The Medical Minute: Taking the stress out of heart stress tests

It can be stressful when your doctor sends you for further evaluation after an office visit. Fears may be heightened when it's a heart stress test.

Dr. Michael Pfeiffer, a cardiologist at Penn State Hershey Heart and Vascular Institute, educates his patients before their evaluation in an effort to make stress tests less stressful.

What is a stress test?

A stress test evaluates the effects of physical activity on the heart. 

The most common type of stress test involves exercise on a treadmill while the heart is monitored by an electrocardiogram (EKG). If a patient cannot exercise, medication is used to simulate exercise. A large number of stress tests include imaging as well.

"We can image the heart using ultrasound, called echocardiography, or using nuclear medicine, with a low dose of a radioactive material that’s injected through an IV," Pfeiffer said.

Why is a stress test needed?

"The most typical reason is to try and determine risk in a patient for the presence of significant heart disease," Pfeiffer said.

When a patient has not yet been diagnosed with heart disease and has symptoms that could be heart related, a stress test helps determine if the patient is at low risk or high risk for significant heart disease.

In a patient who has already been diagnosed with heart disease, a stress test helps evaluate for the progression of their disease.

"People with intermediate risk are the ones who benefit the most from a stress test,” Pfeiffer said. “That’s because it helps to differentiate them into a low risk group where noncardiac testing or routine follow-up might be appropriate, or into a high risk group where they may need additional testing or treatment."

Additionally, a patient may need a stress test to evaluate for valve disease, cardiac function after a heart attack or the possibility of abnormal heart rhythms with exercise.

Is there anything to fear?

Most patients who experience anxiety about a stress test are usually more afraid of what the test may reveal rather than the test itself. Many have had a friend or family member go through the process and know what to expect.

"They recognize that we're doing it to provide more information," Pfeiffer said.

While some may have concerns about complications from the test itself, problems are highly unlikely.

"Any procedure that we do carries certain risks but the risks with stress testing are relatively low," Pfeiffer said.

A patient who has concerns is made aware that their heart is being monitored the entire time and that there is at least one trained professional present during the test. The test can be stopped at any time by either the patient or medical staff.

Who should not have a stress test?

If your doctor thinks that the likelihood of you having heart disease is extremely low or extremely high, they will most likely not order a stress test.

"If they think your risk is extremely high, they may recommend a more definitive test like a heart catheterization," Pfeiffer said. “If they think the risk is extremely low, they will probably recommend monitoring and follow-up.

For more information, talk to you physician or visit the American Heart Association website.

The Medical Minute is a weekly health news feature produced by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

Last Updated February 22, 2016