4 Types and Procedures of Stress Test | Cardiology

What Is a stress test?

Doctors use a stress test, also known as an exercise test or a treadmill test, to see how well a patient’s heart works during physical activity.

A stress test can also help a doctor advise patients on the best type of physical activity for them. A stress test usually involves walking on a treadmill or riding a stationary bike while monitoring the patient’s breathing, blood pressure, and heartbeat.

Some patients, such as those with arthritis, will not be able to do the activities involved in a stress test during exercise. Instead of exercising, the patient can take medication to make the heart work harder, as might happen during exercise.

Types of stress tests

We recommend different types of stress tests based on your general health and symptoms. Our doctors and imaging specialists are experienced in performing stress tests and interpreting the results.

1. Cardiopulmonary exercise test (CPET):

This comprehensive test assesses how well your heart and lungs are working together to deliver oxygen-rich blood to your body. It also shows how well your muscles are using oxygen while you exercise at increased levels. CPET can evaluate:

  • Reasons for shortness of breath
  • Fitness level and ability to exercise, especially after a heart attack or heart surgery
  • Lung function

The CPET test is similar to the exercise stress test but it also measures lung function, including:

  • The amount of oxygen your body uses during exercise
  • Your breathing pattern
  • The amount of carbon dioxide you produce

We use this test not only to identify many types of heart and lung disease but also to:

  • Monitor people who already have these conditions and check for disease progression
  • Measure how well treatments are working
  • Determine if the exercise restrictions are due to a heart or lung problem

2. Exercise stress test

This test uses an EKG during exercise to assess blood flow to your heart. We do a stress test while exercising on the treadmill or stationary bike at a gradually increasing rate. We use this test to raise your heart rate so we can detect heart problems affecting blood flow.

The exercise stress test only measures the electrical activity of your heart, not the lung function like CPET. We use this test to:

  • Determining safe levels of exercise after a heart attack or heart surgery
  • Diagnosing and determining the severity of coronary heart disease and other types of heart disease
  • Diagnose an arrhythmia
  • Find out what causes symptoms that only appear during exercises, such as shortness of breath, fainting or an irregular heartbeat
  • Treatment planning guidance, such as medications, cardiac catheterization (minimally invasive heart procedures), surgery or implantation

3. Pharmacologic stress test

This stress test assesses the blood flow to your heart using an EKG but does not involve any physical activity. We recommend a drug stress test for people who are unable to exercise due to physical limitations such as arthritis, joint or back conditions, injury or disability. For this test, you receive medication to stimulate your heart and make it beat harder and faster as if you were exercising.

Use the drug stress test to:

  • Determine safe levels of physical activity if you have a heart attack or heart surgery
  • Diagnosing many types of heart disease and determining their severity
  • Guiding decisions about treatment options, such as medication, cardiac catheterization (minimally invasive heart procedures), surgery or implantation
  • Evaluate how well your treatment increases blood flow to the heart

4. Nuclear stress test

This type of stress test includes a radioactive dye and imaging studies to show blood flow to the heart, both at rest and when the heart rate is elevated. As with other types of stress tests, we record the electrical activity of your heart with an EKG.

During a nuclear stress test, you receive an injection of a radioactive dye through an intravenous (IV) line. The dye travels through the bloodstream and your heart. While you’re still at rest, we scan your heart with a special camera that captures the radioactive dye to show blood flowing into and through your heart.

In the second part of the test, you start exercising on a treadmill or stationary bike. If you are unable to exercise, we can give you medicine to increase your heart rate. Then we check more images of your heart to capture blood flow to the heart during increased activity.

Nuclear stress tests show which parts of the heart are receiving enough blood and which ones are not. The tests provide details that can indicate heart disease and severity and show tissue damage from a previous heart attack.

Why stress test is done?

Your doctor may recommend a stress test to:

  • Diagnose coronary artery disease: Coronary arteries are the main blood vessels that supply your heart with blood, oxygen, and nutrients. Coronary artery disease develops when these arteries are damaged or sick – usually due to a buildup of plaques containing cholesterol and other substances (plaques).
  • Diagnose heart rhythm problems (arrhythmias): Arrhythmias occur when the electrical impulses that coordinate your heart’s rhythm do not work properly, causing your heart to beat too fast, too slowly or irregularly.
  • Guide treatment of heart disorders: If you’ve already been diagnosed with heart disease, an exercise stress test can help your doctor know how well treatment is working. It can also be used to help create a treatment plan for you by showing how much exercise your heart can handle.
  • Your doctor may use a stress test to help determine the timing of heart surgery, such as valve replacement. In some people with heart failure, results of a stress test may help a doctor determine whether you need a heart transplant or other advanced treatments.

Your doctor may recommend an imaging test, such as a nuclear stress test or an echocardiogram stress test if an exercise stress test doesn’t determine the cause of your symptoms.

By what means should I prepare for the exercise stress test?

  • Do not eat or drink anything except water for the 4 hours before the test.
  • Do not drink or eat anything containing caffeine for the 12 hours before the test.
  • Do not take the following heart medications on the day of the test, unless your doctor tells you otherwise or if medication is needed to treat chest discomfort on the day of the test:
    • Isosorbide dinitrate(for example, Isordil, Dilatrate SR)
    • Isosorbide mononitrate(for example, ISMO, Imdur, Monoket)
    • Nitroglycerin(for example, Deponit, Nitrostat, Nitro-Bid)
  • If you are using a breathing inhaler, bring it to the test.

You may also be asked to stop taking other heart medications on the day of the test. If you have questions about your medications, ask your doctor. Do not stop taking any medication without first consulting with it.

During the stress test

You will slowly start exercising on a treadmill or stationary bike, then gradually increase the speed of the treadmill or resistance bike until your heart works at the target heart rate for your age. Most often, the stress test includes an electrocardiogram to measure the electrical activity of your heart while you exercise on a treadmill or on a stationary bike. Your doctor may also measure the blood oxygen level, blood pressure, heart rate.

During the test, you’ll exercise for 10 to 15 minutes. And we have better stress test equipment. Your primary care physician will stop the test on the off chance that you give any indication of a heart issue, in the event that you are too worn out to even consider continuing the test.

If you are not able to exercise, your doctor will give you the medication for over 10 to 20 minutes through an intravenous (IV) line into a blood vessel.

Your doctor may also take pictures of your heart during or immediately after a stress test to see how well blood flows through your heart and how well your heart pumps blood when it beats. These images can be taken by echocardiogram or by injecting a radioactive dye into a vein, which is called a nuclear heart scan. The amount of radiation in the dye is safe for you and those around you. However, if you are pregnant, this test should not be performed due to the risks it may pose to your unborn baby.

If your doctor also wants to know how well your lungs are working, you may be asked to wear a mask or mouthpiece to measure the gases you breathe in during the stress test.

Following up after an exercise stress test

After the test, you will be given water and asked to rest. If your blood pressure rises during the test, the nurse may continue to monitor your blood pressure.

A couple of days after the test, your primary care physician will survey the outcomes with you. The test can reveal an irregular heartbeat or other symptoms that indicate coronary artery disease, such as blocked arteries.

If your doctor determines that you may have coronary artery disease or other heart problems, he may begin treatment or order further tests, such as a nuclear stress test.

Risk factors

These tests are usually safe. Sometimes, exercise or medication that increases the heart rate can cause symptoms such as chest pain, dizziness, or nausea. You will be monitored closely throughout the test to reduce the risk of complications or to treat any health problems quickly.

The radioactive dye used for a nuclear stress test is safe for most people. In rare cases, it may cause an allergic reaction. Also, a nuclear stress test is not recommended for pregnant women, as the dye may be harmful to a fetus.


If the information gathered during the exercise stress test shows that your heart function is normal, you may not need any other tests. However, if the results are normal and symptoms continue to worsen, your doctor may recommend nuclear or other stress tests that include an echocardiogram before and after exercise or taking medications to increase blood flow to your heart. These tests are more exact and give more data about your heart work, yet they are likewise more costly.

If the stress test results indicate the possibility of coronary artery disease or an irregular heartbeat, your doctor will use the information to create a treatment plan. You may require extra tests, for example, a coronary angiogram. If you have a stress test to help determine a treatment for heart disease, your doctor will use the results to plan or change your treatment.


Procedure of Cerebrospinal fluid analysis | Neurology

What is a Cerebrospinal fluid (CSF) analysis?

Cerebrospinal fluid analysis is a way to look for conditions affecting the brain and spine. Cerebrospinal fluid analysis is a series of laboratory tests that are performed on a sample of cerebrospinal fluid. Cerebrospinal fluid is a clear fluid that serves to provide nutrients to the central nervous system (CNS). The focal sensory system includes the mind and spinal line.

The cerebrospinal fluid is produced by the choroid plexus in the brain and then reabsorbed into the bloodstream. The fluid is completely replaced every few hours. In addition to providing nutrients, cerebrospinal fluid flows around the brain and spine, providing protection, and carrying waste.

A cerebrospinal fluid sample is usually collected by performing a lumbar puncture, also known as a spinal tap. Sample analysis includes measurement and examination:

  • Fluid pressure
  • Red blood cells
  • Chemicals
  • Viruses
  • Bacteria
  • White blood cells
  • Proteins
  • Glucose
  • Other invasive organisms or foreign substances

It can include analysis:

  • Measurement of the physical properties and appearance of CSF
  • Synthetic tests on substances in your cerebrospinal liquid or correlations with levels of comparative substances in your blood
  • Count cells and write down which cells are in your CSF
  • Determine which microorganisms could cause infectious diseases

The cerebrospinal fluid is in direct contact with the brain and spine. So a cerebrospinal fluid analysis is more effective than a blood test for understanding central nervous system symptoms. However, obtaining a cerebrospinal fluid sample is more difficult than obtaining a blood sample. Entering the spinal canal with a needle requires master information on the life systems of the spine and away from any basic states of the cerebrum or spine that may expand the danger of inconveniences from the methodology.

What is it used for?

The cerebrospinal fluid analysis may include tests to diagnose:

  • Irresistible maladies of the cerebrum and spinal line, including meningitis and encephalitis. CSF tests for infection check white blood cells, bacteria, and other substances in the cerebrospinal fluid
  • Autoimmune disorders, for example, Guillain-Barré disorder and multiple sclerosis (MS). CSF tests look for these disorders for high levels of certain proteins in the cerebrospinal fluid. These tests are called albumin protein.
  • Bleeding in the brain
  • Brain tumors

Why do I need a cerebrospinal fluid analysis?

You may need a cerebrospinal fluid analysis if you have symptoms of an infection in the brain or spinal cord, or an autoimmune disorder, such as multiple sclerosis (MS).

Symptoms include inflammation of the brain or spinal cord:

  • Fever
  • Severe headache
  • Stiff neck
  • Confusion
  • Nausea and vomiting
  • Double vision
  • Changes in behaviour
  • Seizures
  • Sensitivity to light

Symptoms of MS include:

  • Blurred or double vision
  • Weak muscles
  • Muscle spasms
  • Dizziness
  • Tingling in the arms, legs, or face
  • Bladder control problems

Side effects of Guillain-Barré disorder remember shortcoming and shivering for the legs, arms, and chest area. You may also need a cerebrospinal fluid analysis if you have had an injury to the brain or spinal cord, or have been diagnosed with cancer that has spread to the brain or spinal cord.

What happens during a cerebrospinal fluid analysis?

Your cerebrospinal liquid will be gathered through a strategy called a spinal tap, otherwise called a lumbar puncture. A spinal tap is usually performed in a hospital. During the cerebrospinal fluid analysis procedure:

  • You will either lie on your side or sit on the exam table.
  • The health care provider will clean your back and inject an anaesthetic into your skin, so you will not feel pain during the procedure. Your supplier may put desensitizing cream on your back before this infusion.
  • When the zone on your back is totally desensitized, your supplier will embed a flimsy, empty needle between two vertebrae in the lower part of your spine. The vertebrae are the small spine that the backbone is made of.
  • Your provider will draw a small amount of cerebrospinal fluid for testing. This will take about five minutes.
  • You will need to remain still while drawing the fluid.
  • Your supplier may request that you lie on your back for an hour or two after the methodology. This may keep you from getting a migraine a short time later.

How to prepare for the Cerebrospinal fluid analysis test?

You needn’t bother with any unique groundwork for the CSF investigation, however, you might be approached to exhaust your bladder and inside before the test.

Diseases detected by CSF analysis

Cerebrospinal fluid analysis can accurately distinguish a wide range of central nervous system diseases that are difficult to diagnose. Conditions it found include CSF analysis:

Infectious diseases

Infections, microscopic organisms, growths, and parasites can contaminate the focal sensory system. Certain injuries can be found by analyzing the cerebrospinal fluid. Common central nervous system infections include:

  • Meningitis
  • Tuberculosis
  • Eastern equine encephalitis virus (EEEV)
  • Fungal infections
  • Encephalitis
  • West Nile virus


Intracranial bleeding can be detected by analysis of the cerebrospinal fluid. However, isolating the exact cause of the bleeding may require additional investigations or investigations. Common causes include high blood pressure, stroke, or aneurysm.

Immune response disorders

A Cerebrospinal fluid (CSF) analysis test can detect disorders of the immune response. The immune system can damage the central nervous system through inflammation, destruction of the myelin sheath around nerves, and antibody production.

Include common diseases of this type:

  • Guillain-Barré syndrome
  • Neurosyphilis
  • Sarcoidosis
  • Multiple sclerosis


Cerebrospinal fluid analysis can detect primary tumors in the brain or spine. It can also detect metastatic cancers that have spread to the central nervous system from other parts of the body.

Risks and considerations

  • Some people experience a headache between 24 and 48 hours after the operation. People describe the pain as a dull or throbbing pain in the front of the head, sometimes spreading to the neck and shoulders.
  • Over-the-counter medications can help ease the pain, but if the pain is severe or accompanied by sickness and vomiting, it is important to seek medical attention.
  • To reduce the risk of developing a post-lumbar headache, the person will be asked to lie down quietly and not raise their head for one to two hours after the procedure.
  • A lumbar puncture is performed below the end of the spinal cord where there are small strings of nerves. Sometimes the needle can touch a small vein, causing the painful tap.
  • If this happens, a small amount of blood may leak into one or more samples, which could affect the results.
  • Some people experience lower back pain in the area where the operation was performed, while others may also experience pain in the back of their legs. Doctors usually recommend over-the-counter pain relievers, and the pain usually goes away within a few days.
  • A person may also experience some bruising and swelling associated with a small amount of fluid leaking under the skin. This tends to go away without treatment.

Cerebrospinal fluid analysis results

The cerebrospinal fluid that is collected during the lumbar puncture will contain protein and glucose and may also contain white blood cells. It will be examined for any disturbance in the normal flow of cerebrospinal fluid or damage to the blood-brain barrier.

Initial tests performed on a CSF examination:

  • Color, clarity, and pressure during assembly
  • Protein levels
  • Glucose levels
  • Total number of cells present (number of cells)
  • Number of different types of cells present (differential cell counts)
  • Gram stain and its culture if the infection is suspected

Depending on the Cerebrospinal fluid analysis test results and the signs and symptoms the individual has experienced, the doctor may perform further tests.

These fall into four broad categories:

  • Physical characteristics: Includes measuring cerebrospinal fluid flow pressure, checking for normal colour and texture.
  • Chemical tests: Detect or measure chemicals in the cerebrospinal fluid, including protein and glucose levels, which are usually related to their concentration in the blood.
  • Cell number and differentiation: Any cells present can be counted and identified under a microscope.
  • Infectious disease tests: Several tests can identify microorganisms if the infection is suspected.

If the Cerebrospinal fluid (CSF) analysis identifies any irregularities, the doctor will recommend further tests to help make a diagnosis.

Following up after a CSF analysis

  • Your follow-up and expectations will depend on why your CNS test is abnormal. It is likely that more tests will be required in order to obtain a definitive diagnosis. Treatment and results will vary.
  • Meningitis caused by a bacterial or parasitic infection is a medical emergency. Symptoms are similar to viral meningitis. However, viral meningitis is less life-threatening.
  • People with bacterial meningitis may receive broad-spectrum antibiotics until the cause of the infection is determined. Prompt treatment is essential to save your life. It can also prevent permanent central nervous system damage.