Who Needs Stress Testing?

You may need a stress test if you've had chest pains, shortness of breath, or other symptoms of limited blood flow to your heart. Imaging stress tests are particularly helpful in showing whether you have coronary artery disease (CAD) or a problem with one of the valves in your heart. (Heart valves are like doors that let blood flow between the heart's chambers and into the heart's arteries. So, like CAD, faulty heart valves can limit the amount of blood reaching your heart.)

If you've been diagnosed with CAD or recently had a heart attack, you may need stress testing to see whether you can tolerate an exercise program. The testing also can show whether treatments designed to improve blood flow in the heart's arteries are necessary and likely to help you. These treatments include angioplasty (with or without stents) and coronary artery bypass grafting. After having one of these treatments, your doctor may want you to have a stress test to see how well the treatment relieves your signs or symptoms of CAD.

You also may need a stress test if, during exercise, you feel faint, get a rapid heartbeat or a fluttering feeling in your chest, or have other symptoms of an arrhythmia (an irregular heartbeat). The stress test can detect an arrhythmia and show whether you need medicine or a pacemaker or implantable cardioverter defibrillator (ICD) to correct irregular heartbeats. It also can reveal the effectiveness of such devices.

You may need a stress test even if you don't have chest pain when you exercise, but just get short of breath. The test can help show whether a heart problem, rather than a lung problem or being out of shape, is causing your breathing problems. For such testing, you breathe into a special tube so a technician can measure the gases you breathe out.

Breathing into the special tube and monitoring of the heart as part of a stress test also is done to assess fitness before a heart transplant. Your doctor also may use this monitoring to figure out the best exercise plan for you after recovery from a heart attack.

Stress testing isn't routinely done to screen people for CAD. Usually you have to have symptoms of CAD before a doctor will recommend that you have a stress test. But your doctor may want to use a stress test to screen for CAD if you have diabetes, which increases your risk for developing CAD.