A diagnostic tool used to evaluate the heart's response to specific physical exertion. This test helps detect possible heart problems, such as poor blood flow and perfusion of the heart muscle, electrical disturbances, and other heart problems. The test is usually performed by walking on a treadmill or riding a stationary bike, while monitoring the heart's electrical activity using an electrocardiogram (EKG). Successive measurements of blood pressure, pulse, and the patient's condition are also taken, focusing on symptoms such as chest pain, fatigue, and shortness of breath. You can learn more about who needs a stress test, the types of tests, and how to prepare for them through Dalili Medical. Follow us for more information.

How long does a stress test last?

 

The duration of a stress test ranges from 30 minutes to 3 hours, depending on the type of test used.

For a regular exercise stress test, the exercise phase takes about 10-15 minutes, plus additional time for preparation and follow-up. Advanced tests, such as nuclear tests or those using echocardiography, may take longer, up to 3 hours, as they include additional tests such as imaging.

What is a stress test?

 

A stress test is a common test used to:

- Evaluate how well the heart pumps blood.

- Measure how well blood flows to the heart muscle.

- Compare your physical performance with others of the same sex and age.

- Try to replicate symptoms (such as chest pain, shortness of breath, or dizziness) during a specific physical activity to detect any heart problems.

**People who need a stress test**

The groups who need a stress test include:

- Patients who have symptoms such as angina, irregular heartbeat, or shortness of breath.

- Patients who are receiving treatment for heart disease and want to evaluate the effectiveness of this treatment.

- Individuals with a family or personal history of heart disease, or who suffer from risk factors such as diabetes, high blood pressure, or smoking.

**Procedures to be followed before the stress test**

- You must refrain from eating for at least two hours before the test.

- It is preferable to avoid smoking during this period.

- It is necessary to consult your doctor about the possibility of taking your usual medications.

- It is recommended to wear comfortable clothes. It is preferable to bring a tracksuit or shorts and sports shoes on the day of the test.

- If it is necessary to perform the stress test in everyday clothes, it is preferable to wear low-heeled shoes with rubber soles and comfortable pants.

**Stress test process**

- If you feel any complaints during exercise, such as chest pain, shortness of breath, dizziness, palpitations, leg pain, fatigue, or others, please inform the test team immediately.

- The exercise portion of the test will be terminated if you reach your target heart rate, or if you feel tired, or if you have complaints that prevent you from continuing, or for medical reasons determined by your doctor.

- During this period, heart rate monitoring, electrocardiogram, and blood pressure are recorded for at least five minutes, and then the procedure is terminated.

***Types of stress tests**

Stress tests include the following types:

1. **Traditional stress test**: This test involves walking on a treadmill or riding a stationary bike, while monitoring the electrical activity of the heart using an electrocardiogram.

2. **Stress test with echocardiogram**: An echocardiogram (echocardiogram) is performed before and after exercise. Ultrasound is used to evaluate blood flow and the function of the heart muscle and valves. This test is recommended if the results of the traditional stress test are unclear.

**3. Nuclear stress test**During this test, a safe radioactive substance is injected to image the activity of the heart and the perfusion of the heart muscle. The heart is imaged before and after exercise using positron emission tomography (PET) or computed tomography (SPECT) techniques. This test is used to evaluate coronary artery disease or to measure the effectiveness of previous treatments such as stents or heart surgeries.

**4. Dobutamine Stress Test**In this test, dobutamine is injected through a controlled intravenous infusion to stimulate the heart and increase blood pressure and pulse, creating a specific pharmacological stress state on the heart's work. An electrocardiogram, pulse and blood pressure measurements are recorded before, during and after the drug is given. This test is used as an alternative to a regular stress test if the patient is unable to walk on a treadmill or ride a medical bike. Sometimes, this test is added to the stress test with an echocardiogram.

**Cardiac Rehabilitation Stress Test**The level of cardiac fitness is determined to develop an appropriate exercise program after a heart attack or heart surgery. This test is also used to assess progress after completing the rehabilitation program.

**How ​​to prepare for the test**

 

To ensure accurate results, it is recommended to follow the following guidelines:

- Avoid eating and drinking for several hours before the test.

- Refrain from consuming caffeine for 24 hours before the test.

- Wear comfortable clothing and shoes.

- Consult your doctor before stopping taking some medications such as beta-blockers.

For diabetics, it is necessary to coordinate with your doctor to avoid low blood sugar during the test, and it is preferable to monitor blood sugar levels before and after the test.

**How ​​to perform the test**

 

The basic steps include:

1. Measuring vital signs such as heart rate and blood pressure.

2. Connecting electrodes to an ECG machine on the chest and arms.3. The patient begins by walking or cycling at a gentle level.

4. The difficulty of the exercise is gradually increased until the target heart rate is reached.

5. The technicians end the test if symptoms such as chest pain or fatigue occur, if there are significant changes in the ECG, or if the patient asks to stop.

**Alternative procedures**

 

If the patient is unable to exercise, medications may be used to stimulate an increase in heart rate to simulate the effect of exercise.

What are the risks associated with a stress test?

 

A stress test is generally a safe procedure, and complications resulting from it are rare, but like any other medical procedure, it may be associated with some risks. Possible complications include:

**Low blood pressure** Blood pressure may drop during or immediately after exercise, which may cause dizziness or fainting. This problem is expected to go away after stopping the physical activity.

**Arrhythmia** Arrhythmia resulting from a stress test usually goes away shortly after stopping exercise.

**Heart attack**Although rare, a stress test can lead to a heart attack in some cases.

What happens if the stress test results are abnormal?

 

Abnormal results indicate the possibility of heart disease. If signs of mild heart disease are present, your doctor may recommend lifestyle changes, such as quitting smoking, following an exercise program to lose weight, and taking medications to treat diabetes, high blood pressure, or cholesterol, to reduce the risk of the condition getting worse. In cases where early abnormalities are found during the test or large areas of the heart muscle are affected, additional tests may be necessary, such as:

- Cardiac catheterization.

- Coronary CT scan.

- Nuclear stress test.

- Stress echocardiography.

Abnormal results may also indicate that your heart is not strong enough to withstand exercise or surgery, which may require additional treatments to prevent heart attacks or heart failure.

How can I do a stress test at home?

 

Although it is not as accurate as medical tests, a stress test can be performed at home through some of the following methods:

- Doing moderate physical exercises, such as brisk walking or climbing stairs for 6 minutes.

- Monitoring symptoms that may appear, such as chest pain, rapid heartbeat, or difficulty breathing during exercise.

- Measuring your heart rate using a smart watch or pulse oximeter. The normal rate of effort is considered to be between 50-85% of the maximum heart rate (which is calculated by subtracting your age from 220). If you feel chest pain or dizziness, you should stop immediately and consult your doctor.

**The importance of the stress test**

 

When the doctor suspects a certain medical condition related to disorders in the function and integrity of the heart muscle, he performs a stress test on the patient. This test is an effective tool in detecting and diagnosing many medical conditions, including:

**Detecting aortic artery diseases** The aorta, or coronary artery, is the main artery directly connected to the heart muscle. Disorders in this artery often occur as a result of the accumulation of some materials and plaques on its walls, as is the case in patients with high levels of harmful cholesterol in the blood.

**Diagnosis of angina** The stress test also helps detect diseases associated with heart disorders, which may lead to shortness of breath and chest pain, such as angina.

**Evaluating heart rhythm disturbances** Many patients suffer from problems with the regularity of the heartbeat; some suffer from an increase in the heart rate, while others suffer from a decrease in this rate. Both conditions indicate the presence of a health problem that requires medical intervention. The stress test works to identify any disturbance in the number of heartbeats per minute, which helps in accurately assessing the condition.

***Determining the patient's permissible level of effort*** On the other hand, performing a stress test for the heart muscle is an effective way to determine the amount of effort that the patient can do daily, which should never be exceeded to avoid any negative effects or serious complications on heart health.

***Following up on the heart treatment plan*** In addition, adhering to a treatment plan to control coronary artery disorder requires continuous monitoring of the heart condition. In this context, the stress test is the best way to evaluate the effectiveness of the treatment plan.

**Interpretation of stress test results**

The results of the heart stress test are generally interpreted according to the following method:

- **Normal stress test results**: indicate that the patient does not suffer from severe coronary artery disorders, but he may still be exposed to disorders and blood clots by less than 70%. If the patient suffers from other symptoms that raise suspicions of heart problems, the doctor may recommend additional tests.

- **Abnormal stress test results**: indicate that the patient suffers from severe coronary artery disorder by more than 70%. However, this result may be a false positive, which requires additional tests to accurately confirm the health condition.

What is normal cardiac stress?

 

Normal cardiac effort means that:

- The heart function is working properly: the heart pumps blood efficiently without any signs of decreased blood flow.

- Heart rate during effort: is within the normal range according to the level of physical fitness and age.

- The maximum normal heart rate is calculated as follows: 220 minus your age.

- During exercise, effort is considered normal if the heart rate is between 50-85% of this maximum.

- Response during and after effort: no electrolyte disturbances appearECG or EKG changes.

What to expect during a stress test?

 

**During a stress test** A nurse or technician will place patches (electrodes) on your chest, legs, and arms, which are connected by wires to an electrocardiogram (ECG or EKG) to record your heart's electrical signals. Your blood pressure will also be measured during the test. You may also be asked to breathe into a tube to assess how well you breathe while exercising. Next, you'll gradually begin walking on a treadmill or using a stationary bike. As the test progresses, the speed of the treadmill and the incline of the bike will increase. You can hold onto the bars on the treadmill to keep your balance, while the resistance of the stationary bike pedals will gradually increase. You'll continue exercising until your heart rate reaches your target level or until you develop symptoms that prevent you from continuing. These symptoms may include:

- Moderate to severe chest pain.

- Difficulty breathing.

- Abnormally high or low blood pressure.

- Irregular heartbeat.

- Feeling dizzy.

- Certain changes in your ECG.

You can ask to stop the test at any time if you feel unable to continue exercising.

**After the stress test**

After you finish exercising, you may be asked to stand upright for a few seconds, then lie down for about five minutes while continuing to record measurements until your heart rate and breathing return to normal. When the stress test is over, you can resume your daily activities as usual.

**Results**

If the data collected during the stress test show that your heart is functioning normally, you may not need additional tests. However, if the results are normal but your symptoms persist or get worse, your doctor may recommend a nuclear stress test or a repeat stress test with an echocardiogram before and after exercising. These tests are more accurate and provide additional information about your heart function. If your stress test results show that you have coronary artery disease or an abnormal heart rhythm, the information collected during the test will be used to help your doctor develop an appropriate treatment plan. You may need additional tests and evaluations such as coronary angiography or cardiac catheterization. If the purpose of the stress test is to guide treatment for a specific heart condition, the doctor will use this data.

**Disadvantages of the stress test**

On the other hand, there are some disadvantages associated with the use of a stress test for the heart, such as:

- This test cannot be relied upon to predict whether the patient is at risk of rupture of some fatty plaques accumulated on the walls of the coronary artery, which may lead to blockage of the artery in the future. Therefore, it becomes necessary to perform other additional tests.

Exposing the patient to a level of physical effort during the test may cause an excessive increase in the heart rate and difficulty breathing. Therefore, it is necessary to monitor the patient carefully to avoid burdening him with additional efforts that may harm his health, especially for patients who are overweight or have high blood fats, and who have previously been diagnosed with some heart diseases. In rare cases, doing physical effort during the test may lead to a heart attack for the patient.

**Guidelines for the stress test**

There are a set of guidelines and conditions that the patient must adhere to before the test, including:

- You must refrain from eating and drinking completely at least two hours before the test.

- It is recommended to stop smoking for a sufficient period before the test.

- Stimulants such as coffee, tea, and any foods or drinks containing caffeine should be avoided, as this affects the heart rate.

- It is necessary to consult a doctor before the test to make sure whether the medications the patient is taking may affect the test results.

- In the event of breathing problems and the use of some treatments such as an asthma inhaler, they must be brought during the test and the doctor and the relevant healthcare team must be informed of this.

- It is preferable for the patient to wear comfortable sportswear as much as possible, and to avoid any psychological or nervous stress before the test. It is also recommended to get enough sleep the night before the test, as these factors may lead to an abnormal increase in heart rate and blood pressure.

The patient must provide the doctor who will perform the test with a complete medical history, in addition to the rate of exercise he/she does during the week. This information helps the doctor accurately determine the level of effort required from the patient during the test.