Noninvasive Stress Testing
Stress Echo Testing
Stress test, also called treadmill test is used to determine the functioning of heart and ability to withstand the stress during exercise or physical stress. It usually involves walking on a treadmill, while your electrocardiogram, heart rate, and blood pressure are monitored.
Your physician may recommend an exercise stress test to
- Evaluate coronary artery disease
- Diagnose the causes for chest pain
- Identify abnormal heart rhythms
- Identify if you had an heart attack
- Assess other problems, such as heart valve diseases
- Assess if you had a heart procedure in the past such as angioplasty or heart bypass surgery
Electrodes using conductive patches will be placed on the specific areas of the chest to record your heart function. Before you start exercising, your heart rate and blood pressure are measured at rest. The blood pressure is measured throughout the test. You will begin walking on a treadmill. Gradually the intensity of the exercise is increased, by increasing the speed and incline of the treadmill. The test is stopped after reaching a target heart rate. During this time, your heart rate, electrocardiogram (ECG, and blood pressure are monitored.
Some patients may rarely experience chest pain, dizziness, shortness of breath and severe fatigue during the test.
You may be instructed not to eat, smoke or drink alcohol several hours before the test. You may be asked to wear comfortable clothes during the test. Do not discontinue any medications without consulting your doctor. Certain medications that may interfere with stress test are often avoided.
Abnormal test results may be due to coronary heart disease, arrhythmias, lack of physical fitness, or stress on the heart increased by exercise.
Myocardial Perfusion Imaging
- No caffeine for 24 hours prior to the exam (including coffee, tea, “decaf” coffee/tea, chocolate, most sodas, all energy drinks, and some pain relievers). Please read the labels.
- No food for four hours. Plain water is permitted and is a good idea, especially if you are hard to draw blood from.
- No powders or lotions on the chest, and no perfume or cologne please.
- Please call at least 48 hours in advance if you need to cancel your test. The drugs for your scan are expensive, ordered in advance, and expire within a few hours of your scheduled exam time.
- You should not undergo this test if you have taken theophylline, dipyridamole, Persantine, Aggrenox, Tegretol, carbamazepine, Viagra, Levitra, or Cialis in the preceding 48 hours.
If you are scheduled for treadmill exercise and are taking a beta blocker, such as metoprolol, Toprol, atenolol, Tenormin, Tenoretic, propranolol, Inderal, Bystolic, carvedilol, Coreg, labetalol, nadolol, bisoprolol or Ziac, and do not have atrial fibrillation, please ask your doctor if you should hold your beta blocker for 24-48 hours prior to your scan. Please take all of your other medications as prescribed unless you are instructed otherwise by your doctor or are diabetic. If you are diabetic and your appointment is before 11:30am, hold oral diabetic medication and, if approved by your doctor, take half of your usual insulin dose. If your appointment is after 11:30am, you may eat 4 hours before your study and take your usual diabetic medications.
Please wear comfortable clothes and shoes for the treadmill. It is helpful to wear a two-piece outfit (i.e. shirt and pants), as we will be attaching EKG electrodes to monitor your heart. The procedure is easy, but typically takes 2-3 hours. At least 30 minutes of this time is spent waiting for the imaging compound to circulate in the body so you may want to bring something to read.
In preparation for the test you will have an IV placed in your arm or hand. We inject the imaging agent through this IV. Most people experience nothing following the injection, though some people notice a slight metallic taste in their mouth.
We do not use any x-ray contrast dyes.
Our imaging agents release a small amount of radioactivity that can be seen by a very sensitive camera. Pictures of your heart are taken by the camera while you are sitting or lying down. Imaging time typically ranges from 4 to 15 minutes. We take two sets of pictures. Before the second set we will either have you walk on a treadmill, or we will give you a drug that directly opens your coronary arteries.
If you are able to walk on a treadmill, we will target a level of exercise that gets your heart rate up to a diagnostic range, which is based on your age. The older you are, the less work you need to do on the treadmill. When we reach your target, we will inject the imaging agent through the IV and have you walk or jog for two more minutes. After you are done on the treadmill, we will take the second set of pictures.
If you are unable to get your heart rate up on a treadmill, we will substitute a drug; such as regadenoson, adenosine, or dobutamine for the treadmill. This drug is given through the IV while you either sit in a recliner or walk slowly on the treadmill. This drug will try to relax your coronary arteries. We will inject the imaging agent while this drug is having its effect on your circulation. The drug’s effect is short in duration, but we do have reversing agents available if needed. We will then take a second set of pictures of your heart, typically after a 30 minutes wait. During this time we would like you to have a small meal or snack, so please bring something with you to eat. You may have caffeine at that time as well.
Frequently asked questions:
Is the radioactivity hazardous to me or my family?
No. You will be given a diagnostic dose of a medically approved agent. The radiation exposure is similar to that of CT scan, and no precautions are needed for your children or pets. However, you should not undergo this test if you are pregnant.
Will I glow in the dark?
No. However, for a period of time, if you cross the border, go through airport security, or board a ferry, they will notice. Most security personnel are very familiar with nuclear medicine testing, but you may want to bring this booklet with you to show them.
How long do I have to walk on the treadmill?
It depends on your age; the older you are, the shorter the time. We are looking to reach a particular target heart rate (based on your age), rather than a distance.
I am claustrophobic. Am I going to be enclosed in a tunnel?
No. You will be either sitting or lying down and the camera will be brought into position close to your chest.
Can my spouse or a relative come with me?
Your spouse, relative, or friend may wait for you in our waiting room. Because of HIPAA privacy laws, they cannot come with you into the nuclear lab unless they are an interpreter or you have special needs, as there are other patients in the lab whose privacy needs must be respected.
Why do you need two sets of pictures?
The first set shows us the health of your heart muscle. If you have any heart muscle damage we will see that on the first set. The second set will show if you have coronary artery blockages that are affecting blood flow. Comparing these two sets of images is an important part of this test. Sometimes a third set of pictures will be required. The second and third sets usually take less than 10 minutes each.
May I use my cell phone in the lab?
No. Cell phones must be turned off.
Can I listen to my iPOD® or CD player?
Yes! Please bring your headphones.
Do I need someone to drive me home?
No. There will be no lingering effects that will prevent you from your normal activities.
When do I get the results?
You should allow about four working days for a written report to be received by your health care provider. You should make a follow-up appointment with the provider who referred you. It is very helpful if you bring the names and addresses of all providers who should receive a copy of your report.
Marko Yakovlevitch, MD, FACP, FACC
Thomas J. Sawyer, MD
Chetan Pungoti, MD
Please note: Above content has been prepared to help you understand the test you are about to undergo. In order to be broadly understandable, the concepts have been simplified and generalized. Please consult your provider for specific and authoritative information.