An exercise stress test entails walking on a treadmill while your heart is continuously monitored with an electrocardiogram (ECG). An ECG is obtained by placing electrodes on your chest which can detect the electrical impulses from your heart. Your doctor personally monitors the ECG while you are exercising looking for changes in the heart rhythm or any other changes that may be suggestive of blockages in your coronary arteries. If your doctor is suspicious that some of your symptoms may be due to a lung problem, you may also have the oxygen content of your blood monitored while you exercise by a device called an oximeter. This device hooks onto either your finger or your ear and is a painless way to measure the oxygen level in your blood.

A treadmill test is used to detect significant heart and/or lung disease that may not be apparent with a resting ECG.

A treadmill stress test is done to:

• evaluate chest pain to determine if the chest pain is due to blockages in your coronary arteries.
• evaluate palpitations to see if there is serious problem with the rhythm of your heart.
• determine a safe level of exercise after a heart attack.
• give advice to a sedentary person who is contemplating a more vigorous exercise program.

• Do not eat for 2 hours prior to the test.
• On the day of your test, do not drink any beverages containing caffeine.
• On the day of your test, do not smoke. In fact, if you do smoke, you should ask for the Dubuque Internal Medicine patient education pamphlet entitled "Kicking the cigarette habit".
• CLOTHING: you should wear comfortable clothing (A two piece outfit is preferred). Also, bring shoes that are suitable for walking on a treadmill.
• Most of the time, you should take your medications as usual on the day of your test. If you are not sure if you should take your medications on the day of your exercise stress test, please ask your doctor.

Please allot at least 1¹/₂ hours for the entire procedure. You need to report to the reception area about 30 minutes prior to the time your treadmill is scheduled. A nurse will take you the stress room or to a room directly connected to the stress room. If you are not wearing suitable clothing, you will be asked to put on a patient gown. Electrodes need to be placed on your chest wall. If you have hair on your chest, the nurse will need to shave areas where the electrodes will be applied. In addition, the nurse may need to rub your skin with sandpaper to help the electrodes stick to the skin. Finally, an ACE bandage will be wrapped around your chest to assure that the electrodes do not fall off while you are walking on the treadmill. Before you begin exercising, the nurse will get three electrocardiograms at rest (lying down, sitting and standing). The nurse will then explain to you the proper way to get on the treadmill so that you can safely start walking on the treadmill.

The doctor and the nurse will both be present with you during your treadmill stress test. Either the nurse or the doctor will be checking your blood pressure periodically during the test. In addition, the physician will be watching the electrocardiogram for any changes. If you have any symptoms, especially symptoms that are similar to those symptoms that prompted your doctor to recommend the treadmill test, please tell the doctor. Your doctor especially wants to know if you develop any symptoms like chest pain, chest tightness, dizziness, lightheadedness, shortness of breath, fatigue or leg pain. The treadmill generally starts at a reasonably slow pace and gets progressively faster and steeper. If you believe you can not keep up with the treadmill when it first starts, your physician may elect to immediately stop this test or try doing the test at a slower speed.

Your physician will immediately interpret the results of the treadmill stress test and will discuss the results with you. If you want your family to be present for this discussion, please let the nurse know. Occasionally, your doctor may want to discuss the results of the test with a cardiologist before deciding the next step. If additional tests are necessary to evaluate your symptoms, these tests can be scheduled before you leave.

When a stress test is performed at Dubuque Internal Medicine, the cost of this test is $270.

If you have symptoms (shortness of breath, fatigue, chest pain, dizziness, or palpitations), most insurance companies will provide coverage for this test. If you have no symptoms of heart problems and the test is being done solely for screening purposes (that is, you may have a family history of heart disease or you are simply over age 50 and want to know if it is safe to begin a vigorous exercise program after years of being sedentary), your insurance company may not cover this test. If you are not certain of coverage, please contact your insurance company.

We hope this brochure has been helpful in answering any questions you may have had regarding your exercise treadmill test. If you have additional questions before your test, please call your physician at 563-557-9111.