How Is an Exercise Stress Test Performed?

Steps involved in an exercise stress test include:

Before the test (preparation)

• You may be asked to avoid eating, drinking (including caffeine), or smoking for some time before a stress test. 
• You may be asked to continue taking all your prescription and over-the-counter medications before the test if not recommended otherwise.
• If you use an inhaler, ensure that your doctor and the healthcare team member monitoring your stress test are aware of it.
• if you use an inhaler for asthma or other breathing problems, ensure to bring it to the test.
• Wear lightweight and comfortable clothes and shoes.
• Inform about your current medical history and the intensity of exercise you are used to.

During the test (actual test)

• A nurse or technician places electrodes (sticky patches) on the chest, legs, and arms, which are connected to the EKG machine.
• Body hair may be shaved (if needed) to help the electrodes stick. 
• A few wires connect the sensors to a computer that records the electrical activity of the heart.
• A cuff is tied to the arm to check your blood pressure during the test. 
• You may be asked to breathe into a tube to determine your breathing capabilities.
• You are asked to initiate exercise on a treadmill or stationary bike, gradually increasing the intensity.
• The exercising is continued until the heart rate has reached a target level or until you have signs and symptoms that prohibit you from continuing. These signs and symptoms may include:
  • Chest pain (moderate to severe)
  • Shortness of breath
  • Abnormally high or low blood pressure
  • An abnormal heart rhythm
  • Dizziness
  • Fatigue
  • Changes in the electrocardiogram
• The doctor will continuously watch your heart activity and stop the test if there are any concerns.

After the test

• After exercising, you may be asked to stand still for several seconds and then lie down with the monitors in place until the heart rate and breathing return to normal.
• You may return to normal daily routine activities unless advised otherwise.

An exercise stress test is performed to determine the heart’s functioning during physical activity. A stress test can help with the following:

• Guide treatment decisions.
• Determine the performance of current heart treatment (if any).
• Diagnose the severity (improving or deteriorating) of an existing heart condition.

People with high-risk occupations (pilots or professional athletes) may need stress tests regularly.

The doctor may recommend a stress test to diagnose or determine the following:

• Coronary artery disease
• Angina
• Arrhythmias (abnormal heart rhythm)
• Treatment of heart disorders (if current treatment is working)
• Condition of the heart before surgery (replacement or a heart transplant)
• Heart muscle or valve issues (heart valve disease, hypertrophic cardiomyopathy)
• Congestive heart failure
• Inadequate or insufficient blood supply to the heart muscle

Although an exercise stress test is considered safe, very rarely, some risks or complications may develop:

• Low blood pressure: A sudden drop during or immediately after an exercise may make the person feel dizzy.
• Abnormal heart rhythms: Occasionally, some people may present with arrhythmias during an exercise stress test.
• Myocardial infarction: Although very rare, an exercise stress test could induce a heart attack.

Contraindications of stress tests include:

• Aortic dissection
• Endocarditis, pericarditis, or myocarditis 
• Recent heart attack
• Severe aortic stenosis
• Uncontrolled, abnormal heart rhythm
• Ongoing chest pain