Quantcast
Follow us On YouTube Follow us On FaceBook



or
Search Language
Browse
Medical Animations
Medical Animation Titles
Custom Legal Animations
Anatomical Models
Patient Health Articles
Custom Interactive
Most Recent Uploads
Body Systems/Regions
Anatomy & Physiology
Diseases & Conditions
Diagnostics & Surgery
Cells & Tissues
Cardiovascular System
Digestive System
Integumentary System
Nervous System
Reproductive System
Respiratory System
Back and Spine
Foot and Ankle
Head and Neck
Hip
Knee
Shoulder
Thorax
Medical Specialties
Cancer
Cardiology
Dentistry
Editorial
Neurology/Neurosurgery
Ob/Gyn
Orthopedics
Pediatrics
Account
Administrator Login
The Doe Report Medical Reference Library
Print this article
Exercise Tolerance Testing

Exercise Tolerance Testing by Elizabeth Heubeck, MA

Anatomy and Physiology
The heart is a muscular pump weighing between 10 and 12 ounces and consisting of four chambers. The left chambers pump oxygen-rich blood throughout the body, while the right chambers pump blood that lacks oxygen to the lungs for replenishment.Loading image. Please wait...

During exercise, your muscles require additional oxygen-rich blood. Your heart supplies this extra blood by contracting more frequently and more forcefully. This increases your cardiac output, which is the volume of blood your heart pumps out to the rest of your body per minute.

Like other muscles in the body, your heart also requires a steady supply of oxygen-rich blood, which it receives through the coronary arteries.

Reasons for Procedure
If the blood supply to the heart muscle is compromised, it may not receive enough oxygen to meet its demand during exercise. Coronary heart disease, also referred to as CHD, is the most common reason for an imbalance between oxygen supply and demand. In CHD, cholesterol plaques block the flow of oxygen-rich blood through one or more coronary arteries.

Insufficient oxygen reaching the heart muscle results in a condition called myocardial ischemia. By measuring the heart's electrical activity during physical activity, an exercise tolerance test helps determine if myocardial ischemia is present.

Your doctor may recommend an exercise tolerance test to: screen for CHD if you are at high risk but have no symptoms, evaluate chest pain, which is often produced by myocardial ischemia, identify an irregular heart rhythm occurring during activity, monitor your heart's response to cardiac treatment, develop a safe exercise regimen, plan a rehabilitation program if you have had a heart attack.

Treatments
The exercise tolerance test is useful because the electrical activity of the heart is often quite sensitive to myocardial ischemia. An electrocardiogram, or EKG, can detect this electrical activity on the surface of the body. Certain changes in the electrical pattern of the EKG during exercise could indicate insufficient supply of oxygen to the heart muscle at times of high demand.

Your doctor may recommend another test closely related to the exercise tolerance test called a myocardial perfusion scan. In this test, which is described later, a special radioactive substance is used to help determine which parts of the heart muscle are receiving blood.

In addition, your physician may recommend these other studies to evaluate the blood supply to your heart muscle: a resting electrocardiogram, testing with certain drugs that put strain on the heart's supply and demand; stress echocardiography, which uses high pitched sound waves to create images of the beating heart during exercise; coronary angiography, which uses x-rays and a special dye to look for atherosclerotic plaques in the coronary arteries; testing your blood to see if the heart muscle has recently been damaged.

Procedure
Before your exercise tolerance test, your physician will perform a physical exam and a resting EKG. He or she will also review your medical history and any medications you are taking.

To prepare for your exercise tolerance test: avoid caffeinated beverages or foods for 12-24 hours prior to the test, avoid consuming anything other than water for four hours before the test, avoid smoking for several hours before the test, wear comfortable clothing and walking shoes, bring a list of any medications, herbs, or dietary supplements that you are taking.Loading image. Please wait...

Immediately before the test begins, a technician will: check your blood pressure; attach small adhesive patches called electrocardiogram electrodes to your chest and arms. These electrodes contain wires that connect to an EKG machine. Perform an EKG test to record your heart's electrical activity while at rest. Throughout the procedure, the technician will closely monitor your blood pressure, heart rate, EKG, and symptoms. Monitoring will continue after the test until levels return to baseline.

During the test, which takes place on a treadmill or stationary bike, you will be asked to: Begin walking or riding slowly. Gradually exercise more strenuously as the technician increases the speed and elevation, or resistance, of the machine every 2-3 minutes. Continue exercising until you are exhausted, or have reached your target heart rate.

During the test, you will be asked to report any of the following symptoms: chest pain, dizziness or lightheadedness, pounding in your chest, extreme shortness of breath, other bothersome symptoms.

If your doctor recommends a myocardial perfusion scan, a technician will inject a small amount of radioactive material into your vein while your heart is working as hard as it can during your exercise tolerance test.

You will then be asked to lie under a special camera while a technician takes pictures of your heart from different positions. About an hour later, after you have rested, the technician will take a second set of pictures.

Risks and Benefits
Possible complications of exercise tolerance testing include: chest pain, shortness of breath, dizziness, or lightheadedness, abnormal heart rhythm, and/or heart attack.

Benefits of exercise tolerance testing include: early detection of heart disease, guidance in planning treatment for heart disease, monitoring the effectiveness of treatment, and/or assessing the risk of future cardiac events.

In an exercise stress test, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate procedure for you.

After the Procedure
After the test is complete, you will be able to go home and resume normal activity, unless you experience any complications or worrisome symptoms. Once your doctor receives the test results, he or she will discuss with you the need to further testing or treatment.

Once home, call your doctor if any of the following symptoms occur: chest pain, pounding in the chest, dizziness or lightheadedness, excessive fatigue or shortness of breath.

Sources:

  • American College of Cardiology Foundation, American Heart Association. ACC/AHA guideline update for exercise testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). American College of Cardiology Foundation. Available at: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3427&nbr=2653#s26. Accessed June 22, 2004.
  • Fowler-Brown A, Pignone M, Pletcher M, Tice JA, Sutton SF, Lohr KN. Exercise Tolerance Testing to Screen for Coronary Heart Disease: A Summary of the Evidence for the U.S. Preventive Services Task Force. February 2004.
  • Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.gov/clinic/3rduspstf/chd/chdsum1.htm. Accessed June 22, 2004.
  • Ordering and Understanding the Exercise Stress Test. American Family Physician website. Available at: http://www.aafp.org/afp/990115ap/401.html. Accessed June 21, 2004.
  • The Normal Heart and How it Works. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=770. Accessed June 21, 2004.


Medical/Legal Disclaimer
Copyright © 2003 Nucleus Medical Art, Inc. All Rights Reserved.
Related Medical Demonstrative Evidence - click thumbnail to review.
Blood Test for Cholesterol
Blood Test for Cholesterol -
Medical Animation
Add to my lightbox
Find More Like This
Heart Failure Overview - Basic
Heart Failure Overview - Basic -
Medical Animation
Add to my lightbox
Find More Like This
Echocardiogram
Echocardiogram -
Medical Animation
Add to my lightbox
Find More Like This
ECG/EKG
ECG/EKG -
Medical Illustration
Add to my lightbox
Find More Like This
ECG /EKG Waves
ECG /EKG Waves -
Medical Illustration
Add to my lightbox
Find More Like This
Pulmonary Rehabilitation
Pulmonary Rehabilitation -
Medical Animation
Add to my lightbox
Find More Like This
Coronary Arteries with Angiogram Films
Coronary Arteries with Angiogram Films -
Medical Exhibit
Add to my lightbox
Find More Like This
About Your Heart Attack
About Your Heart Attack -
Medical Animation
Add to my lightbox
Find More Like This
Blood Flow Through the Heart
Blood Flow Through the Heart -
Medical Illustration
Add to my lightbox
Find More Like This
Managing Lung Cancer
Managing Lung Cancer -
Medical Animation
Add to my lightbox
Find More Like This
Heart Attack Symptoms
Heart Attack Symptoms -
Medical Illustration
Add to my lightbox
Find More Like This
Normal Heart Rhythm
Normal Heart Rhythm -
Medical Animation
Add to my lightbox
Find More Like This
How do I find a personal injury lawyer in my local area?
Find a personal injury lawyer in your local area using LEGALpointer™, a national directory of U.S. attorneys specializing in personal injury, medical malpractice, workers' compensation, medical product liability and other medical legal issues. Or, click on one of the following to see attorneys in your area: Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR), California (CA), Colorado (CO), Connecticut (CT), Delaware (DE), Washington D.C. (DC), Florida (FL), Georgia (GA), Hawaii (HI), Idaho (ID), Illinois (IL), Indiana (IN), Iowa (IA), Kansas (KS), Kentucky (KY), Louisiana (LA), Maine (ME), Maryland (MD), Massachussets (MA), Michigan (MI), (MN), Mississippi (MS), (MO), Montana (MT), North Carolina (NC), North Dakota (ND), Nebraska (NE), Nevada (NV), New Hampshire (NH), New Jersey (NJ), New Mexico (NM), New York (NY), Ohio (OH), Oklahoma (OK), Oregon (OR), Pennsylvania (PA), Puerto Rico (PR), Rhode Island (RI), South Carolina (SC), South Dakota (SD), Tennessee (TN), Texas (TX), Utah (UT), Virginia (VA), Virgin Islands (VI), Vermont (VT), Washington (WA), West Virginia (WV), Wisconsin (WI).












Awards | Resources | Articles | Become an Affiliate | Free Medical Images | Pregnancy Videos
Credits | Jobs | Help | Medical Legal Blog | Find a Lawyer | Hospital Marketing