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Using Stress Tests to Detect Coronary
Artery Disease (CAD)

If you have risk factors for coronary artery disease (CAD) or symptoms of this condition, your doctor may order a stress test. This is a commonly used test to determine whether the heart works properly when it's under stress, and can help diagnose CAD.

Your doctor may also want to conduct a stress test if he or she would like to test a patient for heart valve disease or heart failure. There are several types of stress tests.

What is an exercise stress test? This is the most common stress test.

Other names may include: Exercise electrocardiogram, exercise stress echo, exercise test, stress EKG or ECG, treadmill test , nuclear exercise stress test.

Who is it for?

An exercise stress test may be appropriate for someone who is fit and in good general health. If you already run or walk or ride a bicycle, an exercise stress test may seem familiar to you.

How does it work?

Your heart is monitored while you walk or run on a treadmill or pedal a stationary exercise bike. Here's what happens during the test:

  • Before you start the "stress" part of a stress test, a technician or nurse will put sticky patches called electrodes on the skin of your chest, arms, and legs.
  • The electrodes are connected to an EKG (electrocardiogram) machine. This machine records your heart's electrical activity.
  • The technician or nurse will put a blood pressure cuff on your arm to check your blood pressure during the stress test, and you may be asked to breathe into a special tube so your breathing can be measured.
  • After these preparations, you'll exercise on a treadmill or stationary bicycle. As you walk, run, or pedal, the test becomes gradually more difficult. You can stop whenever you feel the exercise is too much for you.
  • After the test, while you're cooling down, the EKG continues to monitor your heart rate until it returns to normal. Generally, exercise test time is 15 minutes or less.

    Be sure to talk to your doctor in advance about how to prepare for this test including foods, drinks, and medications to avoid—and for how long—before your test. Wear comfortable clothes and walking shoes on the day of your test.

What is a cardiac nuclear stress test? These stress tests can diagnose heart problems that may not be obvious during rest or while taking other stress tests. There are different types of cardiac nuclear stress tests, including nuclear stress tests with exercise and nuclear stress tests using a pharmacologic agent.

Other names for this test may include: Myocardial perfusion imaging, nuclear stress test, pharmacological stress test, Sestamibi stress test, thallium stress test.

Who is a nuclear stress test with exercise for?

A nuclear stress test with exercise may be appropriate for someone who is healthy enough to exercise, and whose doctor wants to increase the diagnostic accuracy of a traditional stress test.

How does it work?

  • A technician will place a catheter (small needle) in a vein in your arm.
  • A technician or nurse will complete the other preparations listed above for a traditional exercise stress test, including connecting you to an EKG machine and putting a blood pressure cuff on your arm.
  • You'll be asked to exercise on a treadmill or stationary bike as the test gradually becomes more difficult.
  • A tracer will be injected through the IV into your bloodstream, after which you'll be asked to continue to exercise for a few more minutes. The tracer contains a small amount of radiation similar to that found in an ordinary x-ray.
  • The tracer is absorbed and distributed through your arteries. Once that occurs, a specialized camera will take two detailed images of your heart—one when the heart is stressed, and another when it is at rest. The pictures are then compared to see how well blood flows into your heart. If there are any blockages, you may have CAD.

Who is a nuclear stress test using a pharmacologic agent for?

Because of physical limitations, some people are unable to exercise enough to raise their heart rate. This type of stress test may be used for people with an injury, severe arthritis, fatigue, back trouble, debilitating illness, or other condition that prevents them from exercising enough for an exercise stress test.

How does it work?

A drug that makes the heart respond as if it were exercising is used during this test.

  • A technician will place a catheter (small needle) in a vein in your arm and a pharmacologic agent will be injected through the catheter into your bloodstream.
  • Then a small dose of radioactive isotope imaging tracer material will be injected.
  • The tracer is absorbed and distributed through your arteries. Once that occurs, a specialized camera will take two detailed images of your heart—one when the heart is stressed, and another when it is at rest. The pictures are then compared to see how well blood flows into your heart. If there are any blockages, you may have CAD.
  • The effects of the pharmacologic agent may be felt quickly. You may experience a warm or flushed sensation, mild chest pressure, or shortness of breath. Remember, these are common reactions.

Be sure to tell your medical team who administers the test if any of these feelings are uncomfortable for you. Talk to your doctor about preparing for the test and which foods, drinks, and medications to avoid beforehand.

Why it's important to take your stress test

A stress test can help diagnose heart problems as you exercise. CAD may not be obvious when your heart is at rest. Allowing your doctor to see how your heart works under stress is critical to getting an accurate diagnosis. You may put off getting a stress test if you are anxious about the procedure or the prospect of poor results, but it's important to overcome your hesitation. Getting diagnosed is the first step toward successful treatment.

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       know?

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