Cardiac Stress Tests

Many people don’t need to make special preparations before having an exercise stress test. Wear comfortable clothing and rubber-soled footwear. If you use an inhaler, bring it with you and let the doctor performing the test know that you use it.

Your doctor will tell you if you need to prepare in any special way. For example:

• You may need to avoid eating, drinking and smoking for a period of time before the test.
• You may need to avoid caffeine, certain foods and certain over-the counter medications.
• You may need to adjust or discontinue certain medications before the test.

The Clinical Physiology Stress Testing Laboratory has multiple locations at BIDMC. If you are scheduled to have a stress test, you'll get directions in your confirmation letter.

Plan to be in the Clinical Physiology Stress Testing Laboratory for one to three hours, depending on the type of test you are having. Most people are on the treadmill for less than 15 minutes.

Arriving for Your Stress Test

First, you will meet the people who will be with you during the test. We will ask you these and other questions:

We’ll explain the test and ask you to sign a consent form. Then, the technologist will place electrodes on the skin of your chest, arms and legs. Electrodes are sticky round patches that attach to an electrocardiogram (ECG) machine. This machine measures and monitors your heart rate and heart rhythm throughout the test.

The team will continuously monitor your blood pressure and ECG during the test, recording and documenting details that your cardiologist needs.

If you’re having an echocardiogram, the echocardiography technician will perform that test before you start to exercise and right after you stop exercising. If you’re having a nuclear stress test, the nuclear medicine technologist will provide appropriate care before, during and after your exercise. 

A lab technologist and a clinical physiologist who are fully certified in cardiopulmonary resuscitation and advanced cardiac life support (ACLS) will be with you for the entire test.

If you are also having an exercise echocardiogram, the echocardiography technologist will be there, too. If you're having a nuclear stress test, the nuclear medicine technologist will be present. A physician and an emergency response team are always available for immediate consultation.

Exercise on the treadmill will begin, starting slowly and gradually increasing in intensity. While you are on the treadmill, the testing team will continuously monitor your ECG results. We’ll also take your blood pressure at regular intervals and ask how you are feeling. Be sure to speak up if you feel short of breath, dizzy, in pain, overheated or any other discomfort.

To get the most accurate results, the goal is to get you to perform as much physical activity as you can, based on your age, weight, health and activity history. This usually requires being on the treadmill from seven to 12 minutes. However, if there are any concerns, the team will stop your test right away. If you choose not to continue, we will stop the test at your request. Otherwise, we will continue until you are physically tired and cannot continue.

You will probably begin to feel out of breath as the intensity of the exercise increases. Exactly when the test ends depends on your individual response. Every person is different, and your safety is our number one concern.

Our team will stop the test at the right time to minimize any risks to you. We’ll help you get off the treadmill and lie down. If you are having an echocardiogram, the technician will perform it right after you get off the treadmill. We'll continue to monitor your heart rate and blood pressure until they return to baseline levels.

The doctor who ordered the test will give you the results, and the report will be available on MyBILH Chart once it is finalized. Reports are generally available on MyBILH Chart within 48 hours. If there is a serious concern, we will contact your doctor with the results immediately.

Risks of Stress Tests

Complications during an exercise stress test are very rare. In the unlikely event of an emergency, our staff is highly trained, and our lab is fully equipped to provide any intervention you need. Possible complications during an exercise stress test are:

Follow these preparation instructions:

• Do not smoke for two hours before this test.
• Do not eat or drink anything except water for two hours before this test.
• Do not eat or drink anything with caffeine for at least 12 hours before your test, including cocoa and chocolate.

Please wear comfortable clothes that break at the waist (a shirt or blouse) and flat, comfortable walking shoes or sneakers. The testing team will place electrodes on your chest to monitor your heart rhythm during exercise.

Bras cannot be worn during the procedure. If you wear an unusually large or small size of clothing, please bring your own T-shirt and pants. You will be working hard during this test. Comfortable clothing will make things easier for you.

The test — including the imaging and exercise — takes a total of three to four hours. Most of that time is spent gathering images.

Medications Before Your Test

Your doctor may tell you to decrease or stop certain medicines for this test. Do not stop your medication unless your doctor tells you to. You should start all your medicines again after the test is over.

Bring a complete listing of all your medicines with you. If you are diabetic and take insulin or another diabetes medication, please check with your doctor for advice regarding doses before and after this test. Bring your insulin or oral diabetes medicine to the hospital so you can take the dose recommended by your doctor.

Avoid taking these over-the-counter medications before this test:

• Anacin
• Excedrin
• NoDoz

Avoid taking these prescription medications before this test:

There are three parts to the test:

1. Taking pictures: For the first part of the test, we’ll put an intravenous (IV) line in your arm. This will feel like a pin prick similar to when you have blood drawn. A member of the testing team then injects the radioactive material through the IV. You won’t feel anything from this injection.

We will wait 30 to 45 minutes while the radioactive material circulates in your body. Then, while you are lying down, we’ll take pictures of your heart with a special camera for about 30 minutes.

2. Exercising: For the second part of the test, you will exercise by walking on a treadmill. Every three minutes, the treadmill goes faster, and we increase the elevation. Most people are on the treadmill for seven to 10 minutes. An electrocardiogram (ECG) monitors your heart. We will take your blood pressure many times during this part of the test. A member of the testing team will inject a radioactive material into the IV about one minute before you stop exercising. You will not feel this injection. We will again wait a short time while the radioactive material circulates in your bloodstream.

3. Taking more pictures: The third part of the test is taking more pictures. You will lie down, and the camera will take pictures for about 30 minutes.

After your test, a nuclear medicine doctor views and interprets your images. They send the results to your doctor within one business day of your test. Your doctor will assess the test results along with your other tests, and then explain the meaning of these results to you.