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May 16, 2012

Stress Tests and Chest Pain

Overall, the majority of stress tests performed on patients with chest pain and low cardiovascular risk are relatively unnecessary.

Cardiac stress testing is used to see how the heart responds to physical stress in a controlled environment. During a stress test, patients either exercise or are given a medicine to make the heart work harder, while the doctor monitors breathing and heart function. Stress tests are usually performed to help diagnose heart disease or see how far the disease has progressed, in those who are known to have it.

Although there are guidelines for when doctors should perform stress tests, like when patients have had a heart attack or have symptoms of heart disease, there are situations when it is less clear whether a stress test is needed or not. For example, should doctors perform stress tests on patients being hospitalized for chest pain who are at low risk for heart disease? The answer to this question is less clear, as doctors want to ensure that patients with underlying heart conditions get the tests they need. However, they also want to avoid performing unnecessary tests on patients, which can waste time and money, and expose patients to rare but possible side effects.

To investigate the issue further, researchers conducted a study in which they followed more than 2,100 patients hospitalized for chest pain at the Baystate Medical Center in Massachusetts over two years between 2007 and 2008. During this period, roughly 70% of these patients received stress tests, and less than 13% had abnormal results. Among those with abnormal results, very few underwent procedures, like cardiac catheterization, to address their condition.

Researchers believe that these findings may support guidelines that advise against performing stress tests on patients with low risk for heart disease who are hospitalized for chest pain. Why? In this study, most patients with low cardiovascular risk received stress tests, even though very few had abnormal results, and even fewer took action in response to abnormal test results. So overall, the majority of stress tests performed on patients with chest pain and low cardiovascular risk were relatively unnecessary. And while additional research is needed on this topic, findings of this study may prove useful in the creation of guidelines regarding the use of stress tests in patients with chest pain and low cardiovascular risk.

Questions for You to Consider

  • What causes chest pain?

  • Chest pain, known as angina, occurs when the heart muscle is not getting enough blood flow. Some patients have stable angina, which is chest pain brought on by extra stress on the body, like anger or physical activity. Others may experience chest pain in a more random way with no particular trigger, which is called unstable angina. Patients with unstable angina – or random chest pain – should seek medical help immediately, as it could be a sign of a heart attack.
  • How long does a stress test take?

  • Stress tests can last anywhere from 1-3 hours, depending on the type of test being done. For example, a simple exercise stress test is usually completed within an hour, but depending on medical history, stress tests may also include medication to stimulate the heart or additional tests, like an echocardiogram, which can take longer.