Cardiac Stress Test
Most people wind up having a cardiac stress test once they reach a certain age, especially if they’ve been experiencing certain symptoms, like shortness of breath, dizziness, or chest pain. This is especially true if the patient has had an abnormal electrocardiogram (ECG or EKG). When I began having pressure in my throat and chest, my primary care physician performed an EKG, and the results came back as “probably normal.” Probably normal?? I asked what that meant, and my doctor explained that the results weren’t conclusive because I have so much breast tissue. Since I’d been having the pressure in my chest, however, she decided I needed to have a cardiac stress test to make sure my heart was functioning properly. Because I have severe arthritis and a deformity in my right knee, I couldn’t do a regular heart stress test on a treadmill or stationary bicycle, so she ordered a chemical stress test and a nuclear stress test.
Typical Stress Test
What’s A Chemical Stress Test?
With a traditional cardiac stress test, patients are made to walk on a treadmill or to pedal a stationary bicycle. The object is to see how exertion affects the heart. During physical stress, blood flow to the heart is increased, making it possible to learn more about the workings of the heart.
Some people can’t do the physical exercise required to increase the heart rate enough for a stress test. Maybe they have joint problems, or perhaps they simply can’t exercise long enough because of some other reason. In such a case, a chemical stress test is often ordered.
With a chemical stress test, a drug is used to dilate the blood vessels and stress the heart, resulting in similar effects of exercise. In most cases, Adenoscan (adenosine), dipyridamole, dobutamine, or Lexiscan (regadenoson) is used. My test was done with Lexiscan.
Chemical Stress Test
What’s a Nuclear Stress Test?
Many people think a nuclear stress test and a chemical stress test are one and the same, but they’re not. Although they’re often used together, the two types of cardiac stress tests are different. The nuclear stress test has to do with how the heart and the arteries are viewed, and as I already explained above, a chemical cardiac stress test has to do with how the heart is stressed.
The nuclear part of the test can be done with a traditional cardiac stress test or with a chemical cardiac stress test. Don’t worry – you’ll receive only a tiny bit of radiation. According to my heart team, however, you’ll probably want to avoid holding any babies or small animals for a day or so after the test.
Nuclear Stress Test
How Does a Nuclear Stress Test Work?
During my nuclear stress test, thallium was used. Thallium is an element classified as a metal. It has numerous isotopes, or forms. Some of the thallium isotopes are mildly radioactive, and it’s one of these that’s used for cardiac nuclear imaging. If I remember correctly, it’s thallium-201 that’s used.
After the thallium is injected into the patient, an imaging device is used to show the heart’s health. The imaging can reveal blocked arteries, arteries that have narrowed, and the chambers of the heart. If the heart has been damaged, that will also show up on the images.
How to Prepare for a Cardiac Stress Test
When you’re scheduled for the procedure, you’ll be given a list of instructions. Be sure to follow them exactly. Go over the list and make sure you fully understand everything. You’ll be told how long in advance of the test you need to stop eating, drinking, and smoking. You’ll probably also be told to avoid any food or beverage containing caffeine. The number of hours varies from doctor to doctor and from hospital to hospital.
You’ll also need to tell your doctor about all the medications you use and about whether or not you have any breathing difficulties like COPD or asthma. In some cases, you might be instructed to skip a dose of your medications before the test.
PLEASE make sure you understand all the instructions. If you have questions, don’t be afraid to have them cleared up before you arrive for the heart stress test.
Description of a Nuclear and Chemical Stress Test
The hospital called me to set up the test. I preregistered over the phone. I was given instructions to follow in preparation for the test. When I arrived at the hospital, I was taken into a room by a nurse. She asked me numerous questions about my health and medications. I voiced my fears to her, and she tried her best to allay them. In addition to asking me questions, the nurse took my blood pressure, pulse rate, oxygen saturation, and temperature. Electrode patches were placed on my arms, my chest, and my legs.
I guess what really surprised me was that I was allowed to keep on all my regular clothes. I figured I’d have to wear one of those ugly hospital gowns, but I didn’t. I was even allowed to keep on my bra.
Next, an IV was started, and I was given an injection of thallium. Thallium is the element that makes the parts of the heart visible with imaging. The thallium caused no sensations at all. Once the thallium was in my system, I was asked to walk to a room that held a large machine. I was asked to lie on a narrow table, and I was slid into the machine. It was very much like an MRI. I had to lie there with my arms over my head for fifteen minutes, while images of my heart were taken. I’m claustrophobic, but being in the device didn’t bother me. That’s probably because my head wasn’t inside. By the way, the machine is quiet.
Once the imaging was finished, I went back to the first room and lay down on a cot. The imaging technician, a nurse, and the PA were there. I was injected with Lexiscan, via my IV line. Lexiscan is a drug that dilates the coronary arteries and stresses the heart, much the same way exercise does.
Lexiscan works quickly, and it didn’t take me long to feel the effects. For just a few seconds, my chest got tight, and breathing was a little difficult. This passed quickly, however. As soon as my heart was stressed enough, the drug was reversed, and I had to go back to the imaging device for more pictures.
The purpose of the test is to see how the heart functions at rest, and how it functions when stressed.
Tips for Chemical Stress Test
When I was told I had to have a chemical stress test and a nuclear stress test, I freaked out a little. That’s because I’d heard so many horror stories about the chemical part. These unsettling accounts didn’t come just from wimps, either. My husband had one, and my best friend, Sandy, had one. Sandy is really tough and rarely gets upset over any sort of medical testing or procedure, but she hated having a chemical stress test.
Both my husband and Sandy reported having chest pain and chest tightness. They said it was hard to breathe. The scariest thing they said was that they felt like they were going to die. Other people I talked to said they were filled with a feeling of impending doom. That certainly wasn’t something I was looking forward to!
I got on the internet and tried to research exactly how the test would feel, but my search was unsuccessful. I found information on medical websites, but that wasn’t what I was looking for. I wanted to read first-person accounts from real patients who had actually gone through the stress tests.
You’re lucky. I’m going to share a few tips for a chemical stress test that will help you through it without freaking out. The PA, the technician, and the nurse all remarked at how well I handled the test. They said the most important thing I did was to control my breathing. Read that again: CONTROL YOUR BREATHING! According to the PA that administered my test, that’s the biggest mistake people make. When the drug makes it hard to breathe, many patients panic and begin breathing too fast. Of course, that just makes things worse. It’s best to breathe slowly, calmly, and regularly. Once your breath “gets away from you,” as the PA put it, you’re much more likely to panic. Try to get a breathing rhythm going, and do your best to maintain that rhythm.
Stay as calm as you can the entire time. Remind yourself that the worst part of the stress test will only last a few seconds. Try thinking of something pleasant instead of focusing on your discomfort. Remember that you’re with a professional health care team, so you’re in good hands. Don’t be afraid to ask that the test be stopped if you’re very uncomfortable.
Is a Chemical Cardiac Stress Test Safe?
Many patients worry about the safety of chemical stress tests. While they’re generally considered safe, there have been some problems. In fact, there have been fatalities related to the procedure.
According to an article by Toni Clarke of NBC NEWS, the riskiest drugs used for chemical stress tests are the two marketed by Astellas. The chemicals in question are Adenoscan and Lexiscan. Yikes! Lexiscan is the one that was used on me!
Cardiac events – some fatal – occurred in some patients several hours after receiving the drugs. Due to this, the FDA issued a warning to physicians and other health care personnel. Apparently, the problems arose in people who were already having symptoms of heart problems.
Of course, this information didn’t give me a warm, fuzzy feeling, so I brought it up to the technician conducting my test. He said of the thousands of chemical stress tests he’s conducted, he’s never had a single problem. That made me feel a little better. Besides, I live just two blocks from our local hospital.
Don’t Be Afraid of a Chemical Cardiac Stress Test!
Once everything was over, I felt silly for dreading the test so much. Really, it was a piece of cake! The worst part of the whole thing was having to hold my arms over my head while I was lying down in the imaging device. Also, I had a headache for about 40 minutes after the test, which is normal for some patients. It wasn’t an excruciating headache – it was more of a dull ache.
So…where did all the horror stories come from? I asked my personal physician about that, and she said the older chemical stress tests were more uncomfortable than the ones they do nowadays. And, of course, everyone perceives pain, fear, and discomfort differently. I think if you go into the test knowing exactly what to expect, remain calm the entire time, and control your breathing, you’ll be fine! And once the procedure is over, you’ll receive some valuable information about your heart’s health.
Wikiminime on August 25, 2019:
Alejandra on January 29, 2015:
Apnraeptly this is what the esteemed Willis was talkin' 'bout.
Vicky on January 26, 2015:
This inomofatirn is off the hizool!
stella vadakin from 3460NW 50 St Bell, Fl32619 on November 23, 2014:
Very good and useful Hub. I had all my stress test and it was alright but don't want any more. You did a wonderful job writing this hub. Stella
moonlake from America on July 06, 2014:
I've had the chemical stress test and it is scary. I have had so many tests in the last 30 years they don't freak me out, but this test did make me feel like I was going to have a heart attack. My heart had main arteries that were no longer working. They said to me later "you just haven't realized how bad your heart is." I knew how bad it was, but the doctor kept trying to hide it from me through the years. This test helped me get done what I needed for my heart.
I once had MUGA scan stress test at Mayo clinic and broke out in spots all over my body. It was like I had measles. They freaked out, but in the end it was ok. I had a reaction to soap and it just happened the same day as the muga test.
Very interesting hub and I hope you are doing ok. Voted up.
Mary Hyatt from Florida on July 06, 2014:
I've had the stress test on the treadmill a couple of times. I was proud of myself for being able to do what I had to do, although it was very tiring. I would be frightened to have the chemical test done , I think.
Very informative Hub, voted UP and shared.
rebekahELLE from Tampa Bay on July 05, 2014:
I hope all is ok with you Holle. You've written an informative, helpful hub for those who may be facing these tests. I don't think anyone looks forward to any kind of tests. I've never had any of these tests, but the thought of any kind of injection makes me queasy. Needless to say, modern technology can save lives. It's so much more interesting to read a first person account.
Andrew from Rep Boston MA on July 03, 2014:
God, easy or not im hoping to never have to take one! I get scared easily of slight chest pains and tightness that happens normally, nevermind willingly induced!
Holle Abee (author) from Georgia on July 03, 2014:
Eric Dierker from Spring Valley, CA. U.S.A. on July 03, 2014:
I am just amazed that they do not have standard stress tests for such people as may be in wheel chairs. Great hub