Health – A weekly column prepared by Dr. Balwant Singh’s Hospital Inc.

This week we will conclude our three-part series on heart disease. Over the last two weeks we have looked at the features, causes, diagnosis, management and prevention of heart attacks. This week we will look at a simple physical test that can tell us a lot about the health of your heart. This involves finding out how your heart deals with vigorous exercise. The exercise stress test is sometimes called the treadmill test, and it shows if the blood supply is reduced in the heart arteries. It also helps to know the kind and level of exercise suitable for patients.

The exercise test is recommended for use in women 50 years and older and in men 40 years and older.

What do you mean by heart stress test?

A stress test is a procedure for assessing the effect of stress on the heart function and the blood supply. Stress may be induced by physical exercise or by the administration of a drug. During exercise healthy arteries dilate more than those with blockages. Narrowed arteries provide less blood and less oxygen to certain areas of the heart.

The lack of oxygen can cause symptoms such as chest pain or shortness of breath. An electrocardiogram done during the stress test shows any abnormality that helps your doctor to determine where the blocked arteries are.

What types of stress test are there?

There are many ways to stress the heart. This test can be performed by a treadmill known as the treadmill stress test or by some specific medications known as the pharmacological stress test.

What is a treadmill stress test?

A treadmill stress test involves stressing the heart by having the patient exercise on a treadmill. By using different grades of evaluation and speeds at regular time intervals, the heart rate is monitored. The higher the heart rate and blood pressure during stress, the more stress is applied to the heart.

Why do you need a stress test?

When you do an exercise stress test, your body works harder during the test. It requires more fuel and your heart has to pump more blood. The test can show if there is a lack of blood supply to the heart arteries. A stress test also helps the doctor to know the kind and level of exercise you need.

How do you prepare for the test?

Do not eat, smoke, drink beverages containing caffeine or alcohol for three hours before the test; continue all medication unless instructed otherwise. Wear comfortable shoes and loose clothing to permit exercise.

What happens during the test?

Certain leads known as cardiac chest leads are attached to your chest to monitor your heart.

Your heart beat, rate and blood pressure in lying down and standing positions are checked.

You walk slowly on the treadmill.

It tilts so you feel as if you are going up a small hill.

It changes speed to make you walk faster.

You can stop the test at any time if you need.

After slowing down for brief intervals you will sit or lie down and your heart rate and blood pressure will be checked.

What is monitored during the test?

Heart rate

Breathing

Blood pressure.

Heart activities (electrocardiogram).

How tired you feel.

What equipment is used?

The electrocardiography machine will record your heart beat and heart waves in an electrocardiogram. Tiny wires and electrodes are attached to your chest, through which your heart is connected to a monitor which records your heart waves.

Is there any risk during test?

There is very little risk – no more than if you walked fast or jogged up a big hill. If you have an arterial blockage in the heart you might develop chest pain during the test. This is a sign that your heart is not getting enough oxygen.

What do you do if you get any

symptoms during test?

If you get any symptoms like pain in the upper part of the body, sweating, head swinging, difficulty in breathing or heaviness, or tightness in chest during the test, it is important to alert the medical staff immediately.

Why is an exercise stress test required?

To diagnose heart disease

To diagnose chest pain related to the heart

To diagnose any chest discomfort (tightness/heaviness)

To diagnose shortness of breath related to the heart

To determine a safe level of exercise

To predict the risk of dangerous heart-related conditions such as a heart attack

To evaluate exercise tolerance when a person has unexplained fatigue or shortness of breath

To evaluate the blood pressure response to exercise in a person with borderline hypertension

To look for exercise induced serious irregular heartbeats.

To check the condition of the arteries which supply blood to heart muscles after angioplasty and by-pass surgery.

The result of a stress test will help your doctor decide if you have heart artery blockage or not, and if so, how severe it is.

What are the warning signs of a heart attack?

Chest pain

Chest discomfort

Tightness of chest or heaviness of chest

Discomfort in other areas of upper body

Shortness of breath with or without chest pain

Cold sweat, nausea, uneasiness, especially in a diabetic case

Sudden extreme fatigue (not associated with lack of sleep)

A heart lost is a life lost. Get to a hospital immediately if you experience signs of a heart attack or stroke.

What happens after a heart stress test?

Your doctor will decide what to do if your stress test is positive. Whether you need medications or further tests like a coronary angiogram all depends on the severity of abnormalities on the stress test.

In conclusion, a stress test is an important diagnostic aid to evaluate problems related to the proper functioning of your heart, and may make all the difference when you are being managed on medical treatment, where surgery would have been the logical course of events.