In case you have been experiencing symptoms like dizziness, shortness of breath, or chest pain, your heart doctor may recommend that you go through a cardiac stress test. In this article, we will discuss what this type of test is all about and explain why it is important in ensuring good heart health and overall well-being. We will also discuss the role of this test in detecting certain heart problems.

The Different Types of Cardiac Stress Tests Available

There are several types of cardiac stress tests and the price varies depending on the medical facility or hospital that you choose. 

1. Exercise Stress ECG – The most common type of stress test involves riding on a stationary bike or walking on a treadmill while your blood pressure, heart rate, and ECG are monitored. It is the simplest stress test but also the least accurate!
2. Stress echocardiogram – Similar to an exercise ECG, echocardiography (heart ultrasound) is also used. It looks for changes in the size and movement of the heart during physical activity and while you are at rest. It is more accurate than an exercise stress ECG. 
3. Nuclear Stress Test – A stress test that utilizes a small amount of radioactive substance which is known as a tracer in order to produce images of the heart while you are at rest and during increased physical activity. By injecting the tracer into a vein, it is able to travel through the bloodstream toward the heart. A special camera is used for taking pictures of the heart to see areas where reduced blood flow happens.
4. Pharmacological Stress Test – People who are unable to exercise due to certain medical conditions will be subjected to this kind of test. It makes use of a medication that simulates the effects of exercise on the heart. All the other processes used in this test are the same as the other stress tests above. 

What Does This Test Measure?

Also known as an exercise stress test or treadmill test, a cardiac stress test is a diagnostic test that aims to measure how well the heart performs during physical stress.  Its primary aim is usually to detect the presence of obstructive coronary artery disease.  

When the heart is at rest it doesn’t require a lot of blood supply, so even if you have a severe blockage in an artery the heart muscle still gets enough blood.  On physical exertion or “stress” the heart muscle requires a lot more blood supply. If there is a severe blockage the heart muscle will not get enough blood supply at stress. This is what we are looking for with a cardiac stress test.

Stress tests usually involve walking on a treadmill or riding a stationary bike. During this “stress,” heart measurements are taken – blood pressure, heart rate, ECG, symptoms, and maybe echo pictures or nuclear imaging.  This measures how well your heart responds when you’re doing increased physical activity and also detect any problems in blood flow toward the heart muscle.

Your heart doctor will look for any fluctuations in blood pressure, heart rate, and the heart’s electrical activity while taking note of any symptoms that you might experience including chest pain and shortness of breath. A cardiac stress test can help in diagnosing certain conditions like heart rhythm problems, coronary artery disease, and other conditions that can affect the proper functioning of your heart. If you want to understand more about certain heart disease risk factors, here’s a guide for you.

Related Article: Atrial Fibrillation Treatment Singapore: All You Need to Know

The Benefits of a Cardiac Stress Test

A cardiac stress test provides crucial information on your heart’s overall health which will help in diagnosing or ruling out certain conditions. Below are some potential benefits of a cardiac stress test:

• Detection of Coronary Artery Disease – Subjecting yourself to a cardiac stress test can help identify any blockages in your coronary arteries. This can cause chest pains or worst, a heart attack!
• Assessing the Risk of Certain Cardiac Events Like Heart Attack – Measuring the heart’s response to physical stress helps your doctor in assessing any risk of future cardiac events.
• Diagnose Heart Rhythm Problems – A cardiac stress test can help detect any abnormal heart rhythms like atrial fibrillation.
• Find out how effective a treatment is – In case a cardiac condition has already been diagnosed, the stress test will give your doctor the needed information on the effectiveness of the treatment performed. 

Preparing for the Stress Test

The process of preparing for a cardiac stress test is pretty straightforward. Here are some simple steps that you can follow:

1. List down any medications that you are taking including supplements and any over-the-counter drugs and tell your doctor about it. There are some medications that need to be stopped before a cardiac stress test.
2. Wear clothing that fit loosely and shoes that are suitable for exercising.
3. At least 2 hours before the test, be sure to avoid eating a heavy meal, drinking caffeinated beverages, or using tobacco products.
4. Bring your inhaler if you have respiratory conditions such as asthma.
5. Bring necessary snacks or drinks along with your glucose meter in case you have diabetes.
6. Leave your watch, jewelry, or any other valuables at home.

It is also important that you arrange for your transportation going home after the test especially if you have certain cardiac conditions. Be sure to follow your doctor’s instructions and be in the clinic, hospital, or medical facility on time. Ask and discuss with your doctor any questions or concerns that you might have about the test. It’s also recommended to ask your insurance provider regarding health screening coverage.

What to Expect During a Cardiac Stress Test

During a cardiac stress test, you will be asked to use a stationary bike, walk on a treadmill, or be given medication to stress your heart. It will start with a warm-up or low-level intensity. This will then be increased gradually over time while your blood pressure and heart rate are monitored.

Electrodes will also be placed on your chest which is connected to an electrocardiograph (ECG) machine. The machine will then record your heart’s electrical activity with the aim of identifying any abnormalities. A blood pressure cuff may also be placed on your arm for monitoring your blood pressure.

The exercise will be stopped once you reach the target heart rate or when you start experiencing symptoms like dizziness, shortness of breath, or chest pain. You will be given a rest period after the test to allow your blood pressure and heart rate to return to normal levels. Expect the test to last anywhere between 30-60 minutes.

Interpreting the Results of a Cardiac Stress Test

You should be able to get the results of your cardiac stress test within a few days and your doctor will review and interpret it in the context of any evaluations or tests you had along with your medical history.

The result can be affected by several factors including age, sex, and overall physical condition. If you got a normal result, it generally means that your heart works normally during increased physical activity and it has enough blood flow. 

If you got an abnormal result, it is usually an indication that a heart condition is present such as heart muscle damage, abnormal heart rhythm, or coronary artery disease. Further testing and treatment may be required by your doctor in these cases.

A cardiac stress test won’t treat or manage other heart conditions. It is only a tool that is used to evaluate your heart’s overall function. Cardiac stress test may also be included in your insurance coverage but be sure to ask your provider regarding such.

The Role of a Cardiologist in a Cardiac Stress Test

The result of your cardiac stress test is going to be reviewed and interpreted by a cardiologist so that proper diagnosis and management of any existing heart condition can be recommended. 

A cardiologist will be involved in different ways such as ordering other diagnostic tests, interpreting the results, and providing any treatment recommendations including medications, and lifestyle changes such as diet and exercise routines to help prevent or manage certain heart conditions. Some are also affiliated with insurance providers which can help lighten your financial load.

If you have any questions about cardiac stress test in Singapore or have other concerns about your heart health, consider giving us a call at +65 6235 5300 or send us an email to book an appointment with one of our recommended heart doctor.

Written by: Dr Michael MacDonald MB ChB, BSc (Hons), MRCP (UK), MD (Research), FESC (Europe).  Dr MacDonald was trained in the UK and is a senior Consultant Cardiologist