Cardiac Stress Test

A cardiac stress test aids in assessing how the heart can cope during exercise, especially when the body need for oxygen puts extra demands on the heart. A cardiac stress test is called a graded test or exercise tolerance test, exercise stress test or exercise electrocardiography. It helps to primarily evaluate the heart and vascular systems during the exercise. In fact, the American Heart Association has recommended the Cardiac stress test (EKG treadmill in particular) as the first choice to be tried on patients with medium risk of coronary heart disease and who exhibit certain risk factors of smoking, family history of coronary stenosis, high blood pressure, and high cholesterol.

• It helps to determine whether coronary arteries are clogged or blocked.
  
• To find the cause of chest pain.
  
• To assess the heart's capability after a heart attack or heart surgery.
  
• To discover the presence of any heart disease.
  
• To set limits on a person's exercise.
  
• To detect arrhythmia, that is extra heart beats, during the exercise.
  
• To assess the capacity of medicine used to control chest pain or extra beats during exercise.

The cardiac stress test can be done in a clinic or a hospital. The patient may be asked to exercise using a bicycle, treadmill or arm ergometer. The patient is attached to an ECG machine. The blood pressure cuff is placed on any one arm. The patient's heart is usually monitored using a 12 - lead EKG or ECG machine. A heart monitor may be used during and after exercise. After a baseline ECG is obtained, the patient begins to perform a low level of exercise, either by walking on a treadmill or pedaling on a stationary bicycle.

At each stage of the exercise, the pulse, the blood pressure and ECG are recorded along with any symptoms that the patient may be experiencing.

The level of exercise is gradually increased until the patient cannot keep up any longer because of fatigue or until symptoms like chest pain, shortness of breath or lightheadedness prevent further exercise. The goal of this stress test is to diagnose the presence or absence of coronary artery disease. In a sub maximal stress test, the patient exercises only until a pre-determined level of exercise is attained. These tests are used in patients with known coronary artery disease, to measure whether the patient can perform a specific level of exercise with relative safety.

The side effects of a cardiac stress test also include palpitation, chest pain, and shortness of breath, headache, nausea and fatigue. The hypertension caused by stress testing is always considered abnormal and it may lead to severe coronary disease. In stress tests, false positive results are not uncommon. There can be occasions when the patient's ECG changes could suggest ischemia, even in the absence of coronary artery disease. Similarly, in stress test, false negatives are also not uncommon. In some patients, no significant ECG changes will be seen even in the presence of coronary artery disease. Presently, a new concept called nuclear perfusion study is added to the stress test. This factor has helped to minimize the limitations and improve the diagnostic capability of stress tests.

Electrocardiogram

An electrocardiogram or ECG is a non-invasive diagnostic test to record the electrical voltage in the heart so as to understand its functioning and regularity of heart beats. The electrocardiogram or EKG can help in diagnosing cardiovascular disease. The ECG is used to check for any damage to the heart and regulate the functioning of the pacemaker.

An electrocardiogram measures the electrical activity within the heart, thereby throwing light on the how the heart muscles function. This test is not painful. An ECG is recommended for patients who complain of regular chest pain or palpitations to check for the normal functioning of the heart. It can help in detecting heart attack or (ischaemia) ischemia. If a patient suffers from hypothermia, pulmonary embolism, mitral stenosis or left ventricular hypertrophy, an EKG can help in diagnosis.

Other non-cardiac problems such as drug overdose or electrolyte imbalance can be diagnosed with an EKG. Abnormal results from an ECG test may be indicative of arrhythmia, myocarditis, impending heart attack or enlarged heart.

Potassium Gluconate

This is a potassium supplement useful in those prone to low blood potassium. Its side effects include numbness and tingling of the extremities, confusion, weakness, arrhythmia, ECG changes, nausea, vomiting, diarrhea, abdominal pain, GI ulcerations, GI bleeding, intestinal obstruction, and intestinal perforation.

Using potassium gluconate

1. Should not be used in cases of severe kidney disease, acute dehydration, or those who are using potassium sparing diuretics (e.g. spironolactone, triamterene).
2. Enteric coated potassium tablets cannot be recommended due to increased risk of GI bleeding and ulceration.
3. Minimize GI symptoms by taking this medication with food.

Adult and adolescent dose: oral, elixir, 10-20 mEq of potassium diluted in one-half glass of cold water or juice, two to four times a day; or 5-10 mEq potassium in tablet form, two to four times a day; dosage adjusted to need (up to 100 mEq potassium per day).