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Take the Stress Out of Stress Tests

We’ve all seen videos of Olympic and world-class athletes undergoing rigorous testing on a treadmill. Their body is covered from head to toe in wires, dripping in sweat and wearing more hoses on their face than a scuba diver. All the while, the super athlete is maxing out the treadmill’s top speed for an audience of at least 8 lab-coat wearing experts, although the runner is wearing nothing more than a tight pair of shorts. So, when your physician recommended a stress test during your last check-up, it’s easy to imagine why you were a bit intimidated.

Like so many things in the world, you can’t trust what Hollywood shows you. We spoke with Samuel Unzek, MD, a cardiologist at Banner Health in Arizona, to explain the process and take the stress out of stress testing.

What is a Stress Test?

“What you’ve seen on TV is probably not the kind of stress test your doctor ordered,” commented Dr. Unzek. “You’re likely watching a series of other tests designed to measure an athlete’s max output under extreme pressure. It’s a much more comfortable experience for our patients.” A stress test is prescribed to evaluate your heart’s health. Some symptoms associated with heart disease and other issues are only seen during exercise, which is why treadmills are used for testing in some cases. Dr. Unzek explained three types of stress testing that he recommends for his patients.

Treadmill Stress Test

In this test, your heart rate and blood pressure are measured to ensure that your heart is working properly. You will wear a few diodes under your shirt to monitor your ECG or your heart electrical signals. Depending on what protocol is used the most common one will have you walk. Every three minutes the treadmill speed and incline will gradually increase, progressing from a slow walk to a jog. This will be under the supervision of specialists that have done this many times and have been trained to handle any type of situation in case something happens.

Echocardiogram Stress Test

Using high frequency sound waves (ultrasound), a picture of your heart will be taken at rest, before your test begins. Then, you will be asked to walk on a treadmill until a target heart rate is achieved, and then another set of images will be taken. Do not worry, if you cannot walk on a treadmill, the test can be done with a medication that simulates the effects of exercise. Your physician will review the results to ensure that the walls of your heart are flexing and functioning properly.

Nuclear Stress Test

A nurse will inject a very small amount of radioactive “tracer” prior to the exercise and take some images. You will then be asked to walk on a treadmill until a target heart rate is achieved, and then another set of images will be taken. Do not worry, if you cannot walk on a treadmill, the test can be done with a medication that simulates the effects of exercise.  The images will show where the tracer went in the heart muscle. Areas with little tracer may suggest there is a blockage. Areas with no uptake might suggest a previous heart attack.

Misconceptions and Fears

Your heart never stops working for you, whether you are relaxing in the pool or pushing for a personal record during your daily workout. Understanding how your heart reacts to stress is an important step in evaluating and predicting health concerns. Dr. Unzek repeatedly assured us that “a stress test for signs of heart disease should never be stressful.” We worked with him to discuss a few common concerns:

“Will a lot of people be watching me?”

Contrary to what you may have seen, a stress test is a relatively private procedure. You will be in a room with a nurse and possibly with an imaging technologist. They will help you get set up and will communicate with you every step of the way. There is no two-way mirror, where a team of experts evaluate your running form with clipboards in hand. The records of your vitals are kept for later evaluation by your physician.

“Will I be pushed beyond my physical limit?”

The target heart rate will be chosen based on your age, gender, and other important attributes. Dr. Unzek reassured patients, “our number one priority is keeping you safe and comfortable. If you say ‘stop,’ we stop. You will never be pushed beyond your comfort level.

“I don’t feel comfortable working out.”

For some people, jogging on a treadmill is a lot to ask. Dr. Unzek commented, “for many of my senior patients, we use a pharmacological option that simulates the effects of exercise while comfortably resting in a bed. It is a safe and controlled way to mimic exercise while eliminating risk of injury or discomfort.”

“How many machines and instruments will I be hooked up to?”

You are not a middle school science experiment, nor a pin cushion. Depending on the type of test you participate in, you will wear about a half dozen diodes (sticky pads) with small wires connected to a machine to monitor your vitals. Occasionally, a nurse will take your blood pressure, using the same cloth sleeve you know so well.

“What will I wear during the test?”

If you will be exercising, Dr. Unzek recommends the clothing that you typically work out in – light fabrics and athletic shoes. The only rule is no sandals. While some of the diodes will need to be applied to your skin, you are welcome to wear a shirt over them. In the case of a pharmacologic test, then normal street clothes are fine.

Who Should Get a Stress Test?

Dr. Unzek described the ideal candidate for a stress test. “I recommend these tests for people who may be showing early signs of heart disease like shortness of breath or light chest discomfort. If the symptoms are limiting your normal activities, you may need a minimally invasive test like a heart catheterization.

How much do you know about your heart’s health? If you have a history of heart disease in your family or if you are beginning to see symptoms of heart disease in your daily life, check out our free heart health risk assessment test or schedule a visit with your Banner Health physician. Whether or not a stress test is needed, you will live more comfortably and safely, knowing that your heart is strong.

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