Stress testing and Hemodynamics

What is a Stress Test?
A stress test also called an “exercise test” or “treadmill test,” shows how your heart works when it is beating fast and hard. An exercise stress test may reveal problems with blood flow within your heart, which may not be detected in the resting state.
A stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure, and breathing are monitored. If you are unable to exercise (or in certain circumstances), you’ll receive a drug that mimics the effects of exercise.
Stress tests may be ordered to check for problems that can happen when the heart works hard.
Reasons for Ordering a Stress Test

• To see if you have coronary heart disease, heart failure, or another heart condition – Coronary heart disease is a condition that puts you at risk for a heart attack and other types of heart disease. Some people have symptoms of coronary heart disease only when they exercise. Heart failure is a condition in which the heart doesn’t pump well.
• To asses how well your heart works after heart surgery.
• For evaluating why you are experiencing chest pain, trouble breathing, or other symptoms.
• To see if you can safely exercise after a heart attack.

Preparation
You may be asked not to eat, drink or smoke for approximately 3 hours before a stress test. You may need to avoid caffeine the day before and the day of the test.
Ask your doctor if it’s safe for you to continue taking all of your prescription and over-the-counter medications (such as Beta-blockers) before the test, as they might interfere with your response to exercise and preclude accurate evaluation.
Wear comfortable clothing and shoes for the test.
If you use an inhaler for asthma or other breathing problems, bring it to the test.
Duration – The entire test usually takes less than thirty minutes, and most people walk on the treadmill for 6 to 12 minutes.
Risks

• When the heart pumps fast and hard, some patients may experience an abnormal heartbeat, trouble breathing, dizziness or may faint.
• If medications are used, they can cause side effects such as headaches, dizziness, or nausea.

What is a Stress Echocardiogram?
A Stress Echocardiogram combines cardiac ultrasound with the standard treadmill test to assess the impact of exercise on the function of your heart. The ultrasound may provide additional diagnostic information regarding the condition of your heart. This is especially useful when the ECG cannot be reliably interpreted. The test involves obtaining ultrasound pictures of the heart before and immediately after exercise (or giving medication to mimic exercise).
Reasons for ordering a Stress Echocardiogram
To evaluate if you have coronary artery disease (see information on Coronary artery disease under “Exercise Stress Test”).
To help find out if your shortness of breath is due to heart problems.
For the evaluation of pulmonary hypertension (a condition in which the pressure in the pulmonary artery is elevated, which may result in heart failure).
For the evaluation of valvular heart disease (including mitral stenosis, mitral regurgitation, and aortic stenosis).
For the evaluation of patients with hypertrophic cardiomyopathy.
Preparation
You may be asked not to eat, drink or smoke for approximately 3 hours before a stress test. You may need to avoid caffeine the day before and the day of the test.
Ask your doctor if it’s safe for you to continue taking all of your prescription and over-the-counter medications (such as Beta-blockers) before the test, as they might interfere with your response to exercise and preclude accurate evaluation.
Wear comfortable clothing and shoes for the test.
If you use an inhaler for asthma or other breathing problems, bring it to the test.
Duration – 30 to 45 minutes.
Risks

• When the heart pumps fast and hard, some patients may experience an abnormal heartbeat, trouble breathing, dizziness or may faint.
• If medications are used, they can cause side effects such as headaches, dizziness, or nausea.

What is a Dobutamine Stress Echocardiogram?
A Dobutamine Stress Echo is a special stress echocardiogram (see above) test that can be used for patients who cannot walk adequately on a treadmill. For this test, a medication called Dobutamine is infused through your veins (using an IV catheter), in four stages to “stress” the heart. Ultrasound images of the heart are acquired before administering dobutamine, at the completion of each stage and during your recovery after stopping the infusion.

Preparation
You may be asked not to eat, drink or smoke for approximately 3 hours before a stress test. You may need to avoid caffeine the day before and the day of the test.
Ask your doctor if it’s safe for you to continue taking all of your prescription and over-the-counter medications (such as Beta-blockers) before the test, as they might interfere with your response to exercise and preclude accurate evaluation.
Wear comfortable clothing and shoes for the test.
If you use an inhaler for asthma or other breathing problems, bring it to the test.
Duration – 30 to 45 minutes.
Risks

• When the heart pumps fast and hard, some patients may experience an abnormal heartbeat, trouble breathing, dizziness or may faint.
• Dobutamine can cause side effects such as arrhythmias, chest pain, elevated or low blood pressure, shortness of breath or nausea.
• Dobutamine should be avoided if you have a known allergy to dobutamine if you recently had a heart attack (in the past week) or have hypertrophic cardiomyopathy, severe aortic stenosis, certain arrhythmias, uncontrolled hypertension (200/110 mm Hg), aortic dissection or large aortic aneurysm.

What is a 24 Hour Holter monitor
A Holter monitor is a small, wearable device that keeps track of your heart rhythm and rate. Your doctor may want you to wear a Holter monitor for one day(24hr). During that time, the device records all of your heartbeats.
A Holter monitor test is usually performed after a traditional test to check your heart rhythm (electrocardiogram), especially if the electrocardiogram doesn’t give your doctor enough information about your heart’s condition.
Reasons for ordering a 24 Hour Holter monitor
To evaluate you for arrhythmias (abnormal heart rhythm), if you are experiencing unexplained and recurrent palpitations or unexplained fainting, near fainting or recurrent episodes of dizziness.
Preparation – Unless your doctor tells you otherwise, plan to bathe before this appointment. This monitor can’t be removed and must be kept dry once monitoring begins. Wear loose-fitting shirts or blouse since the monitor will be fitted to your chest.
Duration – 15 to 20 minutes.

What is a 48 Hour Holter monitor?
?A Holter monitor is a small, wearable device that keeps track of your heart rhythm and rate. Your doctor may want you to wear a Holter monitor for one day(24hr). During that time, the device records all of your heartbeats.
A Holter monitor test is usually performed after a traditional test to check your heart rhythm (electrocardiogram), especially if the electrocardiogram doesn’t give your doctor enough information about your heart’s condition.
Reasons for ordering a 48 Hour Holter monitor
To evaluate you for arrhythmias (abnormal heart rhythm), if you are experiencing unexplained and recurrent palpitations or unexplained fainting, near fainting or recurrent episodes of dizziness.
Preparation
Unless your doctor tells you otherwise, plan to bathe before this appointment. This monitor can’t be removed and must be kept dry once monitoring begins. Wear loose-fitting shirts or blouse since the monitor will be fitted to your chest.
Duration – 15 to 20 minutes.

What is The Ankle-Brachial Index test?
The ankle-brachial index test (also known as a Vascular profile) is a quick, noninvasive way to check your risk of peripheral artery disease (PAD). Peripheral artery disease is a condition in which the arteries in your legs or arms are narrowed or blocked, which may cause pain in your legs with walking. People with peripheral artery disease are at an increased risk of heart attack, stroke, poor circulation, and leg pain.
The ankle-brachial index test compares your blood pressure measured at your ankle with your blood pressure measured at your arm. A low ankle-brachial index number can indicate narrowing or blockage of the arteries in your legs, increasing your risk of circulatory problems, and possibly causing heart disease or stroke.
The ankle-brachial index test is sometimes recommended as part of a series of three tests, including the carotid ultrasound and abdominal ultrasound, to check for blocked or diseased arteries.
Preparation – No special preparation is needed for this test.
Duration – 10 to 15 minutes.

What is an Ambulatory Blood Pressure Monitoring?
An ambulatory blood pressure monitoring test is a 24-hour blood pressure monitoring test. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night. Studies confirm that ambulatory blood pressure monitoring devices more accurately reflect a patient’s blood pressure and correlate more closely with end-organ complications than blood pressure levels measured in the physician’s office.
Reasons for ordering an Ambulatory Blood Pressure Monitoring Test
Ambulatory blood pressure monitoring may be particularly helpful in clinical situations such as borderline hypertension, white-coat hypertension (when the blood pressure readings at your doctor’s office are higher than they are in other settings, such as your home), cases of uncontrolled hypertension despite being on medication, hypotensive symptoms from medications (eg. lightheadedness, dizziness, fainting, nausea), episodic hypertension, and evaluation of how well your blood medications are working.
Preparation
Unless your doctor tells you otherwise, plan to bathe before this appointment. This monitor can’t be removed and must be kept dry once monitoring begins. Wear loose-fitting shirts or blouse since the monitor will be fitted to your chest.
Duration – 15 to 20 minutes.

What is a Pulmonary function test
Pulmonary function test or Spirometry is a common office test used to assess how well your lungs work by measuring how much air you inhale, how much you exhale and how quickly you exhale.
Reasons for ordering a Pulmonary function test
Spirometry may be used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other conditions that affect breathing. Spirometry may also be used periodically to monitor your lung condition and check whether a treatment for a chronic lung condition is helping you breathe better.
Preparation
Follow your doctor’s instructions about whether you should avoid the use of inhaled breathing medications or other medications before the test. Other preparations include the following:
Wear loose clothing that won’t interfere with your ability to take a deep breath.
Avoid eating a large meal before your test, so it will be easier to breathe.
Duration – 15 to 20 minutes

What is a Tilt table test?
A tilt table test is used to evaluate the cause of unexplained fainting (syncope).
Reasons for ordering a Tilt table test
Your doctor may recommend a tilt table test if you’ve had repeated, unexplained episodes of fainting. A tilt table test may also be appropriate to investigate the cause of fainting if you’ve fainted only once, but another episode would put you at high risk of injury due to your work environment, medical history, age or other factors.
How is it Done?
For a tilt table test, you begin by lying flat on a table. Straps are put around your body to hold you in place. After about 15 minutes of lying flat, the table is quickly tilted to raise your body to a head-up position — simulating a change in position from lying down to standing up.
The table will then remain upright for up to 45 minutes, while your heart rate and blood pressure are monitored. This allows doctors to evaluate your body’s cardiovascular response to the change in position.
Preparation
You may be asked not to eat or drink for two hours or more before a tilt table test. You can take your medications as usual, unless your doctor tells you otherwise.
Duration – 60 to 90 minutes.

What is an Electrocardiogram (ECG)
An ECG is a noninvasive, painless test with quick results. During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes your limbs. These sensors are usually left on for just a few minutes.
Reasons for ordering an ECG
The ECG is an important test for interpretation of the heart rhythm, electrical conduction problems in the heart, and the detection of decreased blood supply to the heart (which may lead to a heart attack). It is also beneficial in the evaluation of diseases of your heart valves, structural or inflammatory heart diseases, and the effects of hypertension on the heart. Additionally, ECGs may be of great value in monitoring drug treatment and for metabolic disturbances.
Preparation – No special preparation is needed for this test.
Duration – 10 to 15 minutes.