From the Guidelines
An exercise stress test is primarily used to evaluate how well your heart functions during physical activity and to diagnose coronary artery disease by revealing abnormal heart rhythms or inadequate blood flow to heart muscle that might not be apparent when you're at rest. This test involves monitoring your heart's electrical activity, blood pressure, and symptoms while you exercise on a treadmill or stationary bike 1. The test is particularly useful for patients experiencing chest pain, shortness of breath, or those with risk factors for heart disease.
Key Points to Consider
- The test typically lasts 10-15 minutes, during which the intensity gradually increases until you reach a target heart rate or develop symptoms 1.
- Your doctor may recommend stopping certain medications like beta-blockers 24-48 hours before the test for accurate results.
- The stress test works because exercise makes your heart pump harder and faster, requiring more oxygen and revealing circulation problems that aren't detectable at rest.
- It's generally safe, though you should wear comfortable clothes and athletic shoes, avoid heavy meals before testing, and report any symptoms immediately during the procedure.
- The test is also useful for patients with an intermediate pretest probability of having coronary artery disease, as recommended by the American College of Cardiology and American Heart Association 1.
Important Considerations
- The test has limitations, such as reduced sensitivity and specificity in women, and is not of diagnostic value in the presence of left bundle branch block (LBBB), paced rhythm, and Wolff Parkinson White (WPW) syndrome 1.
- False positive results are more frequent in patients with abnormal resting ECG, LVH, electrolyte imbalance, intraventricular conduction abnormalities, and use of digitalis 1.
- Interpretation of exercise ECG findings requires a Bayesian approach to diagnosis, taking into account the pre-test probability of disease and the results of diagnostic tests to generate individualized post-test disease probabilities for a given patient 1.
From the Research
Uses of Exercise Stress Test
- Exercise stress testing is a diagnostic tool for evaluating suspected or known cardiac disease 2
- It is used to identify myocardial ischemia in asymptomatic patients with elevated cardiac risk 2
- The test can provide valuable prognostic information in asymptomatic patients with cardiac risk factors 2
- Exercise stress testing is useful in management decisions for patients with aortic regurgitation, a valvular heart disorder 2
- The test can help identify the presence of coronary artery disease in older patients 2
- It can be used to evaluate arrhythmia in patients with syncope 2
- Exercise stress testing can help identify patients at risk of developing hypertension if they show an abnormal hypertensive response to exercise 2
Patient Selection for Exercise Stress Test
- Patients at moderate risk for coronary artery disease (CAD) are best served with this kind of screening 3
- Patients with a high pretest probability for CAD should undergo stress testing combined with cardiac imaging or cardiac catheterization directly 3
- Asymptomatic patients are generally not indicated for exercise stress testing, except in select cases such as deconditioned adults before starting a vigorous exercise program 4
- Preoperative exercise stress testing is helpful for risk stratification in patients undergoing vascular surgery or who have active cardiac symptoms before undergoing nonemergent noncardiac surgery 4
Interpretation of Exercise Stress Test Results
- Data from the test, other than ECG changes, should be taken into consideration when interpreting the exercise stress test, as it has a strong prognostic value 3
- The Duke treadmill score has excellent prognostic value for exercise stress testing 4
- Imaging is not necessary if patients are able to achieve more than 10 metabolic equivalents on exercise stress testing 4
- The exercise stress test can be used in conjunction with other diagnostic tools, such as myocardial perfusion imaging, to increase sensitivity and specificity 3