Stress tests help to see how the heart be­haves

The Saline Courier Weekend - - OPINION - DR. GLAZIER Eve Glazier, M.D., MBA, is an in­ternist and as­so­ci­ate pro­fes­sor of medicine at UCLA Health. El­iz­a­beth Ko, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at UCLA Health.

Dear Doc­tor: I’m a 56-year-old man. I have been out of breath lately and have had some mild chest pains. My doc­tor wants me to have a stress test. Is it re­ally nec­es­sary? What will it en­tail?

Dear Reader: The pur­pose of a stress test is to see how some­one’s heart be­haves when it’s be­ing asked to work hard. These types of tests have a num­ber of uses. For in­stance, they can help as­sess gen­eral car­diac health; iden­tify and eval­u­ate var­i­ous types of heart dis­ease or ar­rhyth­mias; and help to gauge the suc­cess of med­i­ca­tions or treat­ments for car­diac-re­lated ail­ments.

For peo­ple liv­ing with heart dis­ease or re­cov­er­ing from a car­diac event, a stress test can help pin­point the type and in­ten­sity of ex­er­cise that is safe. A stress test can also be used to con­firm whether cer­tain symp­toms, which can have a va­ri­ety of causes, are heart-re­lated. This in­cludes the short­ness of breath and chest dis­com­fort that you have de­scribed.

The most com­mon stress tests in­volve walk­ing on a tread­mill or rid­ing a stationary bi­cy­cle. While the per­son ex­er­cises, a va­ri­ety of de­vices mea­sure and mon­i­tor blood pres­sure, heart rate, oxy­gen sat­u­ra­tion and the elec­tri­cal ac­tiv­ity of the heart. Some stress tests, which eval­u­ate lung func­tion, will mea­sure oxy­gen use. The ac­tiv­ity level of a stress test be­gins low and slow, then grad­u­ally in­creases. The idea is that, as the heart is asked to work harder and harder, un­der­ly­ing prob­lems may be re­vealed. This can in­clude the on­set of phys­i­cal symp­toms such as dizzi­ness, un­usual breath­less­ness or chest pain, or ab­nor­mal changes to the elec­tri­cal ac­tiv­ity of the heart.

When you sched­ule a stress test, you’ll be asked to stop eat­ing or drink­ing for a set pe­riod of time be­fore the test be­gins, gen­er­ally a few hours. You will also be in­structed not to smoke and to ab­stain from al­co­hol and caf­feine. Your doc­tor will ask you what med­i­ca­tions and sup­ple­ments you take on a reg­u­lar ba­sis, and will let you know if any of them need to be paused. If you have asthma and use an in­haler, be sure to let your doc­tor know, and bring the in­haler with you.

Elec­trodes to cap­ture the elec­tri­cal ac­tiv­ity of your heart are taped to var­i­ous parts of your chest, and a blood pres­sure cuff is at­tached to your arm. A pulse oxime­ter, to mea­sure blood-oxy­gen sat­u­ra­tion, may be clipped to a fin­ger. Dur­ing the ac­tive por­tion of the test, usu­ally 10 to 15 min­utes, you will ex­er­cise at an in­creas­ingly higher rate, un­til you reach a tar­get goal. If symp­toms de­velop at any point, the test is cut short. These can in­clude chest pain, dizzi­ness, short­ness of breath and ab­nor­mal changes to blood pres­sure or elec­tri­cal ac­tiv­ity. It’s im­por­tant to let the tech ad­min­is­ter­ing the test know if you feel dis­com­fort at any time. Mon­i­tor­ing may con­tinue after the test is com­plete to see how the heart and body re­cover.

Within the next few days, your doc­tor will re­view the test re­sults with you. If coro­nary dis­ease is sus­pected, ei­ther treat­ment or ad­di­tional test­ing may be rec­om­mended.

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— From the First Amend­ment to Con­sti­tu­tion

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