Stress Tests

A stress test can be used to test for heart disease. Stress tests are tests performed by a doctor and/or trained technician to determine the amount of stress that your heart can manage before developing either an abnormal rhythm or evidence of ischemia (not enough blood flow to the heart muscle).

There are many different types of stress tests, including:

Treadmill stress test

As long as you can walk and have a normal ECG, this is normally the first stress test performed. You walk on a treadmill while being monitored to see how far you walk and if you develop chest pain or changes in your ECG that suggest that your heart is not getting enough blood.

Cardiolite Stress Test

A Cardiolite Stress Test helps diagnose coronary artery disease or identifies areas of the heart that lack an adequate blood supply due to narrowed or blocked coronary arteries. Coronary arteries are located on the outside of the heart and bring oxygen rich blood to the heart muscle. While walking on a treadmill Cardiolite is injected at peak exercise through an I.V. in the arm. Cardiolite (a radioactive substance known as a tracer) travels in the blood stream to the heart where it is picked up by the heart muscle cells. Areas of the heart muscle that lack an adequate blood supply pick up the tracer very slowly or not at all. After exercising you will be asked to report to the Radiology Department for the imaging session. The tracer emits a small amount of radioactivity that will be detected by a special scanning camera one hour later in Radiology. This session will last about 30 minutes. If the heart muscle receives less blood supply than the rest of the heart muscle because of narrowed or blocked coronary arteries, this scan will show less tracer in that area of the heart muscle. The scan helps the physician determine areas of the heart muscle that do not receive enough blood supply. An additional resting scan is needed to determine what the heart looks like at rest. This test may be done before the exercise portion of the test. Allow three hours for this scan and remember to fast and avoid cigarettes, chewing tobacco and pipe tobacco six hours prior to the scheduled appointment. The Cardiologist will read the test and serious concerns will be reported to your physician immediately. Test results will be mailed to your physician.

IMPORTANT TESTING INSTRUCTIONS:

  • DO NOT EAT, DRINK OR SMOKE SIX HOURS BEFORE THE TEST
  • Allow approximately three hours for the test
  • Wear or bring comfortable, loose fitting clothing and rubber-soled walking shoes. Sneakers and a short sleeve button down shirt are ideal. A changing area is provided for your convenience.
  • If you are currently taking any heart or blood pressure medicine check with your Cardiologist. He may ask you to stop taking certain medication a day or two before the test.
  • If you are a diabetic taking insulin, notify your doctor for possible dosage adjustments.
  • Before the test, you will be given an explanation of the test and you will be asked to sign a consent form. Feel free to ask any questions.

What Happens During the Test?

Several electrodes (adhesive patches) will be placed on your chest to record heart activity during exercise. You will be shown how to properly use the treadmill with support railings or a stationary bicycle. The treadmill will start slowly, and the speed and incline will increase gradually. The exercise portion usually lasts about 9-12 minutes. You will be instructed to report any symptoms such as chest discomfort, dizziness, and shortness of breath or leg fatigue. When you have completed the test, you will rest for another five -10 minutes while your blood pressure and electrocardiogram are monitored. You will be asked to report for the second scanning session, which last about 30 minutes.

Is the Cardiolite Stress Test Safe?

The radiation exposure during the test is small (less than a chest X-ray), and the doses are safe. The scanning camera detects the Cardiolite; it does not take x-rays. However, if you are pregnant, suspect you may be or are a nursing mother, discuss the test with your doctor. The exercise test is generally safe. A small amount of risk exists with any test that stresses the heart. Possible rare complications include abnormal heart rhythm or heart attack. Experienced personnel are available to handle any emergency.

 

Persantine Cardiolite Stress Test

A Persantine Cardiolite Stress Test helps diagnose coronary artery disease or identifies areas of the heart that lack an adequate blood supply due to narrowed or blocked coronary arteries. Coronary arteries are located on the outside of the heart and bring oxygen rich blood to the heart muscle. Your physician has determined that you are unable to exercise adequately on a treadmill or a stationary bicycle. Persantine (Diprydamole) is a medication that dilates the coronary arteries to produce an effect similar to what happens when you exercise. Persantine and Cardiolite is infused (given over 4 minutes) through a vein in the arm while resting. Cardiolite (a radioactive tracer) travels in the blood stream to the heart where it is picked up by the heart muscle. Areas of the heart muscle that lack an adequate blood supply pick up the tracer very slowly or not at all. The tracer emits a small amount of radioactivity that will be detected by a special scanning camera one hour later in Radiology. This session will last about 30 minutes.  If the area of the heart muscle receives less blood supply than the rest of the heart muscle because of narrowed or blocked coronary arteries, the scan will show less tracer in that area of the heart muscle. The scan helps the physician determine areas of the heart muscle that do not receive enough blood supply.

IMPORTANT TESTING INSTRUCTIONS:

  • DO NOT EAT, DRINK OR SMOKE SIX HOURS BEFORE THE TEST
  • Allow approximately three hours for the test
  • Be sure to mention to the doctor if you have asthma or lung disease before the test is scheduled
  • If you take any medications that contain xanthine, such as Theodur, Theophylline, Slo-bid, Respid or Trental, be sure to check with your doctor. He/she may ask you to stop taking it two or three days before the test.
  • Do not drink coffee or soft drinks that contain caffeine, eat chocolate or take medications containing caffeine like Anacin, Excedrin, No-Doz, Darvon, Caffregot or Fiorinal, 24 hours prior to the test.
  • If you are diabetic taking insulin, notify your doctor for possible dosage adjustments.
  • Bring a list of medications you routinely take.
  • Before the test, you will be given an explanation of the test and you will be asked to sign a consent form. Feel free to ask any questions.
  • Addition heart images will be required on another day. The Radiology Department will discuss this with you on the day of your test. Please allow three hours for the additional session.

What Happens During the Test?

Several electrodes (adhesive patches) will be placed on your chest to record heart activity during the test. While lying on a bed, Persantine is given through a vein in your arm for 4 minutes. You will be instructed to report any symptoms such as chest discomfort, headache, dizziness, nausea, facial flushing and shortness of breath. The radioactive tracer is given a few minutes later through the same vein. You will continue to rest for an additional 5 to 10 minutes while your blood pressure and electrocardiogram are monitored. After eating you will be asked to report to Radiology an hour later for the scanning session, which last about 30 minutes.

Is the Persantine Cardiolite Stress Test Safe?

The radiation exposure during the test is small (less than a chest X-ray), and the doses are safe. The scanning camera detects the Cardiolite; it does not take x-rays. However, if you are pregnant, suspect you may be or are a nursing mother. Discuss the test with your doctor. A small amount of risk exists with any test that stresses the heart. Possible rare complications include abnormal heart rhythm, low blood pressure or heart attack. Experienced personnel are available to handle any emergency.

 

Dobutamine or Adenosine Stress Test

This test is used in people who are unable to exercise. A drug is given to make the heart respond as if the person were exercising. This way the doctor can still determine how the heart responds to stress, but no exercise is required.

IMPORTANT TESTING INSTRUCTIONS:

  • Do not eat, drink, or smoke six hours before the test.
  • Allow approximately two hours for the test.
  • Be sure to mention to your doctor if you have glaucoma.
  • A blood lab test will be ordered by your doctor and performed a few days prior to the dobutamine echo test.
  • If you are currently taking any heart or blood pressure medicine, check with your doctor. He/she may ask you to stop taking certain medicine a day or two before the test.

What Happens During the Test?

An I.V. catheter will be placed in your arm before the exam. Several electrodes (adhesive patches) will be placed on your chest to record heart activity during the test. While lying on a bed, Dobutamine will be given through a vein in your arm by the Cardiologist. An echocardiogram will be performed by placing a transducer on your chest and measuring sound waves that will show Ultrasound images of heart chambers and valves. Your blood pressure will also be monitored during this time. The “Echo” will take approximately 15-30 minutes.

 

Stress echocardiogram

A stress echocardiogram is a test that combines an ultrasound of the heart with an exercise test. The test allows your physician to learn how well your heart functions when it is made to work harder. It helps diagnose coronary artery disease or identifies areas of the heart that lack an adequate blood supply due to narrowed or blocked coronary arteries. Coronary arteries are located on the outside of the heart and bring oxygen rich blood to the heart muscle. During an echocardiogram, a small device called a transducer is held against the chest. The transducer sends ultrasound waves that reflect (echo) off the heart. The echos are converted into moving images of the heart, which are displayed on a computer screen and recorded on videotape. The exercise test is done while you walk on a treadmill or pedal a stationary bicycle. During the test, an electrocardiogram (EKG) records the electrical activity of the heart.

IMPORTANT TESTING INSTRUCTIONS:

  • DO NOT EAT, DRINK OR SMOKE SIX HOURS BEFORE THE TEST. You may have water.
  • Allow approximately two hours for the test.
  • If you taking any heart or blood pressure medications check with your doctor. He/she may ask you to stop taking it two or three days before the test.
  • Bring a list of medications you routinely take.
  • Wear or bring comfortable, loose fitting clothing and rubber-soled walking shoes. Sweat pants or shorts and tennis shoes are ideal. A changing area is provided for your convenience.
  • If you are diabetic taking insulin, notify your doctor for possible dosage adjustments.

What Happens During the Test?

Several electrodes (adhesive patches) will be placed on your chest to record heart activity during exercise. You will be shown how to properly use the treadmill with support railings or a stationary bike. The treadmill will start slowly, and the speed and incline will increase gradually. The exercise portion usually lasts about 9-12 minutes. You will be instructed to report any symptoms such as chest discomfort dizziness, and shortness of breath or leg fatigue. After you have reached peak exercise the treadmill will be stopped and the echocardiogram will be performed. You will be asked to lie on your left side while the echocardiographer records sound waves and other measurements of your heart. A ” contrast” suspension may be needed to improve the quality of the study. If needed this will be administered by the cardiologist with a catheter needle placed in your arm. The “Echo” will take approximately 15 minutes to complete.

 

Nuclear stress test

A stress test, sometimes called a treadmill test, helps your physician know how well the blood flow to the heart muscle works as well as structural information about the heart. Your physician has ordered a nuclear stress test that combines treadmill information with imaging information giving a better picture of your hearts perfusion (blood flow to the heart) and function (how well your heart contracts and pumps blood). The ultimate goal of the test is to see if your heart receives enough blood from the coronary arteries at rest and with increased demand at stress. A nuclear stress test consists of two phases: a stress phase and a resting phase.

IMPORTANT TESTING INSTRUCTIONS:

Please notify the Nuclear Medicine Department or your physician if:

  • you could be pregnant or if you are currently breast feeding
  • you are unable to walk on the treadmill
  • you are claustrophobic (our CT/Spect camera used for imaging is open and most are able to go through the test without difficulty or medication
  • you are unable to lie flat on your back

What is the preparation?

  • Do not eat any food or drink beverages containing caffeine or medications containing caffeine for 24 hours before your test.(Caffeine can be found in coffee, tea, chocolate, decaffeinated beverages, also some medications like Anacin, Excedrin, Theophylline and NODoz)
  • You may have a light breakfast before your test.
  • If you are diabetic, eat and take your diabetic medication as prescribed.
  • Wear comfortable clothing and shoes (sneakers) for exercise. A short sleeved shirt without metal buttons or snaps is suggested.

Do I need to hold my medications for this test?

If you are taking a BETA BLOCKER MEDICATION you may be instructed by your physician to hold this medication prior to the test. (Such as: Acebutolol, Atenolol, Betaxolol, Bisoprolol fumarate, Carvedilol, Metoprolol tartrate, Metopolol succinate, Nadolol, Penbutolol sulfate, Pindolol, Propranolol hydrochloride, Timolol maleate)

Important – Please bring with you any held medications and a current list of your medications.

  • Please refrain from wearing perfumes/lotions
  • It is best to drink fluids and arrive well hydrated but remember no caffeine
  • If you use aerosol bronchodilator inhalers take as prescribed and bring your inhaler with you
  • We want your waiting time between tests to be as pleasant as possible, consider bringing a magazine, book or music player to help pass the time.

What is the exam like?

Nuclear stress testing may be completed in 1 day or 2 separate days. The 1 day test takes 3-5 hours or if your test is done on 2 separate days it will take about 2 hours each day.

You will receive a small injection of a radioactive tracer for each phase of the nuclear stress test. This tracer is taken up by the heart muscle so the heart can be imaged with a special CT/SPECT gamma camera. There are no side effects from the injection tracer and to minimize the number of needle sticks while facilitating an injection during exercise you will receive and IV (intravenous line) for your test.

  • Rest phase: You will receive a small injection of the imaging tracer intravenously. There will be an hour wait before imaging will take place and during this time you may be offered a small snack and drink. Rest imaging will follow the waiting period and will approximately take about 18-22 minutes to acquire. During imaging we will make you as comfortable as possible but we will ask for you to hold very still during the imaging process. The normal position is with your arms above your head; however adjustments can be made if this is difficult.
  • Stress phase: You will be prepared for your exercise test by an exercise technologist and asked to sign an informed consent for the test. Instructions will be given about the exam and walking on the treadmill which is very similar to a treadmill used at a health club. A blood pressure cuff will be places on your arm to monitor your blood pressure before, during, and after exercise. ECG electrodes will be attached to your chest to allow monitoring of your heart rate before, during, and after exercise. This test will be performed by a Cardiologist who will be monitoring your progress throughout the entire exam. The exercise test with preparation and recovery takes 45-60 minutes. The actual exercise time is determined by you and the physician depending on your exercise capacity. At maximum exercise you will be given a 2nd small injection of imaging tracer. There will be a recovery period followed by stress imaging. Stress Imaging will be 18-22 minutes and you will again be asked to hold very still.
  • Pharmacologic stress test: Some people, because of a disability, are unable to use the treadmill or exercise adequately to achieve target heart rate. Therefore, the stress test can be performed with the vasodilator regadenoson medication. This agent is used to simulate the effect of exercise on your heart. This drug can have some mild side effects but has a short half life and can be reversed with medication or caffeine. For this test you will have an hour wait after the stress test before your stress imaging.

You may resume your normal activities there are no posttest restrictions.

Your test will be read by a radiologist and cardiologist and a report sent to your physician who will review the results with you.