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In a stress test, you walk on a treadmill that makes your heart work progressively harder. An electrocardiogram (ECG) monitors your heart's electrical rhythms. The doctor also measures your blood pressure and monitors whether you have symptoms like chest discomfort or fatigue. Abnormalities in blood pressure, heart rate, or ECG or worsening physical symptoms could point to coronary artery disease (CAD): fatty deposits (plaques) that reduce the flow of oxygen-rich blood to the heart muscle.
If stress testing were 100% accurate, everyone would be having them regularly. But stress testing doesn't accurately diagnose all cases of CAD, and sometimes it points to CAD in people who do not actually have the condition. "The test result is never, by itself, certain," Dr. Bhatt says. "It can be used to move the probability up or down of there being coronary artery disease. It can't absolutely rule it out or diagnose it."
For men with symptoms like chest pain with activity or unexplained shortness of breath, an abnormal stress test points to a higher risk of CAD. But it's more worrisome in a man who also has risk factors like older age, being overweight, or high cholesterol. "This points strongly to coronary artery disease." Dr. Bhatt says. Confirming it could require further testing.
If you have symptoms and the test result looks normal, the risk of CAD is lower. "That person is less likely to have significant coronary artery disease," Dr. Bhatt says. Even so, the doctor might still want to do more tests.
But it's important to understand that a "normal" stress test can't rule out the chance that a plaque will later rupture and block an artery the proverbial tale of the man who passes a stress test with flying colors and then has a heart attack a week later. Stress testing detects arteries that are severely narrowed (70% or more). This is what causes symptoms. Heart attacks often result from lesser blockages that rupture and form clots.
The U.S. Preventive Services Task Force, an independent panel that makes recommendations to doctors, urges physicians not to routinely offer exercise stress testing to people without symptoms or strong risk factors for CAD. Physician groups like the American College of Cardiology support this recommendation.
The final decision, though, falls on you and a doctor who knows your health profile. "The guidelines leave a lot to physician judgment, because we're sometimes in a gray zone where we don't really know what's the 'right' thing to do for everyone," Dr. Bhatt says.
Although the tide has turned against exercise stress testing of otherwise healthy men concerned about their heart risk, guidelines say that a stress test could be "considered" in a man who is older and relatively inactive but embarking on a vigorous new exercise program. "In that case I would recommend a stress test," Dr. Bhatt says.
An exercise stress test is designed to find out if one or more of the coronary arteries feeding the heart contain fatty deposits (plaques) that block a blood vessel 70% or more. Additional testing is often required to confirm the test result.