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• Your doctor may do a physical exam. Your medicines will be reviewed. Some medicines should not be taken before the test.
• Your doctor may need to examine your heart. This can be done with:
  • Resting electrocardiogram (EKG)
  • Echocardiogram

In the time leading up to your procedure:

• Do not eat or drink products with caffeine for 12-24 hours before the test.
• Do not eat or drink anything except water for four hours before the test.
• Do not smoke for several hours before the test.
• Wear comfortable clothing and walking shoes or exercise sneakers.
• Bring a list of your current medicines to the test.
• If you have diabetes, bring your glucose monitor to the test.

EKG electrodes will be attached to your chest. The electrodes are small, sticky patches with wires. Your resting blood pressure and EKG readings will be taken.

The cardiac stress test is done on a treadmill or a stationary bike. You will slowly start walking or riding. At regular intervals, the speed and elevation will be increased. Your EKG, blood pressure, heart rate, and symptoms will be closely monitored.

The test may be stopped early if you feel extremely tired, get chest pain, have trouble breathing, or if you have any symptoms that suggest heart problems. Significant changes in the EKG will also stop the test. After exercise is complete, your blood pressure, heart rate, and EKG will be monitored until levels return to normal.

Your doctor may also order a blood flow imaging exam. This is called a nuclear stress test. A small amount of radioactive chemical will be injected into a vein when you are exercising at your peak. Scans will be taken while you lie in different positions under a special camera. The images will help identify areas of the heart that may not be receiving enough oxygen. After you have rested for about an hour, a second set of images will be taken.

A stress echocardiogram may also be done. This is an ultrasound, which takes pictures of the heart before and right after exercise.

You may resume normal activities.

The exercise portion of the test generally takes less than 15 minutes. Your entire appointment will last about an hour. A nuclear stress test may take up to 3-4 hours.

Exercise testing normally causes no pain.

A cardiologist will review the test results and send a report to your doctor. The report is often sent within 24 hours.

One or more of the following are considered a positive stress test:

• EKG changes that show low oxygen supply to the heart
• You develop chest pain or trouble breathing, especially if associated with EKG changes
• Nuclear stress test results that show areas of your heart that are not receiving enough oxygen during exercise
• Failure to properly increase heart rate and/or blood pressure during exercise

A positive test may mean CHD, but not all patients who test positive have CHD. Your doctor will decide if further testing or treatment is needed based on the results of your test.