Millions of people undergo stress testing every year. But the question is, who needs it and who doesn’t?
I hate to sound cynical, but the vast majority of people don’t. To be candid, stress testing is the #1 money-maker for a cardiologist. Trust me, I did this for 10 years in the big cardiology group.
So, let’s talk about:
- What is a stress test
- Why is a stress test done
- Why you may NOT need a stress test
What is a stress test?
A stress test is a non-invasive way to assess for a significant coronary artery blockage. If one or more of the 3 main heart arteries is blocked by 70% or more, a stress test may help to identify the area(s) involved.
There are two ways to perform the “stress” portion: exercise treadmill or pharmacological.
The exercise treadmill can be performed by itself or with an imaging technique. The pharmacological version is always accompanied by imaging.
The exercise treadmill looks for symptoms (chest pain/shortness of breath), blood pressure and heart rate response, and ECG changes consistent with a blockage.
Imaging strategies with either a treadmill or pharmacological stress include echocardiography or nuclear tracers.
Exercise treadmill is by far the preferred technique if the person can perform on a treadmill.
If imaging is needed, MY suggestion is echocardiography as this provides additional information about the heart AND DOES NOT INVOLVE injecting radiation emitting chemicals.
When should a stress test be done?
A stress test is perfect for when someone is having symptoms as a way to determine if the symptoms are cardiac-related or not.
For example, a 54 year old who complains of shortness of breath with exercise. Great reason for a stress test. Or a 63 year old with chest pain for a month.
The stress test if normal would serve to reassure the patient that symptoms are likely not cardiac. An abnormal test would identify the person as likely having significant coronary artery disease and either an angiogram or aggressive holistic and/or pharmacological therapies for next steps.
When should a stress test NOT be done?
If you are NOT having any symptoms such as chest pain or shortness of breath, there is no reason to have a stress test.
Annual stress tests are not of any benefit (except financially for the doctor or hospital).
Stress testing before a surgery is also of no benefit.
The only people who should be considered for a stress test without symptoms are people who have diabetes and thus may not experience symptoms of chest pain or shortness of breath.
If you are having classic angina such as chest pain with exertion or at rest, a stress test is contraindicated. You need an angiogram, anti-anginal medications, and/or natural remedies.
Let’s Talk About It
If you are not sure about your cardiac care plan, we are here to help. Please schedule a call so we can discuss the best course of action for you.