Should You Have These 2 Heart Stress Tests Done?
Part 1 – Part 2
Electrocardiogram
In my article Screening for cardiac heart disease, we have reviewed a series of tests that can help in preventing a heart attack and a stroke. These two other tests, heart stress tests, can also be very helpful in assessing your risk for coronary artery disease or whether or not it is safe for you to engage in vigorous exercise.
Electrocardiogram (ECG or EKG)- What is it?
An electrocardiogram is a test that provides information on the functioning of the heart. An ECG records electrical current and maps this information onto a graph; this printout is known as an electrocardiograph. Although this test may not properly be considered a cardiac stress test, it can be done when the patient is at rest or during exercise, as in a cardiac stress test.
A number of electrically conducting patches connected by wires (called leads) to an ECG machine or a computer equipped with appropriate software are attached with adhesives to the chest, arms, and legs. These leads record the electrical impulse that travels through the heart with each beat, producing a tracing that looks like a series of blips and spikes on a continuous strip or on a 8 ½ by 11 inch sheet of paper.
These tracings allow the cardiologist to indirectly observe the contractions of the small and large heart chambers, as well as the period of rest and restabilization occurring between heartbeats
The electrical activity of an ECG reveals the heart’s rate and rhythm pattern and specific changes that suggest that part of the heart isn’t functioning (usually from a prior heart attack). Damage to the heart muscle produces characteristic irregularities in these waves. These irregularities may indicate the presence and location of a number and disorders including:
1. Insufficient blood supply (ischemia)
2. Tissue death (cardiac infarction)
3. Enlargement of the heart (hypertrophy)
4. Abnormal heart beat (arrhythmia)
5. Valve disease
6. Congenital heart disease
7. Defects in electrical conduction
Should you have an ECG done?
The ECG is an important tool in the emergency department or any setting in which people are experiencing chest discomfort, pounding or fluttering sensations, faintness, or other symptoms that might indicate a problem with the heart. But if you have no symptoms, this test offers little help in assessing your risk for coronary artery disease.
In fact, it may appear completely normal in a person who is on the brink of a massive heart attack. For this reason, an ECG may not necessarily be on the agenda for your routine physical. For someone over forty, however, an ECG can be very useful as a reference for comparison, in case it may be needed.
A treadmill test – a stress exercise
A heart stress test monitors the heart while exercising to see how it performs when exposed to an increased workload. The exercise usually involves walking on a treadmill that gradually increases its speed causing you not only to walk faster but also uphill at an ever increasing angle. The speeds and angles are calculated to cause the heart to reach a maximum rate within nine to twelve minutes.
Blood pressure, pulse, and an ECG tracing are monitored and recorded during the test. Abnormalities of the blood pressure and pulse, and especially of the ECG tracing, during exercise may indicate problems.
Should you have this test done?
Exercise stress tests are not recommended as a routine screening for every adult at any given age. They are usually done in the following cases:
You have one or more symptoms that suggest coronary artery disease such as:
a. Chest pain
b. Chest pressure
c. An unexplained fainting episode, especially if you are over sixty
d. Unusual shortness of breath with minimal effort
You have the following risk factors:
a. You are overweight
b. You are sedentary
c. You have high blood pressure
d. You have high cholesterol and triglyceride levels
e. You are a smoker
f. You have parents or brothers that have had a heart attack before the age of sixty. You may not have all of these factors, but if you have enough of them, your doctor may recommend this type of test.
You are planning to exercise
If you are planning to do moderate exercise, usually defined as a level of effort at about 50 percent of your maximum capacity for thirty to sixty minutes, such as brisk walking, a treadmill would be appropriate if there is known cardiovascular disease, multiple risk factors, or symptoms as described above.
If you are over forty and you are planning vigorous exercise, usually defined as
a. Jogging
b. Running
c. Cross-country skiing
d. Mountain biking
e. Or any activity that results in fatigue within twenty minutes or less
a treadmill test is usually recommended.
Final thoughts
You probably may be thinking after reading these two articles that going through medical examinations and tests is not your idea of having a good time. I feel the same way. However, health screening can be worthwhile for a number of conditions. We all want to detect problems early, ideally before they start causing problems. If you consider you have any risk factor that may turn out into a health problem, use the medical advances available to you.
To Your Success in Preventing Health Problems!
Emilia Klapp, RD, BS
www.TheDiabetesClub.com
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