Three types of stress tests can help doctors begin to identify possible blockages in your heart.
If you’re simply feeling stressed, that’s not a reason for a stress test.
But if you’re having chest pain or tightness, shortness of breath or other potential warning signs of a heart attack or angina, talk to your doctor. These could be signs that an exercise stress test, stress echocardiography, known as a stress echo, or a stress perfusion study can help your doctor uncover a potential health condition.
The three stress tests
- Exercise test: Measures the effect of exercise on your heart.
- Stress echocardiography: Ultrasound imaging that shows how well your heart muscle is working to pump blood through your body.
- Stress perfusion study: A nuclear tracer element is used to evaluate blood flow into the heart.
Stress test limitations
These tests are the workhorses of heart screening, but they have their limitations.
“A stress test cannot find any blockages in the arteries smaller than 70 percent,” said Dr. Ravi Mareedu, a Marshfield Clinic interventional cardiologist. “Any plaque buildup in the arteries can rupture, even if the narrowing is less than 70 percent, but these tests cannot predict which of the plaques are most vulnerable.”
Stress tests go back decades and are very helpful in finding out if a patient’s symptoms are coming from coronary arteries with severe blockages, greater than 70 percent. While generally accurate, stress tests can sometimes be misleading.
They can give a result that ends up being a false positive, needlessly worrying a patient about coronary artery disease. On the other hand, they can deliver a false negative, giving the patient a false sense of security.
Next step: Angiography
After a stress test indicates an abnormality, heart specialists turn to a more invasive but also much more informative test, a heart catheterization with angiography.
A long, thin tube called a catheter is threaded through blood vessels to the heart. Using a special dye, doctors can see the blockages precisely. People who are in the midst of having a heart attack will often have one or more arteries with major or even complete blockages.
“The take-away message is that doing the right thing for the right patient at the right time is very important,” Mareedu said. “If we err, it’s usually on the side of ordering tests that might be inconclusive. The last thing we want to do is overlook a result just because we think it is a false positive and then have the patient have a heart attack two months later.”
Many people can make lifestyle changes to reduce the need for most, if not all, of these tests.
“There’s no substitute for healthy living. That’s the single most important thing,” Mareedu emphasized. “Eat a well-balanced diet, exercise regularly, quit smoking and drink alcohol in moderation.”
About The Team
Heart Care Team
Our team wants to help you keep your heart healthy and reduce your risk for heart problems. We’ll provide you with information and tools to help you know your numbers, stay fit, recognize symptoms and manage your stress and overall health.
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From John Hopkins article –
CT scans outperform stress tests in spotting clogged arteries. – Click to Tweet
CT angiograms detect blockages in nine out of 10 people. – Click to Tweet
Stress tests can miss four out of 10 patients with clogged heart vessels. – Click to Tweet
I am a 70 year old female who had a echo stress test. The echo showed ok but with slight thickening in the left ventricle the stress test I was able to do 6 min but was breathless. I have a severe anxiety disorder but am in decent health and active. I had a false positive then LVH was mentioned. Now going for another more accurate stress test. My anxiety hasn't been this bad in years. Has anyone had similar. God has us by one hand. and our doctors have the other. . .. .blessings to you all during this journey
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Just had a nuclear stress test that showed my heart is not moving enough blood. I have noticed I get winded very easily. I am getting stints next week. Looking forward to getting back in the gym.
Just had my stress test at 25 everything came back normal thank god But I want to tell everyone on here to stay strong and god said don’t be anxious for anything god keeps his promises
I entered the hospital (in St. LOUIS, MO.) with chest pain, shortness of breath, profuse sweating and
vomiting. I had a chemical stress test and a nuclear stress test. It came out normal. It did not show that I had a 90% blocked right coronary artery. The hospital (in St. Louis, Mo) was going to release me and I insisted on a cardiac cath. Thank God I did!!
I had part one of the nuclear stress test today (the stress part). It was not a picnic but the distressing part really doesn't last all that long. I admit I had nausea, faintness, lightheadedness and some bone pain which scared me but I visualized good things while it was happening and I think that helped. Felt really bad for about two hours after–super shaky and weak and my chest hurt. It's been over seven hours since the test and I am still exhausted and shaky but not in pain. The imaging part of the test is nothing.
I had to wait 9 weeks for my last angiogram, during which time I had a SCAD heart attack….stress test with dye….had it today, got my heart up to target rate on treadmill, pain was 10 but did it, hated laying down afterwards for ultrasound, hard to slow down breathing, really focus using your mind to concentrate I wanted to walk it off, other than that this test is nothing to get worked up about! a walk in the park! Keep breathing!
I had a abnormal stress test result which from what I’ve read means 70% or more blockage,,, but doc says only 50% is blocked but that others also have some narrowing.. I’ve been told that they do nothing for me now! Omg
I had stress test myocardial perfusion scan.
Was apprehensive.
But stress part takes only 4 minutes and you suffer from. Old chest pain, tightness, short of breath for 4 to 5 minutes only.
After that next one hour rest then scan which is painless.
I had a stress test a week ago and I am still very tired
Hi Sara,
If you are feeling tired after a stress test, we recommend talking directly to your doctor about what you are experiencing. They can best advise you.
Thanks,
Jake
I'm 42 years old. I just had the nuclear stress test done. It is not that bad little scary when your heart is in over drive but that's about it. 3 days later you get your test back. Mine came back showing I have heart disease and now need more test I just lost my dad 3 months ago from a heart attack. Hospital has told.me for years oh it's just heart burn and indigestion you are to young for heart problems go home but soon as my father passed away they wanna now look at why I have chest pain daily. Then I find out I have heart problems and now on nitro spray. Makes me so mad how hospitals just push people out and don't listen to us we know our body and we know when something is wrong we did not need schooling to figure this out hospitals are getting so lazy and people are dying from lazy hospital staff
I’m so scared of this stress test I have panic anxiety I’m worried about the part they race your heart up I heard.some people pass out ,vomit can’t breath I’ve canceled twice and went to my appointments 3 times only to leave no comforting words just we can’t make you take the test,
I will be having my stress tomorrow at the VA. I am 76 years old and want to know if others have used the VA facility at Lake Nona.
I have a stress test this monday and have been told that the medicine they give you (if you cannot exercise) restricts your breathing. It's highly unplesant and frankly, I would rather opt to exercise on the treadmill. Be wary when using these medications, and READ about them first before you allow the doctor to give it to you. Dint be afraid to make a safe, informative decision for yourself! Personally, I'd rather try getting on the treadmill first, but realize that even I, too, have limitations. Be a FIGHTER and TRY to exercise if you can first, because restricted breathing is no fun…
Don't worry about the nuclear stress test. Just had mine yesterday. I'm 80. A little queasy sensation for about 30 seconds during the stress part of the test when the medicine dilates your blood vessels. But dilating your bloods vessels shouldn't be a cause for worry,
I have to have nuclear stress test next Friday and I am a basket case…I am 69 and nervous person to begin with..look up different sites to get a grip on what happens and how long..to boot I have vertigo so worried about lying flat for the camera part..sorry just scared..anyone can help I would appreciate it..thanks..
I was having some lightheadedness and went in to see a cardiologist. I had an echo and an exercise treadmill stress test, and the stress test came back abnormal. I have a nuclear stress test schedule in 9 days from now and I have been stressing out, I am scared sh*tless and I'm scared I have CAD and my arteries are blocked %70 or higher. The waiting game is horrible and I am so scared of the results, I am only 40. Reading others experiences lets me know I am not the only one worried when they receive these results. God Bless you all!
I had a Chemical stress test first part was abnormal the resting part was good no I have to take Another test where they go up from your groin area to see if there’s a blockage go either June 2 or June 10 Doctors must not realize that we worry why would it take so long to do a second test oh well God’s in charge
Hi Ozler,
Its normal to worry about test you know nothing about
I agree you should talk to your Dr about your concerns, however I have personelay had a stress test as well as my husband and they really are not that bad. Both of us had abnormal results I am now waiting to have the next testing done. You might be sacard however it is so much better too know what is going on then worry about whats wrong.
Hello Maria Q. How was the exams you took I got a stress test coming up at the end of March
Since being hospitalized for severe covid pneumonia.
Never having any problems or history of heart disease.
I now have to have a nuclear stress test, and, ultrasound of my heart. During my hospital stay they found out that my heart was leaking cardiac enzymes. I had inflammation of my heart, blocked arteries, and, heart muscle damage. I'm seriously worried, and, scared. I'm scheduled to have these test done in February! I shall see what happens trying to stay positive.
HeyMike and Susan I had an abnormal stress test I'm right there with u both stay strong!
Abnormal ekg just Great
I just got notified my nuclear stress test is abnormal. I will see a cardiologist in 2 weeks. How I don’t drop dead before! 2 weeks! Must not be serious.
My total cholesterol is 543, triglycerides 54. Keto/carnivore, 3 yrs. My doctor wants me to take the chemical stress test to see if the high cholesterol is effecting my heart. 68 yrs old, no meds
My cardiologist said my neck artery is 40% blocked. Asked my consent to give me stress test. I am afraid of the procedure. Your opinion please
Hello Ozler,
Thank you for reaching out. We recommend discussing your concerns with your cardiologist or primary care provider. They can best advise you due to their knowledge of your medical history and past conditions.
Below are some links about stress tests from trusted sources that hopefully can help provide more information:
https://www.nhlbi.nih.gov/health-topics/stress-test
https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/exercise-stress-test
Thanks,
Jake
Thanks for giving this information