Stress Test - Suburban Diagnostics

SubUrban Icon Stress Test

Stress test is also known as an Exercise test or Treadmill test.

It is used widely for the following:
  • Detection of coronary artery disease (CAD)
  • Evaluation of the functional severity of CAD
  • Prediction of cardiovascular events
  • Evaluation of physical capacity and effort tolerance
  • Evaluation of exercise-related symptoms
  • Assessment of chronotropic and inotropic competence and arrhythmias
  • Assessment of the response to medical interventions

Understanding the purpose of the individual exercise test allows the physician/cardiologist to determine appropriate methodology and to select test endpoints that maximize test safety and obtain needed diagnostic and prognostic information.

Absolute and Relative Contraindications

Absolute and relative contraindications to exercise testing balance the risk of the test with the potential benefit of the information derived from it. Assessment of this balance requires knowledge of the purpose of the test for the individual subject or patient and what symptom or sign endpoints will be for the individual test.

Absolute Contraindications
  • Acute myocardial infarction (MI)
  • Unstable angina
  • Uncontrolled cardiac arrhythmia causing symptoms or hemodynamic compromise
  • Active endocarditis
  • Severe aortic stenosis
  • Decompensated heart failure
  • Acute pulmonary embolism, pulmonary infarction, or deep vein thrombosis
  • Acute myocarditis or pericarditis
  • Acute aortic dissection
  • Physical disability that precludes safe and adequate testing
Relative Contraindications
  • Left main coronary artery stenosis
  • Moderate aortic stenosis
  • Tachyarrhythmias or Bradyarrhythmias
  • High Degree AV block
  • Electrolyte abnormalities
  • Hypertrophic obstructive cardiomyopathy and other forms of outflow tract obstructions
  • Recent stroke or transient ischemic attack
  • Mental impairment with limited ability to co-operate
  • Uncontrolled hypertension
  • Uncorrected medical conditions such as significant anaemia, important electrolyte imbalance and hyperthyroidism
Preparations for testing include the following:
  • The purpose of the test should be clear in advance to maximize diagnostic value and ensure safety
  • The subject or patient should not eat a heavy meal in the 3 hours leading up to the test. Routine medications may be taken with small amounts of water. Subjects should dress in comfortable clothing and wear comfortable walking shoes or sneakers
  • When exercise testing is performed for the diagnosis of ischemia, routine medications may be withheld because some drugs (especially β-blockers) attenuate the HR and blood pressure responses to exercise
How is the test performed?
  • A Stress Test is done under the supervision of a trained physician or a cardiologist. After initial screening, history and examination, consent is taken and an appropriate protocol for the test is selected. The technician then preps the subject’s skin and attaches electrodes on his/her chest. These electrodes are attached to an ECG monitor
  • A resting supine standard 12-lead ECG should be obtained before exercise, followed by standing and hyperventilation
  • ECG and heart rate is recorded throughout the test. Blood pressure is also recorded at regular intervals
  • After this, exercise is started on a treadmill with an initial warm-up period (at low workload), followed by progressive graded exercise with increasing loads and an adequate time interval in each level, and a post–maximum effort recovery period which is recorded

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