What Do Cardiac Stress Tests Reveal?

Dr. Ahmed Sallam

Consultant Cardiologist & Cardiac Electrophysiologist

Originally published in Arabic in Al Khaleej Medical Magazine – October 2024.

Introduction

Cardiac stress testing is an important diagnostic tool that helps evaluate heart function during physical activity. It assists in detecting coronary artery disease, assessing exercise tolerance, and identifying rhythm abnormalities that may not appear at rest.

This test provides valuable clinical information that supports appropriate medical decision-making and early detection of cardiovascular conditions.

What Is a Cardiac Stress Test?

A cardiac stress test evaluates how the heart responds to physical exertion. During the test, heart rate, blood pressure, and electrocardiographic changes are monitored while the patient performs exercise—usually walking on a treadmill or cycling.

In some cases, medications may be used to simulate exercise if the patient is unable to perform physical activity.

Types of stress testing include:

• Exercise stress electrocardiography

• Stress echocardiography

• Nuclear stress testing

Each modality provides specific information depending on the clinical indication.

When Is This Test Recommended?

A physician may recommend a stress test in the following situations:

• Chest discomfort suspected to be cardiac in origin

• Evaluation of treatment effectiveness in known heart disease

• Assessment before starting an exercise program

• Evaluation of certain heart rhythm disturbances

• Risk assessment in patients with cardiovascular risk factors

What Can a Stress Test Detect?

A stress test can help identify:

• Reduced blood flow to the heart muscle (coronary artery disease)

• Abnormal heart rhythms triggered by exertion

• Functional exercise capacity

• Blood pressure response to physical activity

• Need for further diagnostic investigations

How Accurate Is the Test?

The diagnostic accuracy of stress testing varies depending on age, gender, risk profile, and the type of stress test performed.

While it is a valuable screening tool, results must always be interpreted within the full clinical context. False positive and false negative results may occur, which is why additional imaging or evaluation may sometimes be necessary.

Importance of Early Detection

Early identification of heart disease allows timely intervention, lifestyle modification, and preventive strategies.

Stress testing plays an essential role in detecting silent ischemia and guiding safe physical activity recommendations. When used appropriately, it contributes significantly to long-term cardiovascular health.