Stress Testing

An exercise stress test evaluates the effect of exercise on the heart.

An exercise stress test may be indicated in a variety of scenarios:

• When a patient experiences symptoms during exercise, such as dizziness, fainting, shortness of breath or chest pain
• To measure the efficacy of cardiac medications that have been prescribed
• To evaluate exercise tolerance in certain patients with repaired or unrepaired congenital heart disease or in patients with a permanent pacemaker
• To aid in the diagnosis of certain heart rhythm disturbances or channelopathies
• To evaluate the effect of exercise in patients with cardiomyopathy

A basic exercise stress test gives your cardiologist information about:

• Your heart rate and blood pressure response to exercise
• If there are any arrhythmias (abnormal heart beats) during exercise
• Blood flow to the heart muscle during exercise
• An assessment of your level of fitness

A technician will apply stickers (electrodes) to your chest. The stickers will be connected to wires (leads) that will connect to a computer that measures the electrical activity of the heart continuously. Several recordings of your heart rhythm will be made in various body positions (lying down, sitting and standing). Vital signs, including your blood pressure, will also be measured. You will then exercise on a treadmill that is programmed to gradually increase in speed and incline every three minutes. The computer will collect and record data about the electrical activity of your heart before, during and after exercise. Your blood pressure will also be measured periodically during and after the test.

The duration of the testing depends on your tolerance for exercise. You should plan to be in our office for approximately an hour to 1 1/2 hours on the day of testing.

It is important to eat a light meal prior to undergoing an exercise stress test. You should wear comfortable shoes and clothing that are suitable for running.

A pulmonary function test measures how well your lungs work. In the setting of an exercise stress test, a pulmonary function test evaluates how your lungs respond to exercise.

Pulmonary function tests are often ordered for patients with a history of asthma or for patients experiencing shortness of breath with exercise.

Pulmonary function testing gives your doctor information about how your lungs and airways respond to exercise.

There are two methods of obtaining information about your lung status with exercise.

A simplified version involves breathing into a plastic tube called a peak flow meter. The technician will ask you to breathe in as deeply as possible, take the device in your mouth and blow out as strongly and rapidly as possible. The device will report a number (called your forced expiratory flow) that can be compared to predicted values based on your gender, age and height. Three measurements will be taken before and after you exercise on the treadmill.

Alternatively, if full pulmonary function tests are indicated, you will be asked to breathe into and out of a tube that is attached to a machine called a spirometer. The machine will take measurements of the amount and rate of air that you breathe in and out over a period of time. You will wear a clip on your nose to close your nostrils and be instructed by the technician when to take a deep breath and how to exhale. These measurements will be taken before and after your exercise.

If your child uses any inhalers, please refrain from using them on the morning of the test. You should bring the inhalers with you to the treadmill office. Do not smoke on the day of your test.

The metabolic stress test measures the performance of the heart and lungs while they are under physical stress.

A metabolic stress test may be ordered if you have a history of:

• Complex congenital heart disease
• Shortness of breath with exercise or impaired exercise capacity
• A permanent pacemaker
• Heart failure

The metabolic test will give your doctor information about oxygen consumption and carbon dioxide production by your body during exercise. This information helps determine your cardiovascular fitness and evaluate the effectiveness of your cardiac treatment plan.

Metabolic testing involves breathing through a special mask or mouthpiece during exercise. If a mouthpiece is used, your nostrils will be closed with a nose clip. You will be instructed to breathe as you normally would during exercise. Because you won’t be able to talk while wearing the mask or mouthpiece, you will communicate with the technician using hand signals and by nodding/shaking your head during the testing.

If your child uses any inhalers, please refrain from using them on the morning of the test. You should bring the inhalers with you to the treadmill office. Do not smoke on the day of your test.