Chemical Stress Test

(Adenosine Stress Test; Persantine Stress Test; Regadenason (Lexiscan) Stress Test; Dobutamine Stress Test)

Definition

A stress test is used to make sure the heart gets enough blood during activity. A chemical stress test uses chemical agents injected into the body through the vein. These chemicals make the heart function as if it were under stress.

There are many different ways to examine the heart during a stress test. The heart can be examined with:

Reasons for Test

A chemical stress test is used when a traditional stress test cannot be done.

It is often used to:

  • See if chest pain is due to a heart problem
  • Check for coronary artery disease
  • Look for uneven heart beats
  • Check how the heart has responded to treatment or procedures
  • Plan a heart strengthening program after a heart attack

Possible Complications

Problems are rare during the test. The doctor will go over some problems that could happen, such as:

  • Problems breathing
  • Chest pain
  • Uneven heartbeats
  • Heart attack—rare

Technicians and a heart doctor will be present during the test. They will check for signs of heart or lung problems. They will take action right away if there is a problem.

What to Expect

Prior to Test

Your doctor may do a physical exam. Tests may be done, such as:

  • Resting ECG —a test that records the heart's activity
  • Echocardiogram—an ultrasound test used to check how the heart looks and works

The doctor may ask you to:

  • Not eat or drink anything with caffeine 12 to 24 hours before the test
  • Not eat or drink anything, except water, 4 hours before the test
  • Not smoke for several hours before the test
  • Wear comfortable clothing
  • Bring a list of your current medicines to the test.
  • Bring your glucose monitor to the test—if you have diabetes

Description of Test

A technician will place electrodes on your chest. Your resting blood pressure and ECG readings will be taken. An IV will be placed in your arm. A heart monitor will record your heart’s activity. A small amount of chemical will be injected through the IV and into your body. The chemical may make your heart beat faster. It may also further open the blood vessels near your heart. It depends on which chemical is used. An ECG may also be done at this time.

The test may be stopped if there are changes in the ECG or you have certain symptoms. Examples are chest pain, problems breathing, or lightheadedness.

If you have nuclear imaging, a mild radioactive substance will be injected through your IV. You will wait for 30 to 60 minutes after the injection. Next, a special camera or MRI will track the flow of the chemical through and around your heart. Images will be taken. They can show any areas of poor blood flow or blockages in the heart. If you are getting a stress echocardiogram, an ultrasound will be taken at specific times. The pictures of your heart under stress will be compared to pictures of your heart at rest.

After Test

Your blood pressure, heart rate, and ECG will be checked until levels return to normal. You will leave after the test is done. 

How Long Will It Take?

Usually 3 to 4 hours (testing may be done over 1 to 2 days)

Will It Hurt?

It may hurt slightly when the IV is inserted. You may also feel a flushing sensation when the chemical is injected.

Results

Your doctor may discuss some results on the same day as the test. It may take a few days for the full results to be ready.

Call Your Doctor

Call your doctor if you have:

  • Chest pain
  • Problems breathing
  • Fast or uneven heart beats
  • Lightheadedness or weakness
  • Any other unusual symptoms

If you think you have an emergency, call for medical help right away.

RESOURCES:

American Heart Association
http://www.heart.org

American Society of Nuclear Cardiology
https://www.asnc.org

CANADIAN RESOURCES:

Canadian Society of Nuclear Medicine
https://canm-acmn.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

REFERENCES:

Coronary artery disease (CAD). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/coronary-artery-disease-cad. Accessed July 22, 2021.

Rakisheva A, Marwan M, Achenbach S. The ISCHEMIA trial: Implications for non-invasive imaging. Anatol J Cardiol. 2020;24(1):2-6.

Stress testing. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/cardiovascular-disorders/cardiovascular-tests-and-procedures/stress-testing. Accessed July 22, 2021.

Stress testing. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/stress-test. Accessed July 22, 2021.

Last reviewed July 2021 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC  Last Updated: 7/22/2021