From the Guidelines
A stress test is a medical procedure that evaluates how well your heart functions during physical activity, typically involving exercise on a treadmill or stationary bike, or receiving medication that mimics exercise effects if unable to exercise, as recommended by the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery 1.
Key Components of a Stress Test
- The test monitors heart rhythm, blood pressure, and symptoms while recording an electrocardiogram (ECG)
- Common medications used in pharmacological stress tests include dobutamine, adenosine, regadenoson, or dipyridamole
- Stress tests help diagnose coronary artery disease, determine appropriate exercise levels, evaluate heart valve function, and assess the effectiveness of cardiac treatments
Importance of Stress Testing
- According to the 2002 updated guidelines for perioperative cardiovascular evaluation for noncardiac surgery, exercise or pharmacologic stress testing is recommended for diagnosis in adult patients with an intermediate pretest probability of having coronary artery disease 1
- The 2014 ACC/AHA guideline suggests that stress testing can provide an estimate of functional capacity and detect myocardial ischemia through changes in the electrocardiographic and hemodynamic response 1
Considerations for Stress Testing
- Patients with abnormalities on their resting ECG, such as left bundle-branch block or LV hypertrophy with “strain” pattern, may require concomitant stress imaging with echocardiography or MPI
- Pharmacological stress testing with either DSE or MPI may be appropriate for patients who are unable to perform adequate exercise
- The choice of stress test may depend on local expertise and the specific clinical situation, with echocardiographic stress test favored if an assessment of valvular function or pulmonary hypertension is clinically important 1
From the Research
Definition of a STRESS Test
- A stress test is a medical examination used to assess the heart's function under physical stress, typically induced by exercise or medication 2.
- The test is used to diagnose and monitor conditions such as coronary artery disease, and to evaluate the effectiveness of treatments 3, 4.
Types of STRESS Tests
- There are several types of stress tests, including:
- Standard treadmill exercise testing: a widely available and relatively inexpensive test that measures the heart's response to physical exercise 2.
- Stress echocardiography: a test that uses ultrasound imaging to visualize the heart's function under stress, often used in patients who are unable to exercise 3, 5.
- Myocardial perfusion imaging: a test that uses nuclear imaging to visualize blood flow to the heart muscle 2, 4.
- Cardiopulmonary exercise testing: a test that measures the heart's function and lung function under stress, often used to evaluate patients with respiratory or cardiac conditions 2.
- Pharmacologic stress testing: a test that uses medication to induce stress on the heart, often used in patients who are unable to exercise 2, 5.
Indications for STRESS Tests
- Stress tests are typically indicated for patients with symptoms of coronary artery disease, such as chest pain or shortness of breath 2, 6.
- They may also be used to evaluate patients with known cardiac disease, or to assess the risk of cardiac complications before non-cardiac surgery 2, 6.
- Stress tests are not typically indicated for asymptomatic patients, except in certain cases such as before starting a vigorous exercise program 6.