Stress Testing

TREADMILL STRESS TEST (ETT) – An exercise stress test that involves walking on a treadmill with equipment to monitor the heart. This exam helps identify how well your heart handles increasing workloads. As you exercise, your heart works harder to supply adequate blood to the body. An abnormal stress test may be seen if blood supply is reduced through arteries that supply blood to the heart itself, due to blockage. These are also used for other purposes such as evaluating heart rhythm and conduction of electrical signals through the heart at different heart rates.

HOW TO PREPARE FOR YOUR EXERCISE STRESS TEST:

DIET

• If you need to eat a meal before your appointment time please eat a light meal prior. If you are diabetic, do not fast but don’t eat close to the test time

• Try to avoid smoking/tobacco/nicotine use for at least 12 hours prior to the test

MEDICATIONS

• Do NOT take beta blockers (medication ending in “olol”), verapamil, or diltiazem the night before and morning of the test unless your doctor tells you to. A list of the most common beta blockers can be found here (place a link or popup when hovering a mouse over this)

• Do NOT take Viagra, Levitra or Cialis within 48 hours prior to the test.

• If you have an inhaler BRING it with you.

HOW TO DRESS

• Dress comfortably

• Wear athletic type shoes with rubber soles (no slip on or backless shoes; do not wear shoes with “spikes” such as golf shoes)

• Wear loose fitting clothing suitable for walking on a treadmill; you may want to wear a short sleeve or sleeveless top (to allow easier access for BP measurements). Please wash chest area and avoid oil, lotion, powder and perfume so that monitoring leads can stick with confidence and provide good tracings.

• Typically, you can expect to be in the office for 40 mins to 1 hour.

NUCLEAR STRESS TEST (MYOCARDIAL PERFUSION IMAGING or MPI)

Non-invasive test that uses radioactive isotopes and a camera to create images showing blood flow to your heart. This exam can show areas of the heart muscle that may not be receiving enough blood flow, potentially due to blockage in the arteries or due to a prior heart attack. This test examines blood flow through your heart during exercise on a treadmill and while you rest, with two separate isotope injections, given thru IV, and images. If you are unable to exercise to an adequate workload or have certain EKG abnormalities/heart conditions, you will receive medicine that helps mimic the response to exercise by increasing blood flow in the arteries in your heart. The radioactive tracer gets taken up by live and healthy heart muscle cells proportionate to the blood flow to that area. The amount of radiation you receive from this test is similar to a CT scan done with contrast. There is no iodinated contrast, dye, used for this procedure.

HOW TO PREPARE FOR YOUR NUCLEAR STRESS TEST:

DIET

• NO caffeine 24 hours before the test including coffee, sodas, tea, chocolate, decaffeinated drinks and energy drinks.

• Do NOT eat or drink anything other than water and any needed medication, from midnight prior to the test. Having a couple of glasses of water in the morning may help as we will be starting an IV

• Try to avoid smoking/tobacco/nicotine use for at least 12 hours prior to the test

• You can bring a snack and something to drink with you if you wish, as after a certain point you will be told you can eat and drink. This can include the best tasting caffeinated beverage! We keep light snack bars and coffee/tea available in the office.

MEDICATIONS

• Do NOT take beta blockers (see list), diltiazem, verapamil the night before and morning of the test if you will be walking on the treadmill, unless your doctor tells you to. If you are scheduled for a “pharmacologic” study you can take the above medications.

• If you are on Persantine (dipyridamole) or aggrenox hold for about 48 hours prior to the test. If you are on these medications, you can take ASA 81 mg daily to bridge this period, and then go back to Aggrenox or Persantine after testing.

• Do NOT take Viagra, Levitra or Cialis 48 hours prior to the test.

• Bring your morning medications with you, to take after testing.

• If you have an inhaler BRING it with you.

• Do not discontinue any other blood thinner; if there is confusion please ask us to clarify prior to the procedure DIABETIC INSTRUCTIONS

• If you have diabetes, take half your usual insulin the night before or morning of testing.

• If you have an insulin pump, DO NOT STOP the pump.

• If you are on glipizide or amaryl (glimepiride) DO NOT TAKE the night before or morning of testing.

• You can continue Jardiance, Farxiga, Januvia and other such medications (please clarify prior to procedure as needed)

• BRING your diabetic medication and glucose monitoring kit with you.

HOW TO DRESS

• Dress comfortably

• Wear athletic type shoes with rubber soles (no slip on or backless shoes; do not wear shoes with “spikes” such as golf shoes)

• Wear loose fitting clothing suitable for walking on a treadmill; you may want to consider wearing a short sleeve or sleeveless top to allow for easier access for BP measurements. Please wash chest area and avoid oil, lotion, powder and perfume so that monitoring leads can stick with confidence and provide good tracings

• You may also want to bring a sweater or jacket as it is cooler in the office for testing purposes. DURATION OF TEST

• Variable but allow about 4 hours to complete the test (generally a little less).

STRESS ECHOCARDIOGRAPHY

Baseline resting ultrasound pictures of the heart are done with a focus on the main pumping chamber (left ventricle). After walking on a treadmill to achieve a certain workload, the ultrasound is immediately performed again to determine if your heart muscles are able to get enough blood flow while you exercise. An abnormality may be seen if there is blockage in the coronary arteries.

HOW TO PREPARE FOR YOUR STRESS ECHO:

• Come prepared wearing comfortable walking clothes/shoes, and drink plenty of water prior to the exam.

• You do not need to be fasting, but avoid a heavy meal close to the test time.
Try to avoid smoking/nicotine use for at least 12 hours prior to the test.

• Do not take medications such as beta blockers, diltiazem, verapamil the night before or morning of the test.

• You can typically expect to be in the office about 1 hour