Home » Anxious thoughts about my upcoming exercise stress test. Part of my Patient Journey with Heart Disease

Anxious thoughts about my upcoming exercise stress test. Part of my Patient Journey with Heart Disease

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. […]

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.

ECG w heart

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.

exam stress- small

 

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.

running on road

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.

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12 responses to “Anxious thoughts about my upcoming exercise stress test. Part of my Patient Journey with Heart Disease”

  1. Sharon Tomlinson Avatar
    Sharon Tomlinson

    Scott, enjoyed your article. I’m positive many patients can and do relate to your words if honestly.

  2. Good to hear from a researcher, being on the other side. Makes it less stressful for us patients on the other side. Thanks.

    1. It definitely has given me a new perspective.

  3. I just took a stress test to get clearance to go on a difficult hike and felt bad after because I had to stop when my legs felt like they couldn’t go anymore. I was told I needed to get at least 85% of something and I got well past that but I just felt like I could have done better. So I feel a bit more relieved after reading your post, especially after the part where you wrote that the test isn’t meant to make you feel good at the end. Haha!

    1. Thanks for the comment and good to hear it everything turned out okay. I imagine the doctor wanted you to get to at least 85% of your predicted heart rate maximum (usually calculated as 85% of 220 minus your age).

      I had that same feeling after my test- my legs felt awful, but the rest of me felt okay. I’m not a runner so running at an incline was definitely not fun. 🙂

  4. Just wanted to say thank you best advise I have read. I have been stressing about the stress test having severe anxiety doesn’t help.

    1. Thanks for the comment and glad to hear it helps. I hope your test goes well.

  5. I have taken lots of stress echos and get totally stressed each time. I read your article before taking my stress echo today and I felt the best I have prior to doing it and while doing it! The article made me laugh because I’ve done all the things you mentioned such as practicing ahead of time on my treadmill to be at top performance. The test has always been competitive for me and I have always have wanted to ‘pass’ it. That never seems to happen with severe mitral valve insufficiency. So thanks for an article that actually relaxed me and made me chuckle.

    1. That’s great to hear! I’m glad you liked the article and your stress test went well. I have my next one in September. Thanks for the comment and sharing!

  6. I have A-Fib and am worried about having a stress test, especially if the Dr, decides
    on a nuclear ( if I cant do regular test – we both think I am not going to be able to do that) Question 1: is the nuclear safe since I have a-fib and take Coumadin?
    Question 2: I am scheduled for an Echocardiogram two weeks after the stress
    test, is that common? and why cant I have both at same time?
    ( i had a heart attack in 2011 and had stents put in))
    I loved your post and feel you understand the worries in my mind, I hope you will
    answer my questions and I appreciate it very much. Thank you Doctor Lear.
    Grammy Judith

    1. Hi Judith, thanks for the questions.

      For your first question, these tests are regularly done in people with atrial fib for diagnosing and checking on progress of the condition. But you can always call your doctor’s office to check.

      For your second question, I had my annual stress test and echo just a few weeks ago. Originally they were booked two weeks apart (as yours are) but then I had to change the echo and they booked it on the same day as my stress test (a few hours later). I did ask if that was a concern and they said it wasn’t. I imagine you had them booked different days due to scheduling (or what was available). In my hospital, the echo and stress test are done in different places so they book them independently. Of course it is easier to have them done in the same day (saves time and travel). You could call them and see if they have a day when you can do both.

      I hope that helps. I always find getting a good sleep in the days before helpful and not planning to do anything (or much of anything) after the stress test. No matter how much I exercise, I am always tired for the rest of the day after the test.

      Take care,
      Scott

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