Explore the importance of listening to your heart for cardiovascular health with Meri Sehat. Prioritize heart care for a healthier life.

Listen To Your Heart

The Father of Exercise Cardiology, Dr. Bruce, was a professor of medicine at the University of Washington. He was the one who developed the test, which is nowadays taught as the Bruce Protocol in medical schools.

Before the said protocol became so popular, all the cardiologists used an electrocardiogram or, simply put, an ECG for the purpose that yielded inefficient results. If not the ECG, an early stress test called the Master's two-step was done.

Introduction

This was a 1935-developed testing modality in which patients were supposed to take an ECG at rest. They were then asked to step on and off a small platform for almost 90 seconds, and then finally got another ECG. Considering the length of time it has taken me to make it sound logical, I can understand why patients had a hard time finishing the test<a href="#accordion">[1]</a>.

A pharmacological nuclear stress test is essentially an imaging test that your doctor orders to visualize how the blood flows to the heart. It is also called Cardiac Pharmacologic Nuclear Stress Testing or a Chemically Induced Stress Test and makes use of FDA-approved drugs for stress testing, including adenosine, dipyridamole, and dobutamine.

The test results enable your healthcare provider to diagnose any heart conditions if they exist and suggest treatment plans<a href="#accordion">[2]</a>. 
&nbsp;

Understanding Heart Health: The Importance of Stress Tests

The test can be divided into two parts in which your healthcare provider takes two sets of images. Your doctor will<a href="#accordion">[2]</a>:

<ol>
	<li>Inject a radiotracer into a vein in your arm or hand.</li>
	<li>Take the first set of images to determine how your blood vessels and heart functions at rest.</li>
	<li>Administer a medication after the images are taken to dilate your blood vessels in the heart and increase the flow of the blood, mimicking an exercising effect.</li>
	<li>Take the second set of images to assess how well your heart and blood vessels work under stress. 
	&nbsp;</li>
</ol>

There are a variety of symptoms that alert your doctor and lead him to order a stress test. Signs and symptoms that may warrant the test include<a href="#accordion">[4]</a>:

<ul>
	<li><a href="https://merisehat.pk/disease/angina">Angina</a>, which is chest pain caused by reduced blood flow to the heart muscles</li>
	<li>Arrhythmia, which is an irregular heartbeat</li>
	<li>Shortness of breath 
	&nbsp;</li>
</ul>

A stress test can also be used to evaluate how well your heart responds to treatment or how well your heart&rsquo;s recovering after a heart attack. For this reason, an exercise stress test is done while you walk on a treadmill. The speed and incline are increased slowly to get your heart to pump harder. 
&nbsp;

If you have difficulty maintaining their balance or walking, a stationary bike can be used instead of the treadmill.

If it is difficult for you to get on a treadmill or stationary bike for an exercise stress test because of your health, then a chemical stress test can be used as it mimics an increase in your heart rate as if you were exercising. 
&nbsp;

A chemical stress test is usually recommended in case of:

<ul>
	<li>Arthritis</li>
	<li>Back problems</li>
	<li>Joint deformities</li>
	<li>Previous history of stroke</li>
	<li>Chronic obstructive pulmonary disease or other respiratory conditions</li>
	<li>Unsteady gait</li>
	<li>Pacemaker implantation 
	&nbsp;</li>
</ul>

A nuclear stress test is considered quite safe and complications rarely occur. However, like any medical procedure, there is a risk of complications, which include<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>
	Abnormal Heart Rhythms (Arrhythmias)
	</li>
</ul>

Arrhythmias, which occur during a stress test, go away on their own soon after you are done exercising or when the effect of the medication wears off. Nevertheless, fatal arrhythmias are rare.

<ul>
	<li>Heart Attack</li>
</ul>

Even though it is extremely rare to happen, a nuclear stress test may lead to a heart attack.

<ul>
	<li>Low Blood Pressure</li>
</ul>

Your blood pressure might drop during or right after the exercise, making you feel dizzy or even faint. However, it subsides after you have stopped exercising.

<ul>
	<li>Dizziness Or Chest Pain</li>
</ul>

You can feel a bit dizzy during a nuclear stress test.

<ul>
	<li>Other</li>
</ul>

Some people have also reported feeling nauseous, headache, flushing, shortness of breath, and anxiety during the stress test. But these symptoms are mild and short-lived.

Note: Always tell your doctor about any symptoms you experience during a stress test. 
&nbsp;

Radiation And Your Safety: As discussed above, the test involves a radiotracer, hence, some degree of radiation stays in your body for a little while. To avoid complications, you should:

<ul>
	<li>Avoid holding babies or small children for the rest of the day</li>
	<li>Drink water as it will help flush the substance from your body 
	&nbsp;</li>
</ul>

The medications you are administered during a pharmacological nuclear stress test can cause side effects, like:

<ul>
	<li>Chest pain</li>
	<li>Dizziness</li>
	<li>Headache</li>
	<li>Low blood pressure (hypotension)</li>
	<li>Nausea</li>
	<li>Shortness of breath (dyspnea) 
	&nbsp;</li>
</ul>

An isotope treadmill stress test can diagnose important diseases in around 80% of patients with coronary artery disease. That is, it&rsquo;s reliable if you can achieve the targeted heart rate in cases of dobutamine or an appropriate drop in the diastolic blood pressure with dipyridamole, and if good-quality images are obtained<a href="#accordion">[5]</a>.

Almost 10% of the patients get a &quot;false-positive&quot; test, i.e., the result is falsely abnormal in a patient who does not have coronary artery disease. This occurs if a patient is overweight, they may experience technical problems.

Women are more likely than men to have an abnormality at the front of the heart because of the overlying breast tissue. Men present with an inferior wall abnormality because of a prominent diaphragm. Also, generally, individuals with a left bundle branch block on EKG will present with a false positive. 
&nbsp;

Your doctor will compare the two sets of pictures taken during the test and will discuss the results with you. 
&nbsp;

1. Normal Blood Flow During Exercise And Rest

This means everything&rsquo;s normal and you do not need further evaluations.

2. Normal Blood Flow During Rest, But Not During Exercise

This means that a part of your heart is unable to receive enough blood supply when you exercise. This can even hint at coronary artery disease, i.e., you may have one or more clogged arteries.

3. Low Blood Flow During Rest And Exercise

A part of your heart is not getting the required amount of blood at all times, which is an indication of severe coronary artery disease or an earlier heart attack.

4. Lack Of Blood Flow In Parts Of Your Heart

If the radioactive tracer administered did not show up in multiple areas of your heart, it means that they have been damaged from a heart attack. 
&nbsp;

Conclusion

Your heart is an important organ. Despite knowing this, some of you do not take care of it as you should. All you have to do is show up and get yourself checked. So, what is going to be this time, are you going to listen to your heart or wait till some doctor tells you something which makes it explode? 
&nbsp;

Key Takeaways

<ul>
	<li>A pharmacological nuclear stress test is essentially an imaging test that your doctor orders to visualize how the blood flows to the heart.</li>
	<li>The test makes use of FDA-approved drugs for stress testing, including adenosine, dipyridamole, and dobutamine.</li>
	<li>Signs and symptoms that may warrant the test include angina, arrhythmia, and shortness of breath.</li>
	<li>A chemical stress test is usually recommended in case of arthritis, back problems, and joint deformities.</li>
	<li>A nuclear stress test is considered quite safe and complications rarely occur.</li>
	<li>An isotope treadmill stress test can diagnose important diseases in around 80% of patients with coronary artery disease.</li>
	<li>Normal blood flow during rest but not during exercise means that a part of your heart is unable to receive enough blood supply when you exercise.</li>
	<li>Low blood flow during rest and exercise means a part of your heart is not getting the required amount of blood at all times, which is an indication of severe coronary artery disease or an earlier heart attack.</li>
</ul>

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