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Types of Stress Tests

Types of Stress Tests

EKG: A standard exercise stress test while having EKG leads attached. The machine helps record the strength & timing of the electrical signals that pass through from the heart, as well as how fast the heart is beating and show the rhythm of the heart. BP can also be checked on and sometimes a special breathing tube is utilized to evaluate how the patient is breathing while measuring the gases that are breathed out.

By Pierre Sales

Things to be Done Prior to Procedure

1.) Don't eat or drink anything except water for four hours before the test, 2.) Do not eat or drink anything that has caffeine for 12 hours before the test as this will interfere with the end results of the test, 3.) Don't take certain heart medications (i.e.: theophylline) on the day of the test unless instructed by the doctor to do so otherwise, or if the medication is used to help treat chest discomfort on the day of the test, 4.) Wear comfortable shoes and clothing that are suitable for the exercise. Women are advised to wear a loose-fitting blouse or they may be given a hospital gown to put on, 5.) If a patient uses an inhaler for breathing, it's advised to bring it along to the test.

Dobutamine Stress Echo Findings

What is a stress test?

Contra-Indications:

A stress test is a non-invasive measuring technique that echocardiosonographers use to evaluate the heart and how it performs under stress (exercise).

Types of Stress Tests

Normal response: for patients with no coronary artery stenosis to dobutamine stress echo is that the normal wall motion at rest and the myocardial contractility increases continuously with a low dose and high dose of dobutamine.

Stunned: this means that there's akinesis at rest but the contractility improves with low and even becomes better with high dose of dobutamine indicating moderate C.A.D.

Hibernating: this means there is akinesis at rest but the contractility improves with lose dose of dobutamine and shows absence of wall motion again with a high dose of dobutamine. (It's an atypical biphasic response of Hibernating, indicating severe coronary artery stenosis.

Stress test echo exams are not for the following types of patients:

- Patients with unstable (crescendo) aingina

- Patients with a recent M.I.

- Women that are pregnant

- Patients with severe arrhythmias, thrombosis, aortic stenosis or any other condition that would make the exercise dangerous

Types of Stress Testing (cont.)

Imaging Stress Tests: The second type of stress test that involves utilizing the first stress test while the echocardiosonographer obtains images of the heart pre and post stress. A treadmill or an exercise bike is utilized in the test and there are 4 views of the heart that are obtained in a certain order. The views are as follows: Parasternal Long Axis (PLAX), Parasternal Short Axis of the Papillary muscles, and 2 Apical views. The first is the 4 chamber view and the second is 2 chamber. After the patient uses the treadmill (or exercise bike in some places), the echocardiosonographer has a limited window to get the same 4 shots but in reverse order (Apical views, followed by PSAX Pap, and then PLAX). The window for post stress is so small (approximately 45-60 sec) because when the patient is at rest, it doesn't take long for the heart to go back to normal parameters. The reason for taking this test is to compare how the heart performs in both pre and post stress.

Imaging Test via Radioactive dye: involves the use of a small dose of a radioactive dye to create pictures of blood flow to the heart. It's injected into the bloodstream before pictures are taken, and it shows how much of the dye has reached various parts of the heart during exercise and while at rest.

Thank You!

References:

"Dobutamine Drug Info." Medline Plus. N.p., n.d. Web. 09 June 2014. <http://www.nlm.nih.gov/medlineplus/druginfo/meds/a681006.html>.

Stress Test Echo Types. Medline Plus, n.d. Web. 09 June 2014. <http://www.nhlbi.nih.gov/health/health-topics/topics/stress/types.html>

Stress Test Exercise. MedicineNet. N.p., n.d. Web. 09 June 2014. <http://www.medicinenet.com/exercise_stress_test/page2.htm>

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