Cardiologist Serving Katy, Sugar Land, Greater Houston
Cardiologist Serving Katy, Sugar Land, Greater Houston
Abnormal Stress Test Evaluation
An abnormal or “positive” stress test means the heart did not respond to exertion the way it should, and the most common reason is that one or more coronary arteries may be narrowed. It is not a diagnosis by itself. Stress tests produce false positives, particularly in women and in people with baseline EKG changes, and the next step depends on how abnormal the result was, what you felt during the test, and your overall risk. At Advanced Cardiology, Adnan Khalid, MD reviews abnormal stress test results and determines whether further imaging, a catheterization, or medical treatment is the right path.
Patients are seen in Katy and Sugar Land. Mention your result when you call, and ask about current availability.
Board-Certified Cardiologist • Katy & Sugar Land • New Patients Welcome
Dr. Khalid reviews your symptoms, history and test results himself
Visits in Katy and Sugar Land
Catheter and device procedures at an affiliated hospital
Office follow-up on medicines and risk factors
Important Safety Information
If you have had an abnormal stress test and now have chest pain, pressure or discomfort (at rest, lasting more than a few minutes, or coming and going), pain or discomfort spreading to the arm, jaw, neck, back or stomach, shortness of breath, a cold sweat, nausea, lightheadedness, fainting or signs of stroke, call 911, even if the symptoms go away. Those symptoms in someone with a positive stress test may represent a heart attack. This page is for patients whose result was abnormal but who are currently stable and want to understand what happens next.
Understanding Your Result
A stress test looks at how the heart performs when it has to work harder, either on a treadmill or with a medication that mimics exercise. Depending on the type, it tracks the EKG, blood pressure, and symptoms during exertion (exercise stress test), adds ultrasound images of the heart’s motion (stress echocardiogram), or uses a small amount of radioactive tracer to map blood flow to the heart muscle (nuclear stress test).
The test is called abnormal, or positive, when something changes under stress that should not: the EKG develops ST-segment shifts, a section of heart wall stops moving normally on ultrasound, the nuclear images show an area receiving less blood, blood pressure falls instead of rising, or you develop chest pain or an arrhythmia. Each of these can indicate that a coronary artery is narrowed enough to limit blood flow when demand rises.
The key word is “can.” Stress tests are imperfect tests with a meaningful false-positive rate, and results are graded. A mildly abnormal EKG change in a low-risk patient with no symptoms means something very different from a large blood-flow defect in a patient with chest pain. Interpreting the result in context is the cardiologist’s job.
When to Seek Evaluation
Every abnormal stress test should be reviewed by a cardiologist, and sooner rather than later. How quickly depends on the details. A visit within days is appropriate when:
A routine visit is reasonable when the abnormality was mild, you had no symptoms, and the test was ordered as a screening or pre-operative check. Either way, do not assume a mildly abnormal result can be ignored, and do not start or stop medications on your own while waiting to be seen.
Common Findings
Stress test reports use a shared vocabulary. These are the terms that most often bring patients to the office.
Shifts in the EKG's ST segment during exercise are the classic sign of reduced blood flow, though they are less specific in women and in patients with baseline EKG abnormalities.
On a nuclear test, an area that takes up less tracer with stress than at rest suggests a narrowed artery supplying that region. A defect present both at rest and stress may reflect an old heart attack.
On a stress echo, a section of heart wall that moves normally at rest but weakens under stress points to a blood-flow problem in that territory.
Chest discomfort that appears with exertion and resolves with rest is angina, and it carries weight even when the EKG and images are only mildly abnormal.
Blood pressure that fails to rise or drops during exercise is a concerning sign that can indicate extensive disease or a weakened heart muscle.
Stopping in the first few minutes, or an inability to reach the target heart rate, limits what the test can say and sometimes means a different test is needed.
Meet Your Cardiologist
Adnan Khalid, MD is a board-certified cardiologist with fellowship training in cardiovascular disease, interventional cardiology, and advanced heart failure and transplant cardiology. Interventional training is particularly relevant after an abnormal stress test, because the central question is whether the coronary arteries need to be looked at directly, and if so, whether a blockage should be treated with medication, a stent, or bypass surgery.
Dr. Khalid reviews the stress test images and tracings himself, weighs the findings against your symptoms and risk profile, and decides whether the result should be confirmed with another non-invasive test or evaluated with cardiac catheterization. When catheterization is appropriate, it is coordinated at an appropriate hospital facility, and he continues to manage your care afterward.
Possible Causes
Coronary artery disease is the cause everyone worries about, and it is the most important one, but it is not the only explanation.
Plaque narrowing one or more coronary arteries limits blood flow when the heart works harder. This is the finding a stress test is designed to detect, and the more pronounced the abnormality, the more likely a significant narrowing is present. Learn more about cardiovascular disease.
Some patients, women in particular, have reduced blood flow from disease in the heart’s smallest vessels or from artery spasm rather than a fixed blockage. These can produce an abnormal test with arteries that look open on catheterization, and they are treated differently.
A thickened heart muscle from long-standing high blood pressure, a weakened heart from cardiomyopathy, or a narrowed aortic valve can all cause the heart to respond abnormally to exertion without any coronary blockage.
Baseline EKG abnormalities, certain medications such as digoxin, electrolyte shifts, breast tissue or diaphragm attenuation on nuclear images, poor exercise effort, and rapid breathing can all produce an abnormal-appearing result in a healthy heart. This is one reason a positive stress test is often confirmed or put in context before catheterization is recommended.
Your Evaluation
The first task is to estimate how likely it is that the abnormal result reflects real coronary disease. That estimate combines the test itself with everything known about you.
Dr. Khalid reviews the actual EKG tracings, images, and report: how far into the test the changes appeared, how large the affected area was, whether the heart’s pumping function fell under stress, and whether you had symptoms. A test that turned abnormal at high workload with a small defect is a different situation from one that turned abnormal early with a large one.
Chest discomfort with activity, breathlessness, and reduced exercise tolerance raise the likelihood that the finding is real. So do age, diabetes, high blood pressure, high cholesterol, smoking, kidney disease, and a family history of early heart disease. Prior EKGs, echocardiograms, or calcium scores are reviewed if available.
The exam includes blood pressure, heart and lung sounds, and pulses. A resting EKG is obtained, and cholesterol, glucose, and kidney function may be checked if not already on file.
The result of this assessment is one of three paths: reassurance with risk-factor management for a probable false positive, a confirmatory non-invasive test when the picture is unclear, or direct evaluation of the arteries when the probability of significant disease is high.
Cardiac Testing
After an abnormal stress test, further testing is chosen to either confirm the finding non-invasively or to look at the arteries directly.
A resting ultrasound checks pumping function, wall thickness, and valves, and can show whether a region of the heart was damaged by a prior event.
When a plain treadmill EKG test was abnormal, a stress echo or nuclear study adds imaging and is often used to confirm or refute the result.
A CT scan that measures calcified plaque in the coronary arteries. A score of zero makes significant disease unlikely and can help settle a borderline stress test.
A contrast CT that visualizes the coronary arteries without a catheter. Useful for confirming or excluding narrowing in patients at intermediate risk; coordinated at an outside imaging facility.
The reference test for coronary narrowing. A thin catheter is guided to the coronary arteries in a hospital cath lab, and contrast dye shows any narrowing directly. Treatment with a stent can be performed during the same procedure when indicated.
Cholesterol, glucose or A1c, kidney function, and a blood count help define risk and guide medication choices whatever the arteries show.
Management
An abnormal stress test leads to one of a small number of plans, and which one applies depends on what the follow-up evaluation shows.
When coronary artery disease is confirmed but the narrowing is moderate and symptoms are controlled, treatment is medical: a statin, aspirin or another antiplatelet drug when appropriate, blood pressure control, and medication for angina if needed, along with attention to diet, exercise, weight, and smoking. This approach is effective for many patients and does not require a procedure.
When a significant blockage is causing symptoms or affecting a large area of heart muscle, angioplasty with stent placement or bypass surgery may be recommended. The choice depends on the location and pattern of the blockages, heart pumping function, diabetes and other health factors, not simply on how many arteries are narrowed. These decisions are made after catheterization, and Dr. Khalid explains the reasoning and the alternatives before anything is scheduled.
When the stress test proves to have been a false positive, the plan is reassurance and continued risk-factor management. If a non-coronary cause such as a valve or heart muscle problem is found, treatment follows that diagnosis. In every case, the goal is a plan you understand and a clear sense of what symptoms should prompt a call.
Your Visit
Ask the facility that performed the stress test to send the full report and images, not just the summary. Bring any prior EKGs, echocardiograms, calcium scores, or catheterization reports, a complete medication list, and recent cholesterol and glucose results.
The visit covers your symptoms and exercise tolerance, your risk factors, a physical examination, and a resting EKG. Dr. Khalid will walk through the stress test findings with you and explain how likely they are to reflect real disease. If further testing is recommended, you will know which test, why it was chosen over the alternatives, and what each result would mean.
If catheterization is the next step, it is scheduled at the hospital, and you will receive instructions about medications, fasting, and what to expect on the day. The goal is for you to leave the first visit with a clear plan.
Katy Cardiology Care
Patients from Katy, Cinco Ranch, Fulshear, and West Houston come to the Grand Parkway office after a stress test ordered by a primary care physician, a pre-operative clinic, or an emergency room returned abnormal. Because an abnormal result can mean significant disease, mention the result when you call so our staff can discuss scheduling with you.
Resting EKGs are performed in the office; echocardiograms, imaging stress tests, calcium scoring and CT angiography are performed or arranged by our office, and catheterization is scheduled at an affiliated hospital when indicated. For other services at this location, see cardiology care in Katy.
Advanced Cardiology – Katy
410 W Grand Pkwy S Ste 4D
Katy, TX 77494
Phone: (713) 258-6111
Advanced Cardiology – Sugar Land
7102 Tarrington Ave Suite 505
Sugar Land, TX 77479
Phone: (713) 258-6111
Sugar Land Cardiology Care
At the Tarrington Avenue office, Dr. Khalid sees patients from Sugar Land, Richmond, Rosenberg, Missouri City, and Stafford whose stress test was flagged. In patients with diabetes or high blood pressure, an abnormal result is more likely to reflect real coronary disease. Patients who were told to “follow up with cardiology” and are unsure how urgent that is are encouraged to call and ask.
The office performs EKGs; echocardiograms and confirmatory imaging are performed or arranged by our office, and catheterization, when needed, is scheduled at an affiliated hospital. Patients who want a second opinion on an earlier result are welcome to bring their records. Learn more about cardiology care in Sugar Land.
Serving Greater Houston
Patients come to the Katy and Sugar Land offices from across Greater Houston, including Cypress, Richmond, Rosenberg, Fulshear, and West Houston, for follow-up after an abnormal stress test. Both offices offer the same physician and the same approach; choose the one that is easier to reach, and the scheduling team can help if you are unsure.
Patient-Centered Cardiology
Fellowship training in the subspecialty that evaluates and treats coronary blockages, so the same physician can guide you from stress test review to treatment decisions.
Stress test images and tracings are reviewed directly, with the aim of recognizing likely false positives before catheterization is recommended.
When confirmatory testing or catheterization is needed, our office coordinates it with an imaging facility or affiliated hospital.
You understand what the result means, what each option involves, and why one path is recommended over another.
Offices in Katy and Sugar Land serving surrounding Greater Houston communities.
New patients are welcome. Most major insurance plans are accepted, subject to eligibility and coverage verification.
Common Questions
Call our office and our staff will help with appointments, referrals and insurance.
It means the heart showed a change under exertion, most often an EKG shift, a blood-flow defect, or a wall-motion abnormality, that can indicate a narrowed coronary artery. It raises the probability of coronary artery disease but does not confirm it, which is why the result is interpreted alongside your symptoms and risk factors before any decision is made.
No. Stress tests have a meaningful false-positive rate, particularly in women, in patients with baseline EKG abnormalities, and in those taking certain medications. Some abnormal results reflect small-vessel disease, artery spasm, valve or heart muscle conditions, or imaging artifact rather than a fixed blockage. Confirmation with another test is common before proceeding to catheterization.
It depends on how likely the result is to be real. When the probability of significant disease is high, catheterization may be the next step. When the picture is uncertain, a stress echo, nuclear study, coronary calcium score, or CT angiography is often used first. When the result is probably a false positive, the plan is risk-factor management and observation.
Ideally within days. Stress test findings that involve a large area of heart muscle, symptoms during the test, or a drop in blood pressure warrant prompt evaluation. Even a mildly abnormal result should be reviewed within a few weeks. Mention the result when you call.
Not always. Many patients with an abnormal stress test are evaluated with non-invasive imaging first, and some are managed with medication without ever needing a catheterization. Catheterization is recommended when the probability of a significant blockage is high enough that direct visualization, and possibly treatment, is the most useful next step.
Yes, and it happens regularly. Baseline EKG changes, certain medications, poor exercise effort, rapid breathing, breast or diaphragm shadowing on nuclear images, and electrolyte shifts can all produce an abnormal-looking result in a healthy heart. Women have higher false-positive rates on treadmill EKG tests, which is one reason imaging stress tests are often preferred.
Unless your cardiologist has told you otherwise, avoid strenuous exertion until you have been seen, and do not ignore chest discomfort, breathlessness, or fatigue with activity. Keep taking your medications as prescribed unless your care team gives you different instructions. Call 911 for chest pain or pressure at rest or lasting more than a few minutes, pain that spreads to the arm or jaw, shortness of breath, sweating, nausea, or fainting.
A treadmill EKG stress test tracks the heart’s electrical activity and blood pressure during exercise. A nuclear stress test adds a tracer that maps blood flow to the heart muscle, and a stress echocardiogram adds ultrasound images of the heart’s motion. The imaging tests are generally more accurate and are often used to confirm an abnormal treadmill result.
Keep Reading
Related services: Exercise Stress Testing • Stress Echocardiography • Nuclear Cardiac Testing • Coronary Calcium Scan • Cardiac Catheterization • Interventional Cardiology • Chest Pain Evaluation
Sources: MedlinePlus: Exercise Stress Test · NHLBI: Coronary Heart Disease · NHLBI: Cardiac Catheterization · American Heart Association: Warning Signs of a Heart Attack
Your cardiologist: Adnan Khalid, MD
Cardiology Appointments
If your stress test came back abnormal, the next step is a cardiology visit that puts the result in context and maps out what, if anything, needs to happen. Adnan Khalid, MD welcomes new patients at Advanced Cardiology’s Katy and Sugar Land offices.
Katy: 410 W Grand Pkwy S Ste 4D, Katy, TX 77494
Sugar Land: 7102 Tarrington Ave Suite 505, Sugar Land, TX 77479
Chest pain or pressure, pain spreading to the arm or jaw, sweating, nausea, shortness of breath, or fainting after an abnormal stress test may be a heart attack. Call 911, even if the symptoms go away.
Katy & Sugar Land Cardiologist
Advanced Cardiology welcomes new patients at its offices in Katy and Sugar Land. Call our office or send an appointment request, and our staff will follow up.
Most major insurance plans accepted; coverage is verified individually.
For possible heart attack or stroke symptoms, call 911.
