By Bob Hobbs, APRN, MBA
With Healthcare reform focusing on more preventative services we wanted to discuss a diagnostics/screening test that has been around for years. The stress test was developed in 1928 and has been used since 1929 to help diagnose and screen patients with various heart related problems. It has evolved into a cardiac investigative test. Technological improvements over the years have led to the decrease in costs of performing this test which makes it available to more facilities. Patients are being screened now at the primary care level. In this article we will discuss the basics of a cardiopulmonary exercise stress test (CPET), discuss how the results of the test are used, and which patients should be asking their provider more about this test.
What is the CPET Stress Test?
While there are several types of stress tests that are performed such as a Dobutamine or Adenosine Stress Test (chemical stress test for those patients unable to exercise), stress echocardiogram, and nuclear stress test, we will focus on the treadmill or bicycle exercise stress test.
This test measures your cardiovascular, pulmonary and metabolic systems simultaneously. The test will start with a breathing study to determine your resting lung function, followed by a resting EKG to determine a baseline reading of your heart rhythm. As the name suggests there is exercise involved with this test, you will start walking on a treadmill or ride a stationary bike with a gradual increase in resistance until you reach your target heart rate (based on age and gender) or until you feel it is necessary to stop. Most patients will reach their target heart rate in about 7-10 minutes. During the test your blood pressure, oxygen level, breathing rate, heart rate, and EKG will be monitored. Once the exercise portion of the test is complete, a breathing test and resting EKG will be performed again.
How are the results used from the stress test?
Your health care provider uses the results of the CPET stress test in several ways:
- As a preventative screening tool to establish a baseline of your cardiac condition, help develop a safe exercise program, and to determine the likelihood of heart disease or further testing.
- As a diagnostic tool to determine abnormal heart rhythms during exercise, to determine if there is adequate blood flow to your hear during increased levels of activities, to evaluate effectiveness of heart medications, and to assess benefits of procedures performed on the heart. In addition, it helps determine if the patient has any abnormal pulmonary function and can help determine if the patient has asthma or related pulmonary diseases.
The CPET can help your provider determine whether your symptoms are due to a medical problem (such as heart or lung disease) or due to poor fitness. This test helps to determine the proper course of treatment, whether it be prescription of medication, referral to cardiac or pulmonary specialists, exercise prescription or monitoring changes of your condition.
Who is a candidate for the stress test?
Typically, patients who has a history of any of the following:
- A family history of heart disease
- Shortness of breath
- Sleep Apnea
- Chest pain
- Congestive Heart Failure
- Starting an exercise program
While some of these health issues are very apparent, such as chest pain, for the patient to seek immediate assistance with follow up testing, screening patients who have been sedentary and are starting an exercise program, particularly middle aged men, can help prevent that “heart attack waiting to happen.” If you have current health issues such as diabetes, hypothyroidism, sleep apnea, obesity, fatigue, or shortness of breath then speak with your primary care provider about having a screening test performed. In addition, if you are starting an exercise program or have had a family history of heart disease you may want to speak with your primary care provider about scheduling a cardiopulmonary exercise stress test. As Benjamin Franklin said, “an ounce of prevention is worth a pound of cure.”
Where can I have it performed?
Several outpatient centers, cardiologists’ offices, and some primary care offices can perform this test. This test does require a health care providers order and requires supervision by the provider. Since this is a preventive screening test it is covered by health insurance.
Image from: www.junipermed.com
Bob Hobbs, APRN is a nurse practitioner for Louisville Lifestyle Medicine, a primary care office in northeastern Louisville. Bob has over 15 years experience helping patients with their health and fitness needs. Bob is an avid triathlete and has completed over 50 triathlons, including three Ironman triathlons. You can reach Bob by email at firstname.lastname@example.org and get further information at www.louisvillelifestylemedicine.com.