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Exercise stress test

Definition

An exercise stress test is used to measure the effect of exercise on your heart.

Alternative Names

Exercise ECG; ECG - exercise treadmill; EKG - exercise treadmill; Stress ECG; Exercise electrocardiography; Stress test - exercise treadmill

How the Test is Performed

This test is done at a medical center or health care provider's office.

The technician will place 10 flat, sticky patches called electrodes on your chest. These patches are attached to an ECG monitor that follows the electrical activity of your heart during the test.

You will walk on a treadmill or pedal on an exercise bicycle. Slowly (about every 3 minutes), you will be asked to walk (or pedal) faster and on an incline. It is like walking fast or jogging up a hill.

While you exercise, the activity of your heart is measured with an electrocardiogram (ECG). Your blood pressure readings are also taken.

The test continues until:

You will be monitored for 10 - 15 minutes after exercising, or until your heart rate returns to baseline. The total time of the test is around 60 minutes.

How to Prepare for the Test

Wear comfortable shoes and loose clothing to allow you to exercise.

Ask your health care provider if you should take any of your regular medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.

Tell your doctor if you are taking sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil (Levitra) and have taken a dose within the past 24 to 48 hours.

You must not eat, smoke, or drink beverages containing caffeine or alcohol for 3 hours (or more) before the test. In most cases, you will be asked to avoid caffeine for 24 hours before the test. This includes:

How the Test will Feel

Electrodes (conductive patches) will be placed on your chest to record the heart's activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.

The blood pressure cuff on your arm will be inflated every few minutes. This produces a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before exercise starts.

You will start walking on a treadmill or pedaling a stationary bicycle. The pace and incline of the treadmill (or the pedaling resistance) will slowly be increased.

Sometimes, people experience some of the following symptoms during the test:

Why the Test is Performed

Reasons why an exercise stress test may be performed include:

There may be other reasons why your health care provider asks for this test.

Normal Results

The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.

It may be hard to interpret the results of an exercise-only stress test in some patients.

What Abnormal Results Mean

Abnormal results may be due to:

When you have an abnormal exercise stress test, you may have other tests performed on your heart such as:

Risks

Stress tests are generally safe. Some patients may have chest pain or may faint or collapse. A heart attack or dangerous irregular heart rhythm is rare.

People who are more likely to have such complications are often already known to have a weak heart, so they are not given this test.

References

Balady GJ, Morise AP. Exercise stress testing. In: Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 13.

Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 71.

Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126:e354-471.

Goff DC Jr, Lloyd-Jones DM, Bennett G, O'Donnell CJ, Coady S, Robinson J, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; pii: S0735-1097(13)06031-2.



Review Date: 8/12/2014
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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