Exercise Tollerance Test

Functional assessment of the heart

A resting ECG is a useful tool but even normal finding cannot exclude the possibility of significant ischaemic heart disease. If angina is suspected, a more suitable test is and exercise tolerance test (exercise ECG or treadmill test); a recording of your heart beat while your heart is working harder than normal. It is similar to an ECG except that you are walking on a treadmill while the recording is taken. At the treadmill will move very slowly and gradually, as you become used to the pace, the workload will be increased. You will be under close supervision and your heart rate, blood pressure and ECG will be carefully monitored. You will be asked to report any chest discomfort during the test.

Indications

Diagnosis of coronary artery / ischaemic heart disease according to risk factors of smoking, family history of coronary artery stenosis, hypertension, diabetes and high cholesterol. Although the test has a good positive predictive value it’s ability to exclude coronary artery disease is inferior to other tests such as stress echocardiography or angiography.

Assessment of ‘fitness’ / exercise tolerance in certain conditions and occupations, e.g. DVLA criteria for drivers, the police force and some cardiomyopathies.

Diagnosis and assessment of non-life threatening arrhythmias (heart rhythm problems) provoked by exercise.

Risks and complications

There is a small risk of complications, including palpitations, chest pain, shortness of breath, headache, nausea or fatigue. The risk of serious complications, such as significant heart rhythm problem or heart attack, is extremely small and Dr Kirk and the technicians are very experienced at this technique, all the necessary resuscitation equipment and backup to deal with any emergency is available, so reducing the risks to the minimum.

Before the procedure

It is important that you eat only light meal stop drinking 2 hours prior the test. You should avoid strenuous exercise for 4 hours prior the test and refrain from smoking for 24 hours.

Please stop any of medication listed below for 48 hours (i.e last dose taken 72 hours prior the test): beta-blockers, e.g. Atenolol, Bisoprolol, Carvedilol, Labetalol, Metoprolol, Nebivolol, Propranolol, Timolol, calcium channel blockers, e.g. Diltiazem, Verapamil and Ivabradine. Some of these drugs may be known by other names (brand names). If in doubt, check with your pharmacist or doctor. Please also bring the actual list of medication including dosage.

The test will be supervised by Dr Kirk and performed by a cardiac physiologist. Just before the procedure, Dr Kirk will again explain the test to you and answer all your questions. The physiologist will introduce herself to you and take you into the room where the test is to be performed. She will ask you to take your clothing off above the waist, and to sit down. Electrodes will be put on your chest, your blood pressure will be taken and women will be offered a gown. Since we need direct access to the chest ladies are advised to wear trousers or a skirt rather than a dress and it is important that you bring sensible shoes that you can walk in safely.

During the procedure

You will be asked to step on the treadmill and to start walking at a slow pace up a small slope. The speed and slope will increase slightly every three minutes and your blood pressure will be taken regularly. You should keep the physiologist informed of how you are feeling, if you are experiencing any pain or if you are starting to feel short of breath or just getting tired.

If you feel you cannot continue the test will be stopped but it is important that you do as much exercise as you possibly can in order for the results to be meaningful.

Once the test has finished, the physiologist will ask you to sit back in the chair and your heart will be monitored with ECG and blood pressure machine until it returns to its resting rate. You will then be told you can go home. The whole test takes approximately 30 minutes.

Dr Kirk will review and analyse your exercise test and if the characteristic changes on ECG are present, it is a strong indication of ischaemic heart disease. The effect of exercise on the blood pressure will also be assessed and can help in guiding therapy.

After the procedure

Dr Kirk will explain you the results of the exercise ECG and arrange further tests, treatment and follow-up as appropriate. A letter will be sent to your GP confirming this information. You will be able to eat and drink and allowed home.