My Dr. is sending me to a cardiologist for a stress test. I understand there are different types. What r they?

Stress studies can be accomplished with either with exercise (such as a treadmill - though in Europe they use stationary bikes) or with infused medicine. Additional studies are usually coupled with the test to give it more sensitivity and specificity (really shows heart disease when its there)

Within the medicine category two typical types exist -

1. vasodilators (such as adenosine)

2. adrenergic stimulation (such as dobutamine, a cousin to adreniline)

The adrenergic stimulation medication or a treadmill can be coupled with an echocardiogram (Ultrasound) to evaluate heart wall motion during stress.

All three types above (TM, vasodilator, adrenergic) can be coupled with a nuclear scan. An injection is done in the middle of the stress portion. The tracer gets to the heart muscle porportionately to the blood supply at that moment. An initial scan is done for comparison (rest images). Changes in the porportional blood supply indicate the possibility of a critical blockage in the coronary artery - aka heart disease.

A treadmill study may be done by themselves too. The sensitivity and specificity of just a treadmill with accompanying EKG is reduced compared to either of the other modalites above (echo, nuc) - in women and the elderly there is a lot of difference.

Stress echocardiograms have a sensitivity of about 88%. Nuclear studies are slightly better at 90%.

There's a little bit of an art to deciding which test to order and which stress method to employ. It dependents on what you hope to test and what information you are seeking. Is it a matter of evaluating symptoms? Are you following up a cardiac procedure? Are you trying to evaluate the patient for surgical clearance?

All have slightly different conotations and selecting the right study will give you a better answer.

There is the traditional treadmill stress test, where the patient walks on the treadmill until their heart reaches a certain rate. Then, there is a chemical stress test where medicines are injected to cause the heart to speed up (stress). The chemical test is done in people who, for whatever reason, cannot walk on a treadmill (such as your leg injury). The chemical test can be unnerving because your heart will speed up. Remember that they are watching everything, and can stop at any moment if necessary.

Don't worry -- I couldn't do the treadmill either, so I needed to have the stress test with the medication. It also was a nuclear stress test, so I had an injection of radioactive material, too, for imaging.

What they'll do is start an IV and hook you up with wires on your chest like an EKG. Then they'll inject you will a medication that speeds your heart up as if you were exercising on the treadmill. For me, it felt really weird -- like my heart was beating in my throat and I felt the slightest bit breathless. But the staff was right there with me, reassuring me, as I know they'll be right there for you. The whole uncomfortable fast heart-beat part lasted like 2 or 3 minutes and then it was over. They just ran EKG's during that time, then I had pictures taken of my heart because it was a nuclear study.

The bottom line is, the test is safe, is not overly uncomfortable, and there is supportive, kind staff there with you the whole time.

The idea of a stress test is to work the heart up so that some things about the heart that would not show up at rest would reveal themselves. There are many ways to work up the heart; the threadmill is just one of them, maybe one of the most popular.

If for any reason you cannot use your leg, the cardiologist will find another way to exercise you. Why don't you let him figure that out?