Cardiologist tells when it’s time for cardiac stress test

“Doctors typically order stress tests for diagnosis, but they are also extremely useful for following known heart conditions,” said Dr. Jonathan Alexander of Ridgefield.

Stress testing has been a valuable tool in helping cardiologists evaluate the heart for 40 years. It is an extremely effective way of measuring how well the heart works when it is beating fast and working hard.

“When the heart pumps fast, it requires more blood flow to it,” explained Dr. Jonathan Alexander of Ridgefield, a cardiologist with the Western Connecticut Medical Group at Danbury Hospital. “It helps us see if the heart is getting enough blood during these times.”

A stress test is sometimes called an “exercise test” or a “treadmill test,” although other modalities are equally effective at stressing the heart. Evaluation of the electrocardiogram which records the patient’s electrical activity is a key part of a stress test.

Why stress tests?

Dr. Alexander explained two of the most important reasons why doctors order stress tests:

  • To see if you have had a heart attack or if you are at risk of having one, look for other heart conditions or follow a known heart condition, help figure out why you might have chest pain, trouble breathing, dizziness, palpitations and a fast heart rate or other potential cardiac symptoms.
  • To check out how healthy your heart is before you have surgery and check out how well your heart medicines or other heart treatments are working.

According to Dr. Alexander, doctors usually order stress tests to check for problems that can happen when the heart works hard. For instance, a doctor might order a stress test to:

  • See if you have coronary artery disease, heart failure, arrhythmias, or another heart condition. Coronary heart disease is a condition that puts you at risk for a heart attack and other types of heart disease and a stress test is a very effective way of checking for this. Some people have symptoms of coronary artery disease only when they exercise. Heart failure is a condition which the heart doesn’t pump well typically during exercise.
  • Check out how your heart works after heart surgery. Often it is used prior to prescribing an exercise program or prior to enrolling in a formal cardiac rehabilitation program. It can help figure why you have chest pain, breathing difficulties, or other symptoms and see if you can safely exercise after a heart attack.”

Diagnosis and checkup

“Doctors typically order stress tests for diagnosis,” said Dr. Alexander, “but they are also extremely useful for following known heart conditions and your doctor may want you to have one every one to two years.”

Frequently, patients are not able to exercise because of other conditions such as back pain, or other orthopedic difficulty as well as problems with blood flow to the legs.

In these cases, using a medicine to “stress” the heart can be equally effective as regular exercise.

Other techniques

“Many times, because the electrocardiogram is not helpful, doctors use another modality in conjunction with the stress test to help diagnose heart disease,” said Dr. Alexander. “These could include nuclear medicine techniques (using an isotope to look at blood flow) or echocardiogram (to look at how well the heart muscle functions under conditions of stress). This is often referred to as an exercise echocardiogram or in the case of the nuclear tests a cardiolite stress test or thallium stress test.”

According to Dr. Alexander, for a stress test the doctor, nurse or technician will first do an electrocardiogram and measure your blood pressure. Then either he or she will “stress” your heart and increase your heart rate by doing one of the following things:

Have you run or walk on a treadmill; have you pedal a stationary bike; give you a medicine to make your heart beat faster – people who can’t run or walk get a medicine instead of exercising as mentioned before.

“During a stress test the doctor or nurse will watch you,” emphasized Dr. Alexander. “He or she will check your blood pressure, do several electrocardiograms and most importantly ask you how you feel. The test will end when you can’t exercise any longer or when the doctor or the nurse tells you that the test is over.”

Few downsides

The “downsides” of exercise stress testing: An EKG has very few downsides. Some people get a mild rash where the patches are placed.

“When people exercise and the heart rate pumps faster they can have symptoms such as an abnormal heartbeat, breathing difficulty or feeling dizzy/faint,” said Dr. Alexander. “The medicines used during the stress test can also have side effects including headaches, dizziness or nausea. In the vast majority of cases patients tolerate the stress test extremely well and can return to normal activities/work shortly afterwards.”

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