Chest Pain &
Coronary Ischemia Evaluation
The right test can help your cardiology team understand whether the heart is receiving enough blood and identify the next step in your care.
Explore testing options ↓Call 911 now for new, severe or unexplained chest pressure—especially with shortness of breath, sweating, nausea, faintness, or pain spreading to the arm, jaw, back or stomach.
When the heart needs more oxygen than it receives
Coronary ischemia occurs when blood flow through the coronary arteries cannot meet the heart muscle’s oxygen needs. It may cause chest pressure, shortness of breath, fatigue or discomfort in the arm, neck, jaw, back or upper abdomen.
No single test is best for every patient. Your cardiology team considers your symptoms, ability to exercise, ECG, medical history and prior results when choosing an evaluation.
Different ways to evaluate blood flow
Each test answers a different clinical question. Your cardiology team will choose the option that best fits your symptoms and medical history.
Routine Treadmill Stress Testing
Measures your heart’s electrical activity, heart rate, blood pressure and symptoms while you walk on a treadmill. The speed and incline increase gradually.
Exercise Stress Echocardiography
Combines treadmill exercise with ultrasound images taken before and immediately after exercise to show how the heart muscle contracts under stress.
Exercise & Pharmacologic Nuclear Stress Testing
Uses a small amount of radioactive tracer and a special camera to compare blood flow to the heart at rest and during stress. Stress may be created with exercise or medication.
Cardiac Computed Tomography Angiography (CTA)
Creates detailed 3D images of the coronary arteries to look for plaque and narrowing without inserting a catheter into the heart.
How the tests differ
Your provider will select the test that best answers your clinical question.
| Test | Shows | Exercise | Radiation | IV / medication |
|---|---|---|---|---|
| Routine treadmill | ECG response and symptoms | Required | None | Usually none |
| Stress echocardiography | Heart wall motion and function | Required | None | Usually none |
| Nuclear stress | Blood-flow patterns to heart muscle | Optional | Small tracer dose | Tracer; stress medication if needed |
| Cardiac CTA | Coronary plaque and narrowing | Not required | Low-dose X-ray | IV contrast; heart-rate medicine sometimes |
Follow the instructions provided for your specific test
Bring an updated medication list and tell us about allergies, pregnancy, kidney problems or recent illnesses.
Ask whether you should avoid food, caffeine, nicotine or certain medicines. Do not stop prescriptions unless instructed.
Wear comfortable clothing and walking shoes if exercise may be part of your test.
Important: This page provides general education and does not replace medical advice. Testing choices and preparation instructions vary by patient. Follow the directions from your cardiology team.