What can we learn about our heart from a cardiac stress test?

Upper Kananaskis Lake, Alberta, Canada. (Dr. Noorali Bharwani)
Upper Kananaskis Lake, Alberta, Canada. (Dr. Noorali Bharwani)

Let us start by understanding the difference between cardiac stress test and cardiac Holter monitor.

What is cardiac stress test?

Robert Arthur Bruce (1916-2004) was an American cardiologist who invented the treadmill cardiac stress test used to diagnose heart disease. Patient’s heart signals are monitored on a treadmill set at successive stages of difficulty. Bruce also created the Bruce Protocol in the early 1960s, monitoring the heart signals of a patient on a treadmill.

Why is cardiac stress test important? Some heart problems only appear when your heart needs to work harder. Cardiac stress test helps to show how your heart copes under stress.

A cardiac stress test is done in a controlled clinical environment. It measures the heart’s ability to respond to external stress.  The stress response is induced by exercise or by intravenous injection of a medication.

What is cardiac Holter monitor?

Norman “Jeff” Holter (1914 – 1983) was an American biophysicist who invented the Holter monitor, a portable device for continuously monitoring the electrical activity (ECG) of the heart for 24 hours or more. Holter donated the rights to his invention to medicine.

The test is used to identify any heart rhythm problems. The device is the size of a small camera. It has wires with silver dollar-sized electrodes that attach to your skin.

Who needs cardiac stress test?

Any person who has a worrisome symptom like chest pain – especially in older men with risk factors for heart disease. An exercise stress test is not 100 per cent accurate. But it helps decide what the next step should be.

When to get a cardiac stress test?

The U.S. Preventive Services Task Force, an independent panel that makes recommendations to doctors, urges physicians not to routinely offer exercise stress testing to people without symptoms or strong risk factors for coronary artery disease.

Main indication for ordering stress test is when a person complaints of chest pain. Chest pain is not an uncommon complaint. Chest pain can have many possible causes besides heart disease.

For example, chest pain can be due to indigestion, anxiety, or muscle injury. If your doctor finds that you probably don’t have a heart problem, you may not need a stress test at all, says Choosing Wisely (2017 Consumer Reports. Developed in cooperation with the American Society of Nuclear Cardiology).

If you do have a heart problem, your first choice should often be a simple stress test without imaging. This test has little risk and is inexpensive. It is usually accurate for people with a low risk of heart problems.

Imaging stress tests are usually safe and can use little or no radiation. But for people at low risk, the tests may produce false alarms. This can lead to follow-up tests that you don’t really need. The extra tests can expose you to more radiation. Inappropriate testing can also lead to unnecessary treatment, says Choosing Wisely.

An imaging stress test can cost 10 times more than a regular stress test. You should only get an imaging stress test when it will help your doctor manage your disease or lead you to a better treatment. Discuss your symptoms with your family doctor. We can learn a lot from cardiac stress test if appropriately ordered.

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