What is it?
The stress test, also known as an exercise test or ergometry, is a common study used to diagnose coronary artery disease and to assess a person’s exercise capacity. It evaluates the heart’s response during physical exertion. During the stress test, an echocardiogram may also be performed (known as a “stress echocardiogram”), or radioactive isotopes may be injected into the bloodstream (referred to as a “nuclear stress test”). These studies provide more detailed information about the heart’s structure and blood flow.
At Clínica Magnasalud, a treadmill is available for conducting stress tests. Compared to a stationary bike, the treadmill more often allows for reaching target heart rates and exercise capacity. This is because walking is a more natural activity for most people than cycling, making it the most commonly used method in clinical practice.
How is it performed?
Before conducting a stress test, a physical examination, medical history, and electrocardiogram (ECG) are performed. Ten electrodes are initially placed on the chest to monitor the ECG. The Bruce protocol is primarily used, consisting of a series of 3-minute stages with progressively increasing speed and incline.
A continuous ECG is monitored, with readings taken at rest, during each stage, and after exercise ends. Blood pressure is measured at the beginning, during each stage, and multiple times during recovery. The goal is to reach the maximum heart rate for the patient’s age (220 minus age), at which point the test is stopped, or earlier if limiting symptoms occur (chest pain, fatigue, dizziness). The test is considered valid in patients suspected of ischemic heart disease if they exercise for at least 5 minutes and reach 85% of their age-based maximum heart rate.
The report will include the protocol used, when the test was stopped, the metabolic equivalents achieved (known as METs), and whether there are ECG signs of coronary artery disease (ischemia or reduced blood flow), including onset, duration, and extent. It also notes whether chest pain occurred, when it started and resolved, any arrhythmias, blood pressure and heart rate responses to exercise, and overall physical capacity for age.
What is it for?
A stress test can often detect coronary artery blockages before symptoms appear. This enables early intervention to prevent complete obstruction and the potential for a heart attack.
Most common indications:
- Diagnostic and prognostic evaluation of ischemic heart disease (myocardial infarction, angina, etc.)
- Assessment of physical capacity in other conditions: valvular disease, heart failure.
- Evaluation of pacemaker need in patients with fatigue during walking and slow heart rate.
- Assessment of exercise-induced arrhythmias.
- Evaluation of functional capacity and training programs in athletes (including oxygen consumption and anaerobic threshold measurements).
- Pre-exercise assessment in individuals over 35–40 years old.
How to prepare for the test:
- Wear comfortable sports clothing and footwear.
- Do not eat, drink coffee, alcohol, or smoke within 3 hours of the test.
- Avoid intense physical activity or exercise within 12 hours before the test.
- Consult your doctor to determine if any medications should be stopped 2 days before the test.
Stress test complications:
It is considered a safe procedure, with an estimated risk of one fatality per 10,000 tests. The highest risk is in patients with recent myocardial infarction, prior arrhythmias, or advanced heart disease. Although rare, complications during the test may include heart attack, heart failure, loss of consciousness due to low blood pressure, and arrhythmias. The latter are the most common but are usually temporary.
The patient must sign an informed consent form prior to the test, which outlines the procedure, possible complications, and includes the names and signatures of the doctor and patient.
If there is concern about possible coronary artery disease, athletic safety, or general heart health, it is advisable to consult a specialized physician.
Stress test with echocardiogram
The echocardiogram (or heart ultrasound) is a diagnostic test that provides a moving image of the heart, offering information about its shape, size, function, strength, wall motion and thickness, and the performance of its valves. It can also reveal details about pulmonary circulation and pressure, the initial portion of the aorta, and detect fluid around the heart (pericardial effusion). By combining a stress test with an echocardiogram, it is possible to assess:
- Diagnosis and prognosis of ischemic heart disease (heart attack, angina, etc.)
- Physical capacity in other heart conditions: valvular disease, heart failure.
- Need for a pacemaker in patients with fatigue when walking and low heart rate.
- Exercise-induced arrhythmias.
- Pre-participation evaluation before starting a sport.
Both tests are performed at the clinic by a cardiologist, who will interpret the results and provide a full report.
Stress test fees
- Stress test: €110
- Stress test + echocardiogram: €160
Both options include a physical examination, medical history review, cardiologist evaluation, and a written report.