Stress testing

• What is the purpose of a stress test?

  To evaluate and manage patients with known or suspected heart disease
• What is the main objective of a stress test?

  To measure the ability of the heart to respond to stress
• What is another name for a stress test?

  Treadmill test or exercise test
• What does the ST segment represent in an ECG?

  The interval between ventricular depolarization and repolarization
• How does a stress test work?

  It increases the heart rate, checks blood pressure, and measures blood flow through coronary arteries
• What do coronary arteries supply blood to?

  The heart
• What are some reasons patients may be subjected to a stress test?

  Irregular heartbeat, symptoms related to the heart, and suspected narrow arteries
• What should patients inform their doctor about before a stress test?

  Any medicines they take
• What does NPO mean in the context of stress test preparation?

  No food or drink for a specified period
• How long should patients avoid smoking before a stress test?

  1. 2 days or 2-4 hours before the procedure
• What should patients wear for a stress test?

  Comfortable clothes and shoes
• How long does a typical stress test last?

  Usually lasts for 1 hour
• What are the signs and symptoms that indicate a patient should stop the stress test?

  Moderate to severe chest pain, severe shortness of breath, and abnormal heart rhythm
• What should patients do after the stress test?

  Stand still for several seconds and then lie down for a period of time
• What are contraindications for taking a stress test?

  Acute myocardial infarction within 2 to 3 days and unstable angina
• What is a positive stress test an indicator of?

  Advanced coronary artery disease (CAD)
• What is a coronary angiogram?


  An additional test that detects blockage and narrowed blood vessels in the heart
• What is the most commonly used type of stress test?

  Exercise stress test
• What is the formula for calculating the maximal predicted heart rate (MPHR)?

  $MPHR =$$220 - \text{age}$
• What is the purpose of a nuclear stress test?


  To assess patients who are unable to exercise adequately
• What radioactive tracer is typically used in a nuclear stress test?

  Technetium-99 (Tc-99)
• What is the difference between Tc-99 and Tc-99m?

  Tc-99m is a short-lived form of Tc-99
• What are some drugs used to induce transient physiological cardiac stress?

  Adenosine, Dipyridamole, and Dobutamine
• What is the weight capacity of a treadmill used for stress testing?

  157.5 kg (350 lbs)
• What is the maximum speed of a treadmill used for stress testing?

  12.8 km/h (8 mph)
• What is the purpose of a bicycle ergometer in stress testing?

  It serves as an alternative to treadmill testing for patients with limitations
• What is the recommended method for blood pressure measurement during a stress test?

  Manual auscultation
• Why is a mercury manometer recommended over an aneroid manometer?

  It is more accurate and easier to maintain and calibrate
• What are the main types of stress tests?

  • Exercise Stress Test
  • Nuclear Stress Test
  • Pharmacologic Stress Test
• What are the risks and precautions associated with stress tests?

  • Very little risk for treadmill stress test
  • Medical professionals on-site for unusual situations
  • Rare allergic reaction to radioactive tracer
  • Expect fatigue from exercise, but no significant side effects
  • Report any unusual symptoms to a doctor
• What are the patient preparation steps before a stress test?

  • Inform doctor about medications
  • NPO for 2-4 hours
  • Avoid smoking for 1-2 days or 2-4 hours before
  • Avoid unusual physical exertion
  • Wear comfortable clothes and shoes
  • Do not apply oil, lotion, or cream for nuclear stress test
• What should patients do during the stress test?

  • No eating or drinking until both parts are completed
  • Follow medical professionals' instructions
  • Stop the test if too uncomfortable
• What are the contraindications for taking a stress test?

  • Acute myocardial infarction within 2-3 days
  • Unstable angina not stabilized by therapy
  • Uncontrolled cardiac arrhythmias
  • Symptomatic severe aortic stenosis
  • Uncontrolled symptomatic heart failure
  • Acute pulmonary embolus or infarction
  • Severe pulmonary hypertension
  • Acute myocarditis, pericarditis, or endocarditis
  • Acute aortic dissection
  • High-grade AV blocks
  • SBP > 200 mmHg or DBP > 110 mmHg
  • Extreme obesity or physical/mental impairment
  • Patient unable to walk or sit up
• What are the components of the treadmill used for stress testing?

  • Electrically driven with padded front and side rails
  • Emergency stop button
  • Weight capacity: 157.5 kg (350 lbs)
  • Speed range: 1.6 km/h (1 mph) to 12.8 km/h (8 mph)
  • Elevation: 0% to 20%
  • Dimensions: Length 127 cm (50 in), Width 40.64 cm (16 in)
• What are the features of a bicycle ergometer used in stress testing?

  • Alternative to treadmill testing
  • Less expensive and portable
  • Adjustable resistance and cycling rate
  • Maximum oxygen uptake: 5-20% lower than treadmill
  • Mechanically and electrically braked options available
• What is the role of an electrocardiogram (ECG) machine in stress testing?


  • Continuous monitoring of heart rhythm
  • Evaluation of ischemic ECG changes during exercise and recovery
  • Produces 12-lead hard copy
• What is the importance of blood pressure equipment during a stress test?

  • Manual auscultation is the most feasible method
  • Automated units may perform erratically at high intensities
  • Mercury manometer is recommended for accuracy