Editing Cardiac stress test (section)

{{short description|Measures the heart's ability to respond to external stress in a controlled clinical environment}}
{{cs1 config|name-list-style=vanc}}{{Infobox medical intervention |
  Name        = Cardiac stress test |
  Image       = Stress test.jpg |
  Caption     = A male patient walks on a stress test treadmill to have his heart's function checked. |
  MedlinePlus = 003878 |
  ICD10       = |
  ICD9        = {{ICD9proc|89.4}} |
  MeshID      = D025401 |
  synonyms  = Cardiopulmonary exercise test|
}}
A '''cardiac stress test''' is a cardiological examination that evaluates the cardiovascular system's response to external stress within a controlled clinical setting. This stress response can be induced through physical exercise (usually a treadmill) or intravenous pharmacological stimulation of heart rate.<ref>{{Cite web |title=Stress Tests: MedlinePlus Medical Test |url=https://medlineplus.gov/lab-tests/stress-tests/ |access-date=2023-11-09 |website=medlineplus.gov |language=en}}</ref>

As the heart works progressively harder (stressed) it is monitored using an [[Electrocardiography|electrocardiogram]] (ECG) monitor. This measures the heart's electrical rhythms and broader [[Cardiac electrophysiology|electrophysiology]]. Pulse rate, blood pressure and symptoms such as chest discomfort or fatigue are simultaneously monitored by attending clinical staff. Clinical staff will question the patient throughout the procedure asking questions that relate to pain and perceived discomfort. Abnormalities in blood pressure, heart rate, ECG or worsening physical symptoms could be indicative of [[coronary artery disease]].<ref>{{Cite web |title=Exercise ECG |url=https://www.bhf.org.uk/informationsupport/tests/exercise-ecg |access-date=2023-11-09 |website=British Heart Foundation |language=en}}</ref>

Stress testing does not accurately diagnose all cases of coronary artery disease, and can often indicate that it exists in people who do not have the condition. The test can also detect heart abnormalities such as [[Arrhythmia|arrhythmias]], and conditions affecting  electrical conduction within the heart such as various types of fascicular blocks.<ref>{{Cite journal |last1=Ladapo |first1=Joseph A. |last2=Blecker |first2=Saul |last3=O'Donnell |first3=Michael |last4=Jumkhawala |first4=Saahil A. |last5=Douglas |first5=Pamela S. |date=2016-08-18 |title=Appropriate Use of Cardiac Stress Testing with Imaging: A Systematic Review and Meta-Analysis |journal=PLOS ONE |language=en |volume=11 |issue=8 |pages=e0161153 |doi=10.1371/journal.pone.0161153 |issn=1932-6203 |pmc=4990235 |pmid=27536775 |bibcode=2016PLoSO..1161153L |doi-access=free }}</ref>

A "normal" stress test does not offer any substantial reassurance that a future unstable coronary plaque will not rupture and block an artery, inducing a [[heart attack]]. As with all medical diagnostic procedures, data is only from a moment in time. A primary reason stress testing is not perceived as a robust method of CAD detection {{emdash}} is that stress testing generally only detects arteries that are severely narrowed (~70% or more).<ref>{{Citation |last1=Vilcant |first1=Viliane |title=Treadmill Stress Testing |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK499903/ |work=StatPearls |access-date=2023-11-09 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29763078 |last2=Zeltser |first2=Roman}}</ref><ref>{{Cite journal |last1=Schoenhagen |first1=Paul |last2=Ziada |first2=Khaled M. |last3=Kapadia |first3=Samir R. |last4=Crowe |first4=Timothy D. |last5=Nissen |first5=Steven E. |last6=Tuzcu |first6=E. Murat |date=2000-02-15 |title=Extent and Direction of Arterial Remodeling in Stable Versus Unstable Coronary Syndromes: An Intravascular Ultrasound Study |journal=Circulation |language=en |volume=101 |issue=6 |pages=598–603 |doi=10.1161/01.CIR.101.6.598 |pmid=10673250 |issn=0009-7322|doi-access=free }}</ref><ref>{{Cite journal |last1=Steeds |first1=Richard P |last2=Wheeler |first2=Richard |last3=Bhattacharyya |first3=Sanjeev |last4=Reiken |first4=Joseph |last5=Nihoyannopoulos |first5=Petros |last6=Senior |first6=Roxy |last7=Monaghan |first7=Mark J |last8=Sharma |first8=Vishal |date=2019-03-28 |title=Stress echocardiography in coronary artery disease: a practical guideline from the British Society of Echocardiography |journal=Echo Research and Practice |volume=6 |issue=2 |pages=G17–G33 |doi=10.1530/ERP-18-0068 |issn=2055-0464 |pmc=6477657 |pmid=30921767}}</ref>