What Does a Cardiac Stress Test Reveal?

December 21, 2020

Clinical Contributors to this Story

Aristotelis Vlahos, M.D. contributes to topics such as Interventional Cardiology.

Todd Cohen, D.O. contributes to topics such as Cardiology.

The idea of undergoing a stress test can sound, well, stressful. But this common cardiac assessment tool can also put your mind at ease by revealing key indicators of how well your heart is working.

Routinely performed by cardiologists on patients who either have signs of heart problems—such as chest pain, shortness of breath or irregular heartbeat—stress tests may also be recommended for some people with no symptoms but a strong family history of heart disease.

Misconceptions still surround what cardiac stress tests can show, Hackensack Meridian Health cardiologists say.

“Most people think a stress test identifies blockages to the heart, but it does not,” explains Aristotelis Vlahos, M.D., director of the Cardiac Catheterization Lab at Riverview Medical Center. “It looks at blood flow to the heart muscle and determines if blood flow is adequate or not. The operative word is ‘stress.’ We want to do something that’s going to force your heart to increase its workload or blood flow using either exercise or medications.”

Types of Stress Tests

Stress tests come in several varieties:

  • Exercise versions: You’ll get on a treadmill or stationary bicycle.
  • Chemical stress test: A special type of medication is given to “mimic a high-flow state to the heart,” Dr. Vlahos says. Chemical stress tests are given to those who cannot exercise because of a health reason.
  • Nuclear stress test: This involves an injection of radioactive dye and an imaging machine that shows pictures of blood flow to your heart both at rest and after exercise.

What to Expect

Stress tests can be used alone or combined with other tests. But regardless of which type of stress test you undergo, electrodes (small, pain-free plastic patches) will be placed on your chest, legs and arms, and connected to an electrocardiogram (ECG) machine, which monitors your heart’s electrical rhythms. Your blood pressure and breathing will also be tracked.

“Based on the results, we have to make a decision whether a patient needs no treatment, can be treated with medication or needs further testing because we suspect there are blockages,” explains Todd Cohen, D.O., a cardiologist at Ocean Medical Center.

Patients whose testing indicates possible narrowed arteries are generally referred for cardiac catheterization, a procedure that can confirm the diagnosis. “In step-wise fashion, we decide how to treat a patient based on information from each step,” Dr. Cohen adds, noting that those with coronary blockages may undergo cardiac bypass surgery to re-establish proper blood flow to the heart.

Should You Get a Stress Test?

Cardiologists typically use their best judgment when deciding if a patient should receive a stress test, Drs. Cohen and Vlahos say. Because the test can falsely indicate a problem, national organizations such as the American College of Cardiology advise doctors not to routinely offer stress tests to those without symptoms or strong risk factors for coronary artery disease.

If you’re wondering if you or a loved one might benefit from cardiac stress testing, ask your doctor. “It depends on their risk profile—their genetics, age and possible symptoms, and if they have other health issues such as diabetes or high blood pressure,” Dr. Vlahos says.

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