arterial Pressure - MEDZCOOL

Medzcool/YouTube

3:38

British Heart Foundation - Your guide to an exercise ECG (stress test), heart disease test

British Heart Foundation/YouTube

What Are The Risks?

Heart Disease & Arrhythmia

Image by TheVisualMD

Heart Disease & Arrhythmia

Heart disease is a major cause of arrhythmia, due to lack of blood flow and heart tissue damage.

Image by TheVisualMD

What Are the Risks of Stress Testing?

Stress tests pose little risk of serious harm. The chance of these tests causing a heart attack or death is about 1 in 5,000. More common, but less serious side effects linked to stress testing include:

An arrhythmia (irregular heartbeat). Often, an arrhythmia will go away quickly once you're at rest. But if it persists, you may need monitoring or treatment in a hospital.
Low blood pressure, which can cause you to feel dizzy or faint. This problem may go away once your heart stops working hard; it usually doesn't require treatment.
Jitteriness or discomfort while getting medicine to make your heart work hard and beat fast (you may be given medicine if you can’t exercise). These side effects usually go away shortly after you stop getting the medicine. Sometimes the symptoms may last a few hours.

Also, some of the medicines used for pharmacological stress tests can cause wheezing, shortness of breath, and other asthma-like symptoms. Sometimes these symptoms are severe and require treatment.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (3)

What to Expect: Nuclear Medicine Stress Test | Cedars-Sinai

Video by Cedars-Sinai/YouTube

Phosphorus, Heart Function (EKG)

Most of the body's phosphorus is in a form combined with calcium to help form bones and teeth, but it is also found in muscle, nerve tissue, and, in tiny but crucial amounts, within cells throughout the body, where it is a component of key molecules such as DNA. Phosphorus assists in the contraction of muscles, nerve conduction and the regulation of heartbeat. Using phosphorus supplements along with potassium supplements may elevate potassium levels, which can result in life-threatening arrhythmias.

Image by TheVisualMD

What is a Stress Test?

Video by Henry Ford Allegiance Health/YouTube

3:57

What to Expect: Nuclear Medicine Stress Test | Cedars-Sinai

Cedars-Sinai/YouTube

Phosphorus, Heart Function (EKG)

TheVisualMD

2:42

What is a Stress Test?

Henry Ford Allegiance Health/YouTube

What Does It Show?

The Electric Heart

Image by TheVisualMD

The Electric Heart

Image by TheVisualMD

What Does Stress Testing Show?

Stress testing shows how your heart works during physical stress (exercise) and how healthy your heart is.

A standard exercise stress test uses an EKG (electrocardiogram) to monitor changes in your heart's electrical activity. Imaging stress tests take pictures of blood flow throughout your heart. They also show your heart valves and the movement of your heart muscle.

Doctors use both types of stress tests to look for signs that your heart isn't getting enough blood flow during exercise. Abnormal test results may be due to coronary heart disease (CHD) or other factors, such as poor physical fitness.

If you have a standard exercise stress test and the results are normal, you may not need further testing or treatment. But if your test results are abnormal, or if you're physically unable to exercise, your doctor may want you to have an imaging stress test or other tests.

Even if your standard exercise stress test results are normal, your doctor may want you to have an imaging stress test if you continue having symptoms (such as shortness of breath or chest pain).

Imaging stress tests are more accurate than standard exercise stress tests, but they're much more expensive.

Imaging stress tests show how well blood is flowing in the heart muscle and reveal parts of the heart that aren't contracting strongly. They also can show the parts of the heart that aren't getting enough blood, as well as dead tissue in the heart, where no blood flows. (A heart attack can cause heart tissue to die.)

If your imaging stress test suggests significant CHD, your doctor may want you to have more testing and treatment.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (4)

Mayo Clinic Minute: What is a cardiac stress test?

Video by Mayo Clinic/YouTube

Nuclear Cardiac Stress Test

Video by Madisonhealth/YouTube

Cardiac stress test: Mayo Clinic Radio

Video by Mayo Clinic/YouTube

When to get a stress test? - Cardiologist talks about symptoms to look out for

Video by BAYSTATEHEALTH/YouTube

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Mayo Clinic Minute: What is a cardiac stress test?

Mayo Clinic/YouTube

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Nuclear Cardiac Stress Test

Madisonhealth/YouTube

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Cardiac stress test: Mayo Clinic Radio

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When to get a stress test? - Cardiologist talks about symptoms to look out for

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Stress Testing

A stress test measures how healthy your heart is and how well it works during physical stress. Some heart problems are easier to identify when your heart is working hard to pump blood throughout your body, such as when you exercise. Read on to understand who needs it and the associated risks.

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