1. What is Exercise Treadmill Stresstest?

This is a simple and quite readily available test where an ECG continuously monitor the heart while running on the treadmill. The bottom line here is that patients are made to exercise so the heart rate goes up and if there is significant coronary artery disease (artery blockage), distinct abnormalities maybe picked up from the ECG.

2. Who needs an Exercise stresstest?

Anybody with whom there is fair amount of suspicion to have CAD, regardless of symptoms. Patients at risk include those with Diabetes mellitus, Elevated cholesterol, those with premature CAD and those having some exercise chest discomfort or angina.

3. Why should CAD be diagnosed early?

CAD can manifests in 3 ways. First, it maybe in the form of sudden death. Second, it may be in the form of an acute coronary syndrome or "heart attack" as we commonly know it. Third, it may present itself as a form of stable angina, a manifestation that can predictively be induced by effort or exertion and is relieved by either rest or with the use of sublingual nitroglycerine.

From the discussion above, it is quite obvious why CAD needs to be diagnosed early. Of the 3 manifestations, I consider those having exertional angina as the lucky subgroup of patients mainly because they are likely to seek medical evaluation.

4. What are the different types of stresstests?

The most commonly employed is by the use of a treadmill and in some rare instances with the us of a bycicle ergometer. This is the simplest and most practical form to screen patients at risk of CAD.

5. What if I can't run on the treadmill?

Pharmacologic stresstesting maybe an alternative for patients unable to walk or run on the treadmill. This is done with the use of medications given via the IV route to stimulate the heart i.e. dobutamine. More often than not, pharmacologic stressors are used alongside an imaging modality like echocardiogram or radionuclide isotopes like thallium or technetium.

6. How do we know which type of stresstesting we need?

As a rule if your resting ECG is normal, treadmill stresstest maybe good enough otherwise the addition of an imaging modality maybe advised i.e. echocardiogram or radioactive isotope. Your doctor will be in the best position to explain which test would be appropriate given your situation.

7. What is the difference between the different modalities of stresstesting?

A regular stresstest has a sensitivity of about 70%, while those incorporating the imaging modality i.e echocardiogram or radioactive isotope, can give us a yield of at least 90% sensitivity making it a superior test in detecting CAD.

8. How much does a treadmill stresstest cost?

Regular treadmill stresstest costs about P2000, stress echocardiogram may cost around P7-8,000 and a stress myocardial perfusion imaging study will cost almost P15,000. Cost would vary slightly from different institutions.

9. If the test is "Positive" what does it mean?

A positive stresstest generally means that there is a high likelihood of significant coronary artery disease or blockage. A confirmatory test usually coronary angiogram maybe warranted to know the severity and extent of involvement.

10. Do we need to have an exercise stresstest before embarking on an exercise regimen?

It is a good idea to get a baseline evaluation of your physical condition before embarking on an exercise regimen. As a rule, gyms would require a medical evaluation from the doctor preferably a cardiologist to protect them from any lawsuits in the event you run into some cardiovascular complication while in their facility.