Diagnostic Testing

Exercise Stress Test

In some cases, EKG irregularities can only be identified during exercise or while symptoms are present. An exercise stress test demonstrates the effect that exercise and physical activity has on the heart. In many cases, the exercise stress test is performed to determine the causes of chest pain and/or to identify rhythm abnormalities during exercise.

A standard stress test involves the patient walking on a treadmill or pedaling a stationary bike while being monitored by an electrocardiogram and blood pressure readings to measure the heart’s response to the body’s increased need for oxygen.

The patient continues the test until a target heart rate is reached, unless chest pain or a dramatic rise in blood pressure occurs. The heart will continue to be monitored for several minutes after exercising.

Nuclear Stress Testing

A nuclear stress test demonstrates how well blood flows into the heart when it is at rest versus during normal activity. A physician may recommend a nuclear stress test to diagnose coronary artery disease, examine the size and shape of your heart, and guide treatment of existing heart disorders.

A radioactive dye is injected into a vein, and during the scan a camera takes pictures of the heart as the tracer travels through the blood into the heart muscle. Areas not absorbing the tracer may not be receiving adequate blood.

Two scans may be performed during nuclear stress testing; one while resting and one while the heart is stressed by exercise or medicine. The images are then compared.


An echocardiogram (ultrasound test of the heart) is a non-invasive test that uses sound waves to create a real-time image of the heart. The high frequency sound waves use no radiation and provide detailed pictures of the valves and chambers. This aids the physician in determining appropriate treatment.

Echocardiograms produce images that show:

  • Heart defects
  • Valve problems
  • Damage to heart muscle
  • Heart size
  • Heart pumping efficiency

A physician may recommend an echocardiogram if he or she suspects a problem involving the patient's valves, chambers or pumping strength.

Stress Echocardiogram

Stress echocardiography combines elements of both an echocardiogram and the standard exercise stress test. This test identifies the heart’s reaction during periods of rest and physical activity. When the two tests are administered together, your doctor can assess the status of your heart at rest compared to your heart during and immediately following stress.

A stress echocardiogram may be performed to help in the diagnosis of coronary heart disease and the presence of blockages in the coronary arteries.

Holter Monitor

When a patient experiences irregular heart rate, dizziness, shortness of breath, chest pain, abnormal pacemaker function or fainting and/or falling spells, a Holter monitor may be recommended to monitor and record heart rhythms over a 24 hour period.

Worn by the patient, the Holter monitor is a portable EKG device that monitors the electrical activity of a person’s heart during normal activity. Following the 24 hour period, the patient brings the monitor back to his or her physician, and a technician scans through the thousands of beats and generates a report of irregular rhythms or rates.

Coronary Calcium Score

An ultrafast CAT scan of the heart can determine the amount of coronary artery calcium deposits when cholesterol is starting to accumulate within the walls of these arteries. Normal coronary arteries have no cholesterol deposits and therefor no calcium deposits. With a zero coronary calcium score the risk for a heart attack is almost zero over 10 years. When the coronary arteries develop cholesterol deposits, called cholesterol plaques, microscopic calcium will be deposited within these cholesterol accumulations. The amount of calcium in the 3 coronary arteries is poportional to the amount of cholesterol and proportional to the 10 year risk for a heart attack.

Non-Invasive Coronary CT Angiogram 

This is also a CAT scan of the heart but it actually provides 3-D images of the coronary arteries and any blockages non-invasively, something that before this test became available around 2005, required an invasive cardiac catheterization or angiogram.