As a researcher focused on heart disease, exercise stress tests are part of my life. I’ve referred countless patients for the tests as part of their care and as participants in my research. Now, I feel like the tables have turned somewhat with my first follow-up test coming up since being diagnosed with heart disease.
I’ve done exercise stress tests before as part of research studies and my kinesiology training (yes, we do exercise in kinesiology courses at university). And of course I did one last year in when I was being investigated for my heart palpitations, but with this one, there seems to be more in the balance. Before I didn’t know I had heart disease, now I I do. The test is meant to see how I’m doing but I really don’t expect (or hope?) for much to have changed.
The exercise stress test is exactly what it sounds like: it’s a test of how much physical stress you can take and how your body responds to that stress. In fact, they are generally known as just plain stress tests. The most common type is on a treadmill in which the speed and grade increase every three minutes (referred to as the BRUCE protocol) and after about the first three stages, most people need to start running. Throughout the test, your heart is continuously monitored by an ECG and there are staff nearby asking how you feel.
The test goes until you get too tired or get symptoms and the doctor decides to stop it. As a result, you’re not meant to feel good at the end. How could you? You’re either stop because you can’t go any more or you’ve got symptoms that force you to stop. Either way, not a good way to finish.
This often conjures up images of having a heart attack or being too tired at the end of the test that you fly off the back end of the treadmill. Fortunately, I haven’t seen either of these two things happen.
Apart from a blood test, the stress test is the most common tool used to assess someone with, or suspected of having, heart disease. In our cardiac rehabilitation program we have patients undergo a stress test before they start (to get a measure of their symptoms and fitness) and sometimes once they’re done to assess progress. Many patients have stress tests every year, too. That’s a lot of people undergoing a lot of tests
Whoever thought that calling something a stress test was a good idea most certainly wasn’t a patient. The last thing someone with heart disease needs is more stress. Add that to the word test and you’ve got something that stirs up anxiety in even the most unflappable people. Many patients I know openly state how they hate the tests, in others you can see the anxiety in their face, and even some will try to delay the test so they can go out and study as they haven’t kept up with their exercise. More than one patient has asked me for the exact speed and grade of the treadmill stages to go to the gym and train for it.
With most tests, you either pass or fail, but not with a stress test. There’s no real passing. Sure, you can do better, but no passing. There is only fail and not fail. That may seem a bit defeatist, but the point of the test is to rule out heart problems. It’s not 100% accurate but it is a very simple (and inexpensive) test as a first look for heart disease and a patient’s progress.
Just the thought of my upcoming stress test gets me anxious. I don’t know about you, but I still get those dreams where I show up to my English exam and haven’t studied (it’s always English, never math or science- good thing I didn’t get an Arts degree). Add that to my competitive nature and I’m curious to see how I’ll do. Will I do as well or better than last time? If I don’t, what does that mean? That I’m just another year older, or are things getting worse. I’m not a runner but perhaps getting in a few runs in before the test will help.
Of course this thinking is a bit over the top, although it’s common, especially in competitive, type A personalities. In the end, though, it’s a test of one’s performance, and people are watching. Not only that, the first thing my heart colleagues say when I tell them I’ve done a stress test is “How did you do?” They’re not asking whether I had symptoms or not, they want to know how long I lasted. It’s as if I’ve just ridden one of those mechanical bulls. They want to know when I got kicked off.
I’ve never seen anyone get anxious or worried about having an echocardiogram or an ultrasound. Maybe it’s because all you do is lie down in a dimly lit room. Even the technician talks to you quietly. It’s all very relaxing (apart from when you first feel the cold gel on your body). This is the kind of test I’m happy to take in the middle of the day. It’s almost like a mid-afternoon nap.
In contrast, the stress test room is brightly lit. There are usually motivational posters of people running off into the sunset or down the beach. The technicians are all pumped up and ready to cheer you on. This is a good, because they want you to put in your best effort.
In preparation, I’ll make sure I’m well-rested and get a good night’s sleep. I may even limit my activity the day before so I’m not overworked before doing the test. After the test I’ll meet with my cardiologist to talk about the results and how things have gone the past year. Honestly, I don’t feel much different, my exercise is going well and I am well-looked after and supported, for which I am grateful. For now, I’m going to get in some exercise to get my mind off the test.