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Rest and Exercise Stress

An electrocardiogram records the electrical signals generated in the heart. It is one of the most common and painless tests to detect heart problems and quickly monitor cardiac health. It is standard equipment in operating rooms and ambulances.

An electrocardiogram (ECG) is a painless, non-invasive way to diagnose several common heart problems. A healthcare professional may use ECG to detect:-

  • Irregular rhythms of the heart

  • If blockage of arteries is causing chest pain

  • Whether one had a previous episode of a heart attack

  • How well specific treatments for heart diseases are working

An ECG is often advisable if one experiences any of the following signs and symptoms:-

  • Chest pain

  • Dizziness or lightheadedness

  • Palpitations

  • Increase in pulse rate

  • Shortness in breath

  • Generalized weakness

ECG can be taken at rest or while exercising (an exercise stress test). An exercise stress test, also known as stress electrocardiography, helps determine how well the heart performs during exercise. It typically involves walking on a treadmill or pedaling on a stationary bike to monitor the heart's activity. When the heart rate reaches its peak levels, the physician takes an electrocardiogram.

A stress test is usually performed to determine the following:-

  • How well the heart pumps the blood

  • Whether the heart is receiving an adequate amount of blood

  • The symptoms you are experiencing can be reproduced while performing physical activity.

A cardiac stress test helps the healthcare provider determine if one needs additional, often invasive, tests to confirm a diagnosis or if treatment may lower the chances of a heart attack. At the time of the stress test, the healthcare provider assesses the response to the increased workload by measuring the blood pressure, heart rate, oxygen levels, electrical activity in the heart, and how healthy our heart is compared to other people of the same age and sex. 

Common indications of doing a stress test are:

  • Congenital heart diseases

  • Congestive heart failure

  • Coronary heart disease

  • Heart valve disease

  • Hypertrophic cardiomyopathy

  • Diagnose arrhythmias

  • Guide treatment of heart diseases

  • People with high-risk occupations, like pilots or athletes, may need stress tests.

Stress tests are also done for people with a heart ailment who want to start exercising. Furthermore, it is done for those who want to assess how well their current medications work. The stress test is recommended for people with diabetes, hypertension, high blood cholesterol, and a family history of premature heart disease.

Although a stress test is always safe, complications may occur rarely. A few incidences of chest pain, syncope, heart attack, and arrhythmia have been reported while doing this test.

Stress tests can be done with or without imaging. The most common exercise stress tests are:

  • A blood pressure cuff is placed around the arm.

  • Electrodes are placed on the body. Electrodes are the sensors that pick up the electrical signals of the heart. The electrodes are connected to the computer or ECG machine to record the electrical activity in the heart during a stress test.

  • If one cannot exercise, an intravenous line is inserted into the arm's vein. A medicine is injected through the intravenous catheter. The medicine makes the heart beat faster, while the ECG machine records the activities of the heart.

  • If you can exercise, you must walk on a treadmill or ride a stationary bike. On a treadmill, the speed increases slowly. On a bicycle, the resistance increases slowly, so your heart beats faster. However, the test stops when you develop chest pain, breathlessness, dizziness, or fatigue. 

  • The patient is monitored for 10–15 minutes, or until the heart rate returns to normal.

If one plans to undergo a stress test, one must wear comfortable shoes and clothing. The health care provider usually provides instructions for the other test prerequisites. One may be asked to fast and stop smoking for at least a few hours before the test. Caffeinated drinks are typically avoided. One must consult a doctor before stopping the medications.

Recently, a few more tests have been performed in a few centers to enhance diagnostic accuracy. Some of them are:-

  • Stress echocardiogram

  • Nuclear stress test

  • Cardiac MRI test


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Who should not undergo stress tests and should rely on rest ECG?

The following groups should avoid undergoing a stress test-

  • People who have coronary heart disease and are doing well on medical therapy

  • There is no history of risk factors for coronary heart disease.

  • People with a low risk of developing heart disease, including people who do not smoke, are physically active and eat a healthy diet.

  • People with aortic dissection, endocarditis, recent heart attack, severe aortic stenosis, and chest pain.

How long does it take for a stress test?

If one is undergoing a basic stress test, the exercise lasts about 10 to 15 minutes. Additional time is necessary for the patient to get ready to exercise and recover afterward.

How is stress testing different in people who cannot exercise?

The steps are usually the same as an exercise stress test. Additionally, one may lie on a table before and after exercising for an echocardiogram.

What does a normal stress test mean?

If the tests are normal, it means that the heart is pumping blood as it should and that there is adequate blood flow.

Is it safe to undergo cardiac stress testing?

Exercise stress tests are safe as long as you do not have any contraindications to the test. There are very few people who face complications. Trained personnel are present in the rare event that you have a complication. The performance, data, and symptoms are assessed throughout the tests, and immediate care is taken to prevent unwanted consequences.

What should women know about exercise stress testing?

Females experience different heart diseases than males. Healthcare providers generally decide on stress testing and imaging methods during stress based on sex and age.

What happens after a heart stress test?

After completing the test, the healthcare provider monitors the symptoms, heart rate, blood pressure, and ECG until it returns to normal. This takes approximately 15 minutes.

What happens if the tests are abnormal?

Abnormal tests may mean that you have an underlying cardiac condition—additional tests like cardiac catheterization, CT coronary angiography, nuclear stress test, and stress echocardiogram.


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