Who Should Not Have a Stress Test?
It is important to discuss with your doctor the risks, benefits, and alternatives of a stress test. Specifically, you should review medical conditions and diagnoses that make the test dangerous. Depending upon the type of stress test, different risks apply. If you think you may have any of the conditions below mention it to your doctor prior to the test.
The medical staff supervising your stress test will review your medical record, conduct a brief physical examination and may ask you specific questions about your medical history and recent symptoms. If a reason to not perform the stress test is suspected your test may be canceled or postponed. Further evaluation may be necessary prior to rescheduling.
Exercise Stress Test: Reasons to Definitely Not Have the Test
You should definitely not have an exercise stress test if any of the following apply to you:
- Unstable angina and high risk for CAD
- Heart attack (myocardial infarction) within the last 4 days
- Poorly controlled congestive heart failure
- Very high blood pressure (>200/110 mm Hg)
- Uncontrolled cardiac rhythms (unstable arrhythmias)
- Severe narrowing of the aortic valve (severe aortic stenosis)
- Recent (acute) blood clot in the lungs (pulmonary embolism)
- Inflammation of the heart (myocarditis) or the tissues surrounding the heart (pericarditis)
- Acute tear of the aorta – a major artery leading out of the heart
- Severely elevated blood pressure in the lungs (pulmonary hypertension)
Exercise Stress Test: Reasons to Probably Not Have the Test
You should probably not have an exercise stress test if any of the following apply to you:
- Obstruction of a major coronary artery known as the left main coronary artery
- Moderate narrowing of the aortic valve (moderate aortic stenosis)
- Blockage to the exit of blood out of the heart (outflow tract obstruction)
- Significant slow or fast heart rhythms
- Abnormal conduction of electrical impulses through the heart (AV block)
- Abnormal salt levels in the blood (electrolyte abnormalities)
- Mental or physical impairment preventing adequate exercise
If a medical condition or physical symptoms such as back or leg pain prevents you from walking on a treadmill at an incline, let your doctor know. Also tell your doctor if you don’t think you’ll be able to exercise to a level approximating rapidly climbing one flight of stairs. Finally, communicate to your doctor if you have never used a treadmill or feel anxious about doing so. Alternate methods besides the treadmill can be used. These include a medical, or pharmacologic, stress test.
Exercise Stress Test With Imaging: Reasons to Not Have the Test
In some cases pictures of your heart (imaging) are included in the stress test. These can be done with an ultrasound machine (echocardiography) or with a nuclear camera.
In addition to the risks listed above, several other issues apply to an exercise stress test which includes imaging. Importantly, it’s not the imaging that adds additional risk. Instead, the pictures can show an abnormality that is not really there (false positive) if you have these conditions. A pharmacologic stress test (see below) may be appropriate in these situations.
- Conduction abnormality known as a left bundle branch block (LBBB)
- Heart rhythm controlled by a pacemaker
- Inherited conduction abnormality (Wolff-Parkinson-White syndrome)
Pharmacologic Stress Test: Reasons to Not Have the Test
A pharmacologic stress test can be used to evaluate your heart if you have one or more of the above conditions. This type of test can be done while you are laying or sitting; no treadmill is required. Alternatively, a very low-speed walk on a treadmill can minimize some of the side effects of the pharmaceutical agents used during a stress test. Your doctor and you should discuss whether this combination is appropriate.
Reasons to not have a pharmacologic stress test depend on the specific agent used to mimic exercise. Make sure to discuss your specific risk with your doctor prior to the test.
Reasons to Avoid an Adeonsine or Dipiridamole (Persantine) Stress Test:
- Active asthma (wheezing)
- Conduction abnormalities of the heart (heart block)
- Low blood pressure (systolic <90mm Hg)
- Slow heart rate (<40/minute)
- Use of dipiridamole, dipiridamole-containing medications within 24 hours
- Ingestion of caffeinated drinks (soda, both regular and decaf coffee, and tea) or foods (chocolate) within 12 hours
- Allergy to adenosine or dipyridamole
- Unstable chest pain or myocardial infarction
Reasons to Avoid a Dobutamine Stress Test:
- Heart attack within one week
- Unstable angina
- Significant blockage of blood leaving the heart (outflow tract obstruction)
- Severe narrowing of the aortic valve (severe aortic stenosis)
- Fast heart rhythms (atrial tachyarrhythmias with uncontrolled ventricular response)
- History of a dangerous heart rhythm called ventricular tachycardia
- Very high blood pressure (>200/110 mm Hg)
- Damaged aorta (dissection or aneurysm)
- If you take beta-blockers
Sources:
ACC/AHA 2002 Guideline Update for Stress Testing
ACC/AHA/ASNC 2003 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging