STRESS TESTING
Enhanced Stress Testing

• Stress Echocardiography
• Stress and Adenosine Nuclear Testing

A stress test may be ordered for a variety of reasons. Most commonly, it is done to diagnose the cause of chest pain. Other reasons include evaluation of heart rhythm disturbances and exercise capacity, particularly after an intervention such as bypass surgery or angioplasty. To conduct the test, we carefully place electrocardiographic leads(small patches applied to the skin that are easily removed) on the chest wall. With these we are able to monitor changes in the pattern of the EKG as the patient walks on a stationary treadmill. If the patient develops chest pain due to coronary artery disease, typical changes are seen allowing us to make the correct diagnosis. The entire test typically takes one-half hour, with the patient walking on average about 6-8 minutes.
The test preparation requires that the patient have nothing to eat for at least 4 hours before the scheduled time of the test. Please bring along all pertinent insurance information.

ENHANCED STRESS TESTING
STRESS ECHO
A Stress Echo test utilizes the principle of routine treadmill testing (see section on treadmill testing) and combines it with echocardiography (cardiac ultrasound) to derive a more accurate diagnosis in patients with chest pain. During this test, the patient exercises on a treadmill however before and immediately after the test an echo of the heart is performed. The heart muscle will contract or beat more vigorously after exercise except in areas which receive less blood flow. These areas will show reduced or abnormal contraction. Using this principle we can determine if the arteries supplying the heart muscle are blocked or narrowed. The test is painless but does require the ability to walk on the treadmill. The entire study takes about 30-40 minutes. In special circumstances, patients may need to have the test performed utilizing medication to stimulate the heart instead of a treadmill. Special instructions will be given in that situation.
Preparation for the test requires nothing to eat for at least 4 hours before the scheduled time. Please bring along all pertinent insurance information.

ENHANCED TREADMILL TESTING
NUCLEAR TESTING

The word nuclear often causes concern among patients. We first want to reassure you that the amount of radiation received by the patient in this type of test is less than that of a standard chest x-ray. There are two types of Nuclear Stress Tests performed in our office.
The first utilizes the principle of exercise on the treadmill coupled with the fact that blood flow to the heart muscle can be assessed by the amount of tracer (nuclear) that is taken up by the heart muscle. We can use this information to determine if blood flow or circulation to the heart muscle is abnormal as is the case with blocked arteries.
The alternative test uses a medication (Persantine) that will simulate exercise to give us similar information. The test takes approximately 1-11/2 hours initially with a brief second imaging session required ( 25 minutes) four hours later. The test requires intravenous access which is skillfully attained by our nuclear technologists and nurses. There are no untoward lasting side effects of the test or the medication.
We will explain the test and the necessary preparation at the time of scheduling. Preparation for the test requires no caffeine products (coffee, chocolate, sodas, etc.) for 24 hours prior to the test. Please wear comfortable clothing. Please bring your insurance information with you.