Cardiac Stress Tests | Types | MedStar Health

Assessing How Your Heart Works During Physical Activity

Exercise makes your heart work harder and can reveal problems that might not be noticeable otherwise. Stress tests are used to determine how much physical activity your heart can safely handle before developing an irregular heartbeat or loss of blood flow.

Your doctor might recommend one of several types of stress tests to detect evidence of heart conditions such as coronary artery disease, heart failure or an abnormal heart rhythm (arrhythmia).

Types of stress tests

Exercise stress test

In this test, you’ll walk on a treadmill or ride a stationary bike while we monitor your heart rhythm, blood pressure and breathing. Wear comfortable clothing and walking shoes.

You’ll wear sticky patches called electrodes on your chest, arms and legs to records your heart’s electrical signals and a cuff on your arm to monitor your blood pressure. You also may need to breathe into a tube to evaluate your oxygen levels.

As you walk on the treadmill, the speed and incline of the treadmill will increase. Similarly, if you’re pedaling a stationary bike, the resistance will increase. You’ll continue until you reach a target heart rate or you experience:

  • Abnormal heartbeat
  • Changes in your heart rhythm
  • Chest pain
  • High or low blood pressure
  • Shortness of breath

When the test is over, you will be asked to rest until your heart rate and breathing return to normal. You can then return to your normal activities for the day. The appointment will take about an hour, but you’ll only be exercising for 10 to 15 minutes. Depending on the results of the test, additional testing or a more advanced stress test, such as a nuclear stress test or stress echocardiogram, may be needed.

Myocardial flow reserve

Myocardial flow reserve (MFR) is a measurement of how much blood flow can increase through the coronary microvascular arteries when the heart is under stress and the need for oxygen increases. This test is a tool for the diagnosis, risk stratification and management of patients with coronary artery disease.

A Rubidium-82 radioactive tracer, which produces a type of energy called gamma rays, is injected into your blood vessel. These gamma rays are detected by positron emission tomography-computed tomography (PET-CT) and are used to create three-dimensional images of the heart. The is a safe test for most people as the patient is only radioactive for about 10 minutes during the scan before it decays.

Nuclear stress test

A nuclear stress test, also known as a thallium stress test, may be recommended in addition to an exercise stress test. It will take two to five hours and include taking images of your heart before and after exercise.

A very small amount of a radioactive dye will be injected through an IV in your arm. Then we’ll take detailed pictures of the heart tissue with a special camera that detects the dye. These images can identify areas of the heart that have decreased blood flow. After we take these images, you’ll proceed with the treadmill or bike stress test. Once that is over, another set of images will be taken.

When the nuclear stress test is over, you should be able to return to your daily activities. You can help flush the dye out of your system by drinking extra water. The results of this test will help determine whether you need additional testing or treatment.

Stress Echocardiogram

This type of stress test helps us better assess the structures of the heart by doing an echocardiogram before, during and after a treadmill or bike stress test.

For the echocardiogram, or echo, a technician will stick patches called electrodes to your body so we can monitor your heartbeat. They will then rub gel on the area to be tested and will press a device called a transducer against your chest. The transducer creates sound waves and picks them up as they bounce back from your heart. These sound waves will create detailed images of your heart.

After these images are taken, you’ll begin the treadmill or bike stress test. You may be stopped at one or more points to take additional echo images. One last image will be taken when you’ve finished exercising.

The appointment will take about an hour, but you’ll only be exercising for 10 to 15 minutes. When the stress echocardiogram is over, you should be able to return to your daily activities. The results of this test will help determine whether you need additional testing or treatment.

Chemically induced stress test

If you’re unable to endure the level of physical activity needed to get the test results, you may be given medication that triggers a similar effect on the heart as that of exercise. This allows the doctor to assess the heart’s response to stress without physical activity.

This test can be performed as a nuclear stress test or stress echocardiogram. You’ll feel your heart rate increasing during the test, but it should not be uncomfortable otherwise. The length of the appointment depends on whether images will be taken. You should be able to return to your daily activities when it is over.


Alcohol Septal Ablation

Alcohol septal ablation, also known as septal alcohol ablation, is a minimally invasive procedure our doctors use to treat hypertrophic cardiomyopathy. The procedure shrinks abnormal tissue and improves blood flow throughout the body.


Angioplasty improves blood flow through the arteries by clearing plaque buildup.

Atrial Fibrillation Ablation

Atrial fibrillation ablation uses extreme heat or cold to destroy tissue causing faulty electrical signals in the heart.

Cardiac Rehabilitation

Cardiac rehabilitation is an exercise program designed to help people recover from certain heart conditions or treatments.

Catheter Ablation for Atrial Fibrillation

Catheter ablation is a minimally invasive procedure that uses heat or cold to destroy heart tissue causing atrial fibrillation, a type of abnormal heart rhythm.

Congenital Heart Disease Treatments

Treatments for congenital heart conditions range from atrial septal defect and patent foramen ovale closures to cardiac ablations and heart valve replacements to heart transplants.

Convergent Procedure (MAZE)

A convergent maze procedure is a procedure that aggressively treats atrial fibrillation (AFib). Maze procedures create a pattern, or maze, of scar tissue in the heart to disrupt faulty electrical signals causing your abnormal heart rhythm.

Coronary Artery Stenting

Coronary artery stents are small mesh tubes placed within the artery to prevent blockages and allow better blood flow.

Electrical Cardioversion

Electrical cardioversion uses electrical shocks to treat heart rhythm disorders.

Heart Failure Surgery

Surgical treatments for heart failure can include coronary bypass surgery, mechanical support devices and heart transplants.

Heart Failure Treatment

Treatments for heart failure such as medications, surgery and mechanical devices vary based on the cause and severity of your condition.

Heart Surgery

Heart surgery is an option to treat many heart conditions. You may need heart surgery either as a lifesaving procedure or when other treatments haven’t worked.

Heart Surgery for Atrial Fibrillation (Maze)

A surgical maze procedure treats atrial fibrillation (AFib) by creating a pattern, or maze, of scar tissue in the heart to disrupt faulty electrical signals causing your abnormal heart rhythm.

Heart Transplants

A heart transplant replaces a diseased, failing heart with a healthier heart from a donor.

Implantable Cardioverter Defibrillator (ICD)

An implantable cardioverter defibrillator (ICD) is a device implanted below your collarbone that monitors your heart’s rhythm. When it detects an abnormal rhythm, it delivers an electrical impulse or shock to the heart to correct it.

Leadless Pacemakers

A leadless pacemaker is a small capsule placed in the heart’s right ventricle that delivers an electric pulse to regulate the heartbeat.

Left Atrial Appendage Closure

Closing the left atrial appendage can decrease the risk of dangerous blood clots and stroke for patients with atrial fibrillation.

Left Ventricular Assist Device (LVAD)

A left ventricular assist device (LVAD) helps the heart pump blood more effectively during end-stage heart failure.

Left Ventricular Reconstructive Surgery (Modified DOR Procedure)

During left ventricular reconstructive surgery, the left ventricle is reshaped to remove scar tissue caused by heart failure.

Minimally Invasive Heart Surgery

Minimally invasive heart surgery is used whenever possible to reduce risks and shorten recovery time after surgery to treat a variety of conditions.


MitraClip is a device our doctors use to treat mitral insufficiency, also known as mitral regurgitation.

Mitral Valve Disease Treatments

Mitral valve disease treatments may include medication, minimally invasive procedures and surgery to treat a damaged valve.

Mitral Valvuloplasty

Mitral valvuloplasty improves blood flow through the heart to the lungs and body by opening a narrow or stiff heart valve.

Off-Pump Bypass Surgery (Beating-Heart Bypass)

Off-pump bypass surgery, also known as beating-heart bypass surgery, is an option for many patients to have coronary artery bypass surgery without needing to stop the heart or lungs during the procedure.


A pacemaker is a device that helps control various types of heart rhythm disorders.

Percutaneous Valve Treatments

Percutaneous valve procedures use catheter-based methods to replace a damaged heart valve and are less invasive than traditional open-heart surgeries.

Pulmonary Vein Isolation

Pulmonary vein isolation creates scar tissue to disrupt electrical signals coming from the pulmonary veins that cause atrial fibrillation (AFib), a type of abnormal heart rhythm.

Radiofrequency Ablation for Atrial Fibrillation

Radiofrequency ablation uses extreme heat to destroy heart tissue causing an abnormal heart rhythm known as atrial fibrillation.

Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD)

Subcutaneous implantable cardioverter-defibrillators (S-ICD) deliver electrical shocks to regulate your heart during ventricular arrhythmias.


Stenting uses a mesh tube to open narrow blood vessels and improve blood flow.

Structural Heart and Valve Disease Treatments

Structural heart and valve disease treatments address defects or abnormalities with the heart’s muscle or valves with or without surgery.

Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) is a minimally invasive option to replace a narrowed aortic valve that fails to open properly and blocks the flow of blood.

Transradial Catheterization

Transradial catheterization is a form of cardiac catheterization in which doctors use the radial artery, located in the wrist, to treat many heart and vascular conditions.

Valve Disease Treatments

Valve disease treatments include monitoring, medication or surgery to repair or replace a damaged valve.

Valve Sparing or Valve Preserving Surgery (Reimplantation Surgery)

Valve sparing surgery is a procedure to repair an aortic root aneurysm without replacing the aortic valve.

Ventricular Assist Device (VAD)

A ventricular assist device (VAD), also known as a mechanical circulatory support device, helps the heart pump blood more effectively during end-stage heart failure.

WATCHMAN™ Device (Left Atrial Appendage Closure)

We can implant a WATCHMAN device to permanently seal off the left atrial appendage (LAA), which is a small pouch in the top left chamber of the heart that is the site of almost all stroke-causing blood clots in people with atrial fibrillation (AFib).

Wearable Cardioverter Defibrillator

A vest that contains a device that monitors your heart and, if an abnormal heart rhythm is detected, delivers a shock to restore a normal heartbeat.

Why Do I Need A Stress Test?

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