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Cardiac Stress Test

in the Non-Invasive Testing Department

Cardiac Stress Test

A Cardiac Stress Test, also called an Exercise Stress Test, shows how your heart works during physical activity. During exercise, your heart pumps harder and faster which increases demand for blood flow to your heart muscles. A Cardiac Stress Test can reveal areas of poor blood flow within the heart.

A Cardiac Stress Test involves walking on a treadmill while your heart rhythm, blood pressure and breathing are monitored. If you are unable to walk on a treadmill, your doctor may order a cardiac stress test using a drug that mimics the effects of exercise.

Why are you having a Cardiac Stress Test?

Your doctor may recommend a Cardiac Stress Test to:

  • Diagnose coronary artery disease
  • Diagnose heart rhythm problems (arrhythmias)
  • Guide treatment of heart disorders

Your doctor may use a Cardiac Stress Test to help determine if you have heart disease, and if so, how your symptoms correlated to it and what, if any, intervention might be needed.

If your Cardiac Stress Test provides inconclusive information, your doctor may recommend a test with imaging, such as a Nuclear Stress Test or Echocardiographic Stress Test.

Risks

A Cardiac Stress Test is generally very safe and complications during the exam remain rare. However, as with any medical procedure, there is a risk of complications, including:

  • Low or high blood pressure. Your blood pressure may drop or rise during or immediately after exercise, possibly causing you to feel dizzy or faint. Your blood pressure will be monitored throughout your exam and the test will be stopped by the cardiologist if needed.
  • Abnormal heart rhythms (arrhythmias). Arrhythmias brought on by a Cardiac Stress Test are common and usually go away soon after exercise has ended.
  • Heart attack (myocardial infarction). Although exceedingly rare, it's possible that a Cardiac Stress Test could cause a heart attack. There will be a cardiologist in the room with you during your exam, monitoring your heart health at all stages of the exam.

How to prepare for your test

Food and medications:

You may be asked not to eat, drink or smoke for a period of time before a Cardiac Stress Test. You may need to avoid caffeine the day before and the day of the test. Please check with your doctor’s office or Special Testing at 617-983-7104.

Ask your doctor if you should continue taking your prescription and over-the-counter medications before the test, because they might interfere with certain Cardiac Stress Tests.

If you use an inhaler for asthma or other breathing problems, bring it with you to your test. Be sure to inform the cardiologist monitoring your stress test that you may need your inhaler during the test.

Clothing and personal items:

Wear or bring comfortable clothes and walking shoes. You will be walking at a fast pace and will need to be in proper clothing to accommodate exercise. Please do not apply oil, lotion or cream to your skin that day.

What to expect during your Cardiac Stress Test

Your Cardiac Stress Test will take around 45 minutes, including both your prep time and the time it takes to perform the actual test. The test itself takes only around 15 minutes to perform.

A technician will place 12 electrodes on your chest. Some areas may require shaving to help the electrodes adhere better to your skin. The electrodes will connect you via wire to an electrocardiogram (EKG) machine, which records the electrical signals of your heart.

You will be asked to stand up on the treadmill and the test will begin once you have a brief conversation with the cardiologist in the room. The treadmill will start out at a slow pace and will increase every few minutes in both speed and incline (grade). The cardiac technician will be by your side in case you need us to stop the treadmill or help you in any way.

You will continue on the treadmill until your heart rate has reached the set target for your age or until you develop limiting symptoms such as shortness of breath, leg cramps or exhaustion. The cardiologist may decide to stop your test early in the case of:

  • Chest pain
  • Severe shortness of breath
  • Abnormal heart rhythm
  • High or low blood pressure
  • Certain changes in your electrocardiogram
  • Dizziness

After your Cardiac Stress Test

Once the treadmill has stopped and you have completed the exercise portion of the exam, you may be asked to stand still for several seconds or lie down. The staff will continue to monitor your heartrate and blood pressure. You will be allowed to leave once your heartrate and blood pressure return to your baseline readings.

Once you have completed your exam, you may return to your normal activities, unless instructed otherwise at the time of the test by the cardiologist.

Results

A full report will be provided to the doctor or clinician who ordered the test for you, usually on the same day as your exam. Any further testing that may be needed will be at the discretion of your doctor.

Frequently Asked Questions About Cardiac Stress Testing

What does a Cardiac Stress Test tell you?

A Cardiac Stress Test shows how the blood is flowing to the heart. Doctors use these tests to detect blockages in the arteries that are causing symptoms. It can also be used to detect arrythmias that may require more attention.

How long does the test take?

Exercise Stress (no imaging): 45 minutes

Exercise Stress Echo: 1 hour

Dobutamine Stress Echo: 1.5 hours

Nuclear Stress Test: 4 hours (includes wait time)
Can I take my medications the day of testing?

We cannot ask a patient to hold any regularly taken medications. Please ask the physician ordering the test for you for specifics. If a nuclear stress test is scheduled, the test cannot be performed if the patient has taken medications with caffeine, aminophylline or theophylline for 12 hours prior to the exam and dipyridamole for 48 hours prior to the exam.

What is the preparation for the test?

Exercise Stress, Stress Echo and Dobutamine Stress Echo: No caffeine for 3 hours before the test. Wear comfortable clothing including closed-toed shoes that would be no problem running in. No one-piece garments (dresses, etc.).

Nuclear Stress: No caffeine for a minimum of 12 hours before the test. NPO (nothing by mouth) for 12 hours prior to testing (medications are ok if ordering physician oks them, just none with caffeine, aminophylline, theophylline or dipyridamole). Wear comfortable clothing and footwear if walking on the treadmill.

What does the Exercise Stress Test consist of?

The patient is set up with a heart monitor, similar to an ECG. The blood pressure and an ECG are taken. The patient starts walking at a slow to moderate pace. Every 3 minutes the treadmill gets faster and steeper. The goal is to get the patient to 85 percent of their heart rate maximum (age-determined). The patient can request to stop at any time.

What does the Stress Echo Test consist of?

The patient will change into a gown, with everything from the waist-up off. The patient is set up with a heart monitor, similar to an ECG. The blood pressure and an ECG are taken. The patient has echo images (ultrasound) taken of their heart while lying on a stretcher. The patient starts walking at a slow to moderate pace. Every 3 minutes the treadmill gets faster and steeper. The goal is to get the patient to 85 percent of their heart rate maximum (age-determined). The patient can request to stop at any time. When the patient stops on the treadmill, they will as quickly and safely as they can get on the stretcher in the same position as before. The sonographer will take a few more images.

What does the Dobutamine Stress Echo consist of?

The patient will change into a gown, with everything from the waist-up off. The patient is set up with a heart monitor, similar to an ECG. The blood pressure and an ECG are taken. The patient has an IV put in. The patient has echo images (ultrasound) taken of their heart while lying on a stretcher. The patient is connected to an IV pump of Dobutamine. The medication increases in dose every 3 minutes for a total of 12 minutes. The goal is to get the patient to 85 percent of their heart rate maximum (age-determined). The patient can request to stop the medicine at any time. The sonographer will take ultrasound pictures throughout the test. The patient is lying down for the entire test.

How does Dobutamine make you feel?

Dobutamine can make you feel short of breath, like your heart is racing or beating hard, and in some cases, chest discomfort.

What does the Nuclear Stress Test consist of?

The patient will have an IV put in and be injected with a dose of nuclear tracer. There will be a waiting period after the injection. The patient will be put on a nuclear camera similar to an MRI, but not as enclosed as an MRI machine. Resting images will be taken for about 20 minutes, and sometimes images must be re-taken. The patient is then sent to wait in the Special Testing waiting room until the technician brings them back for testing. The patient is either exercised on a treadmill (see Exercise Stress Test) or given a medication to stress the heart. After this, another dose of nuclear tracer is given and the patient is taken back to Nuclear Medicine to complete a last set of images on the nuclear camera.

What medications are given during the Nuclear Stress Test and how do they make you feel?

Lexiscan, Persantine or Dobutamine can be given. Lexiscan is used most often. It takes effect within 20 seconds and patients typically feel no effects after a few minutes. The patient may feel shortness of breath, dizzy, lightheaded, tingling, chest discomfort, headache and stomach discomfort. Many patients feel nothing. If the patient still does not feel well after a few minutes, a medication can be given to reverse it. This medication is either caffeine or something similar to caffeine (aminophylline).

I only had a sip of coffee this morning. Can I still have my Nuclear Stress Test?

No. If there is any amount of caffeine in the patient’s system within 12 hours of the test, the test could be falsely negative.

Will my doctor get the results of this test?

If your doctor is in the Mass General Brigham network, they will have access to your results immediately after the attending physician signs the test. If they are not in the Mass General Brigham network, we will fax them a copy as soon as it is requested by your doctor’s office.

Can I have a copy of my results?

If you have access to Mass General Brigham Patient Gateway, the results will post there usually within 24 hours. Otherwise, you can request a copy from the ordering physician.

What if I am running late to my appointment?

Any patient arriving more than 15 minutes late to an appointment will have to be rescheduled. Any cancellations should be made by calling 617-983-7160.

Any specific test-related questions not answered by this list can be answered by calling us at 617-983-7415.

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