Patients are advised to refrain from eating or drinking anything other than water after midnight before a morning test, or after the morning before an afternoon test. It is easier to evaluate the heart’s performance when the patient’s stomach is empty because intense exercise can lead to nausea or cramping. Physicians may also reduce or stop certain medications prior to the test. Certain medications, such as beta blockers and digitalis, will reduce the target heart rate for the test or otherwise affect the results.

Patients should wear comfortable, loose clothing and appropriate shoes. Some patients may be asked to remove their clothes from the waist up and put on a gown. Also, it may be necessary for the patient to sign a consent form before beginning the test.

Depending on the physician, an exercise stress test will take place either in the physician’s office or at a facility such as a hospital. Once the patient has removed his or her clothes from the waist up, a nurse or technician will thoroughly clean about a dozen small areas on the patient’s body – usually the chest, arms and legs. Usually the technician will apply a conductive gel to these areas. About 10 to 12 small metal devices (electrodes) are then taped to the skin and attached by wires to the electrocardiograph machine. Each electrode produces a “tracing” or “lead” of a particular area of the heart and its activity.

The patient will sit down and the technician will enter the following information about the patient into the computer:

Using this information, the physician can determine the patient’s maximum heart rate. This yields a target goal during the test. The patient then sits perfectly still for about one minute while the resting heart rate and blood pressure are measured and recorded. Blood pressure will be monitored throughout the test, and oxygen levels in the blood may also be measured by a small pulse oximeter on the finger, nose or ear.

If the patient is scheduled for a pharmacological stress test, he or she will then be given an injection that mimics the effects of exertion on the heart. If the patient is scheduled for a standard exercise stress test, he or she will complete the exercise component of the test.

Exercise will begin at a slow pace. Typically after three minutes (one stage), blood pressure is remeasured and recorded, and the speed and elevation of the treadmill or bicycle is increased. Throughout the test, the physician will speak with the patient, regularly monitoring and observing his or her physical condition, heart rate and EKG. Oxygen and carbon dioxide levels in the patient’s exhaled air may be measured. Generally, these measurements are taken at least once during each stage, and usually for about 30 seconds each.

Because patients are asked to exercise rather vigorously during the exercise phase of the test, some patients may experience symptoms including:

• Lightheadedness
• Discomfort or cramping
• Tiredness or fatigue

If the patient experiences severe pain at any time or significant change in his or her physical state, the test will most likely be stopped.

The exercise portion of the test (up to 15 minutes) is ended either by the patient’s signal that he or she is too uncomfortable to continue (due to fatigue, pain or breathlessness), or because the patient’s heart rate has reached the target heart rate. The test may also be stopped if the physician discovers any serious abnormalities in the EKG or blood pressure measurements. A cool-down period of a few minutes will follow. Upon returning to a resting state, the patient’s EKG will once again be monitored, recorded and compared to the initial at-rest measurement.