& Health Education
is Exercise Stress
Modifications for a Healthy
Body, Mind and Spirit
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do you test for Heart Disease?
Story of Heart Attack - Part - 3
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is an exercise stress test?
Exercise Stress Test, which is also known as "Exercise Tolerance Test",
"Stress EKG" and "Treadmill Test" is performed on a motorized treadmill or sometimes
on a bicycle ergometer, to assess the heart's function and its blood supply to
determine the exercise capacity of the individual and blockages of the arteries
to the heart that can lead to heart attack. It is also performed to evaluate the
functional capacity of heart and also about abnormal heart beats in a person already
known to have heart disease or had heart surgery.
principle behind a stress test is simple. Coronary arteries that are diseased,
blocked or narrow may function adequately when a person is at rest. When they
exercise, they unable to meet the increase in the requirements of the heart for
oxygenated blood supply. This results in a characteristic change in the heart's
electrical activity. This will be seen in the EKG tracings recorded during several
stages of such an exercise or exertion. This may or may not cause a chest pain
or angina. The EKG and blood pressures are recorded before, during and after a
set pattern of exercise performed on a motorized treadmill or bicycle at varying
speed. A healthy person taking the test may feel little or no discomfort while
exercising. However, a person who has a heart condition may feel a transient uncomfortable
feeling of pressure or pain in the chest or weakness early during the test. This
may cause a classical abnormality in the EKG at that time.
needs Exercise Test?
are three major Categories of individuals who may undergo an exercise stress testing
and benefit from it. Certain percentage of false positive and false negative outcome
of the test has to be kept in mind, like any other medical investigations, based
on the age, risk factors, index of suspicion, prevalence in the community and
the pretest probability of coronary artery disease, to come to a meaningful consideration
of the test results.
Apparently healthy persons with no significant major risk factors.
Individuals at a high risk who have indications of possible heart disease or with
more than one or two risk factors for heart disease.
Individuals with known or suspected heart disease who need to be investigated
for the treatment and follow up. These will include persons who already had a
heart attacks, had heart surgery or has been on medical treatment.
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under the age of 45 years can usually begin exercise programs
without the need for a doctor's physical examination or an exercise stress testing
if they had no known risk factors. An exercise stress testing is of no diagnostic
value in this population and is of no use. However, the exercise program should
begin at a slow pace and proceed gradually. The individual should also be very
alert to look for the development of any unusual signs or symptoms that might
indicate an underlying heart problems, like difficulty in breathing, chest pain,
dizziness or weakness after a short period of exercise. At or above the age of
45 years, it is desirable to have a maximal exercise stress testing done before
beginning an exercise program. It is also desirable for those already exercising,
once they reach the age of 45 years.
at high risk
are those with at
least two major coronary risk factors or symptoms suggestive of a heart disease.
A stress test prior to beginning a vigorous exercise program is desirable for
individuals of any age if they have abnormal EKG or symptoms suggestive of heart
disease such as chest pain after normal activity. Individuals over the age of
45 years with two or more risk factors and those between 35 years to 44 years
with more than two risk factors for coronary artery disease must undergo a maximal
exercise stress test after a thorough physical examination, even if they feel
normal and have no symptoms. A maximal exercise testing is desirable in this group
of people for diagnosis and early treatment, even if they are not planning an
with known heart disease
should have an exercise stress test done under a physician's
supervision. It is helpful to assess the extent of the heart problems, effects
of treatment and prognosis and to make plans for further evaluation for treatment.
The test must be done prior to starting any vigorous exercise program. This is
important to measure the functional capacity of the person, to monitor the progress
of the heart condition and to assess the safety of a vigorous exercise program.
They should perform only the amount of exercise prescribed by the physician. If
any symptoms occur during the exercise, they should get reevaluated by the physician
again and may need a stress test.
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with certain abnormalities of the heart like
birth defects of the heart, abnormal and irregular heart beats, with heart valve
disease, heart failure, lung problems like bronchial asthma and emphysema and
persons with musculoskeletal problems may not be suitable for stress testing and
will need evaluation by the physicians. Certain birth defects of the heart are
associated with abnormal body growth and appearance including thin, tall stature
with long fingers and hands. These individuals will need evaluation including
an echocardiogram and may not be suitable for any strenuous exercises or
with certain abnormal heart conduction like bundle branch blocks and
those with heart valve diseases are not suitable for exercise stress test. Similarly,
individuals with musculoskeletal problems and lung problems will not be able to
walk on a treadmill properly. These persons can have stress test and heart imaging
studies done by other pharmocological methods to increase the oxygen demand of
the heart or increase of heart rate and using radio-isotope imaging of the heart.
Results of the exercise stress tests may indicate new problems and may dictate
reclassification of the individuals for medical treatment or heart surgery and
for an exercise program.
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is how the test is performed.
the day you are scheduled for the test, you should only eat a light breakfast
that morning [not on empty stomach]. You should refrain from coffee, alcohol and
cigarettes for at least 4 hours before the test. You should report to the Cardiologist's
office [or the hospital where the test is to be performed] in comfortable clothing
like pant or shorts and should wear or bring comfortable shoes like sneakers.
EKG electrodes are painlessly attached to your chest after cleaning the skin.
A blood pressure cuff is wrapped around the arm [usually right arm] to check the
blood pressure during the test. EKG, heart rate and blood pressure will be recorded
while you are at rest before the test. Then, you will be walking on a motorized
treadmill. You begin a slow and steady exercise on the Treadmill. The speed and
elevation will be gradually increased every 2 or 3 minutes. During the exercise
test the heart rate, EKG and blood pressure are continuously monitored and periodically
recorded. The heart rate and blood pressure will gradually increase as you walk
on the treadmill.
is how long the test will last.
object of the test is to put a strain on the heart [under controlled condition]
to cause symptoms or a change in the EKG pattern to reveal any strain or any underlying
heart problems. As the speed and angle [elevation] of the treadmill increases
every few minutes you will notice increasing strain on walking though it may appear
simple to begin with. As speed increases, you may start jogging as needed. The
test will be terminated and the moving belt will be stopped if you reach a target
heart rate or stage of exercise or if you developed any significant symptoms or
EKG changes. Usually the test may last from 8 to 14 minutes of walking or jogging.
Sometimes it may be quite short if you get symptoms or EKG changes or if you are
physically not well conditioned though healthy. After the test resting studies
are done during recovery for about 8 to 10 minutes. You are free to leave after
resting for about 15 minutes.
is what the outcome might be.
healthy person taking the test may feel little or no discomfort. A person with
a heart condition may notice significant chest pains, weakness or shortness of
breath. Severe anxiety alone can cause some of the problems. Sometimes, arthritis
or other painful conditions may prevent you from completing the test. An untrained
weak person, otherwise healthy, may not be able to walk for too long. It is not
a test for your bravery. So, if you notice any discomfort, you should tell the
supervising physician to decide if the test should be stopped.
test will cause a strain on the heart. There is a very small risk of heart
attack or a serious abnormal, fast or very slow and irregular heart rhythm. This
is why this test is administered under the direct supervision of a Cardiologist
and in a place where all the proper test equipment and necessary emergency drugs
are available. When the test is completed, it is possible that it could be positive
which means that you have a high probability of having significant blockages of
the arteries of the heart. This may require further testing like heart catherterization.
on those findings, one may be advised the need for a balloon angioplasty immediately
or a heart bypass surgery or intensive medical treatment for the heart condition.
The test can be "Positive" in a person with normal heart and can also
be "Negetive" in a person with a heart condition. The Cardiologist will
be able to determine the "probability of a persons heart condition and its
functioning capacity taking into consideration of various factors in addition
to the test.
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