A test in which the heart's oxygen demand is increased through controlled, progressive exertion on a treadmill or stationary bicycle. It investigates coronary artery narrowing and rhythm disorders that emerge with exercise.
Indication
- Suspicion of coronary heart disease in typical or atypical chest pain
- Evaluation of exertional shortness of breath, easy fatigue or palpitations
- Follow-up of treatment response and functional capacity in known coronary artery disease
- Investigation of residual ischemia (insufficient blood flow) after stent or bypass procedures
- Comprehensive cardiac evaluation in high-risk occupations (e.g. pilot, professional athlete)
- Investigation of exercise-induced rhythm disorders and blood pressure response
- Measurement of exercise tolerance in valvular disease or heart failure
Preparation
- It is recommended not to eat a heavy meal, drink tea, coffee or smoke for 2-3 hours before the procedure
- Unless your physician advises otherwise, heart-rate-lowering medications such as beta blockers or calcium channel blockers may need to be discontinued; always consult your physician beforehand
- Wear comfortable clothing suitable for walking and athletic shoes; a two-piece top (shirt + outer layer) is practical for recording
- Inform your physician in advance if you have asthma, advanced age or musculoskeletal disease; medications and protocol may change
- Bring previous ECG, echocardiography and prior exercise stress tests with you
How it's performed
- Several ECG electrodes are placed on the chest and a blood pressure cuff is applied to the arm
- Resting ECG and blood pressure are recorded; the target heart rate is determined according to your age
- The treadmill or bicycle workload is increased gradually at set intervals (typically every 3 minutes)
- ECG, blood pressure and your symptoms are continuously monitored during the test; you are asked to report any change you feel
- The test is terminated in a controlled manner when the target heart rate is reached or in case of chest pain, significant blood pressure changes or other findings
- ECG and blood pressure recordings continue for several minutes during the recovery phase after exercise
Post-procedure
- The physician reports the findings together with exercise duration, achieved heart rate, ECG changes and symptoms
- If the result supports coronary artery disease, further tests such as angiography, myocardial perfusion scintigraphy or CT angiography may be recommended
- It is recommended to avoid heavy exercise for the rest of the day after the test and to drink plenty of water
- Medication changes recommended during the test (resumption, dose adjustment) are applied according to your physician's instructions
- You should seek care without delay in case of new or persistent chest pain, loss of consciousness or marked palpitations
Risks
- The exercise stress test is performed under medical supervision; the risk of serious events is low but not zero
- Exertional chest pain (angina), increase or decrease in blood pressure, and dizziness may occur
- Rhythm disorders (arrhythmia), fainting or, during the test, a heart attack (acute coronary syndrome) may rarely develop
- Severe arrhythmia or sudden death has been reported very rarely; the risk of an advanced event is reported to be approximately 1 in 10,000 tests
- To minimize risks, the test is performed in a center with the necessary intervention equipment and under specialist supervision
FAQ
How hard will I be pushed during the test?
The target is to reach 85% of the age-predicted maximum heart rate. Speed and incline increase gradually; most people reach the target in 8-12 minutes. Always report any shortness of breath or fatigue you feel; you or the physician can stop the test at any time.
Can a heart attack occur during the exercise test?
The risk is low but not entirely zero. For this reason the test is performed under cardiologist supervision with continuous ECG and blood pressure monitoring; a defibrillator and emergency medications are ready. The test is stopped immediately if chest pain, marked blood pressure changes or arrhythmia occur.
How is it performed in patients who cannot walk or have knee or back problems?
In these patients, a pharmacological stress test (medication producing an effect similar to exercise) or bicycle ergometry may be preferred. Pharmacological tests are usually combined with echocardiography or nuclear imaging.
If my exercise test is normal, are my arteries definitely clear?
A normal exercise test reduces the likelihood of coronary heart disease but does not entirely rule it out. Depending on the type of symptoms, age, sex and risk factors, the physician may consider additional tests (CT angiography, coronary angiography, perfusion scintigraphy) necessary.
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