Your doctor will likely do the following:

• Physical exam
• Resting electrocardiogram (ECG, EKG) a test that records the heart's activity by measuring electrical currents through the heart muscle
• Echocardiogram a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart and the function of its valves
• Review of medications; some should not be taken before testing

In the time leading up to your procedure:

• Do not eat or drink products with caffeine for 12-24 hours before testing
• Do not eat or drink anything except water for four hours before testing
• Do not smoke for several hours before testing
• Wear comfortable clothing and walking shoes or exercise sneakers
• Bring a list of your current medications to the test
• If you have diabetes , bring your glucose monitor to the test

• An IV may be started prior to the test if a thallium stress test is planned
• Continuous ECG and intermittent blood pressure monitoring

No anesthesia will be administered.

The technician checks your blood pressure, attaches electrocardiogram electrodes (small adhesive patches with wires that connect to an ECG machine) to your chest and arms, and performs a resting ECG.

The cardiac stress test is done either on a treadmill (most common) or a stationary bike. You slowly start walking or riding. At 2 or 3-minute intervals, the technician increases the speed and elevation or resistance to make the exercise more strenuous. The technician closely monitors the ECG, blood pressure, and your symptoms to assess the status or your heart. Try to exercise until you are exhausted or you have reached the target heart rate.

Report any chest discomfort, dizziness, lightheadedness, pounding in your chest, extreme shortness of breath, or other symptoms to the technician. The test may be stopped early if you complain of excessive fatigue, chest pain, shortness of breath, or any symptoms that suggest heart problems, or if the technician observes significant changes in the ECG. After exercising is complete, blood pressure, heart rate, and ECG monitoring continues until levels return to normal.

In conjunction with a cardiac stress test, a doctor will sometimes order a blood-flow imaging exam, called a thallium stress test. A small amount of thallium, which is a radioactive material, is injected into a vein during maximal heart rate. You'll continue exercising for about another minute, to allow the substance to circulate and enter cardiac cells. Scans are taken while you lie in different positions under a special camera. The images help identify areas of the heart muscle that may not be receiving enough oxygen. A second set of images is taken about an hour later, after you have rested.

You may resume normal activities including eating.

The exercise portion of the test generally takes less than 15 minutes, but with monitoring before and after the test, expect your appointment to last an hour. A thallium test may take up to 3-4 hours.

Exercise testing normally causes no pain.

• Chest pain (angina)
• Irregular heart rhythm
• Heart attack (rare)

A cardiac stress test presents minimal risk and is not considered any more dangerous than walking quickly uphill. Technicians are alert for any signs of cardiac problems, such as chest pain or irregular heartbeats, and are prepared to take immediate action if complications develop. A doctor (usually a cardiologist) will be readily available during the stress test as well.

This procedure does not usually require a hospital stay.

There are no actions required once the test in complete.