Will I need to have a cardiac stress test also called an exercise test before surgery

It is possible your surgeon will want you to have an exercise stress test prior to your surgery. People who are likely to require a stress test include people who have had heart disease, diabetes, or a stroke. In addition if you have multiple heart disease risk factors including high blood pressure, high cholesterol, cigarette smoking, or a strong family history of heart disease your doctor may request that you have a stress test. Men over the age of forty-five and women over fifty-five may also require a stress test.

There are a number of different options when it comes to stress tests. In the first type of stress test you will have small pads (electrodes) placed on your upper body to monitor your heart rate and rhythm. Once you have the electrodes in place you will be asked to begin walking on a treadmill or pedaling on a stationary bike. In order to get an accurate assessment of your heart health you will be asked to exercise for several minutes. At first, the pace will be slow and easy but it will gradually get a bit more difficult. In order to get the most information possible, you should exercise as long as you can. If you develop chest, arm, or jaw pressure or pain, shortness of breath, leg pain, or dizziness during the test, be sure to let the physician performing the test know. During the stress test your blood pressure, heart rate, and heart rhythm will be monitored. People who experience a dramatic change in blood pressure with exercise may have underlying cardiac problems and may require a more complete cardiac evaluation. Likewise if a person is noted to have changes in his or her electrocardiogram (ECG or EKG) with exercise (indicating that the heart muscle is not getting proper blood flow during exercise), further heart testing may be indicated. While no test is perfect, in general if you do well on a stress test, your surgery will probably go well from a cardiac standpoint. On the other hand, if the stress test indicates possible cardiac problems, these will need to be addressed prior to surgery. This might mean the addition of some new medications. Alternatively it could mean a cardiac procedure (angioplasty or even bypass surgery). The bottom line is that it makes more sense to find out about a problem and correct it before surgery than to go into the operation and get into trouble mid-procedure.

The other thing that an exercise stress test can do for you is give you an "exercise prescription" prior to surgery. In other words your doctor will be able to evaluate your stress test and tell you that it is safe to get your heart rate to a certain level with exercise. This is certainly important because it allows you to feel safer from a cardiac standpoint as you develop an exercise program before and after surgery.

In terms of the nuts and bolts of having this test, make sure you don't eat, drink, smoke, or have any caffeine for three hours before your stress test. Also make sure you wear sneakers or good walking shoes and a two-piece outfit—you will have electrodes on your chest and upper body (women are given a hospital gown to wear, while men typically perform the test topless, although a gown can be requested). The entire test takes about thirty minutes. In preparation for the stress test, you may be instructed to withhold taking certain medications. Make sure to ask the person performing the stress test when you should resume taking the medications you have held.

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