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An exercise stress test is generally safe, and complications are rare. But, as with any medical procedure, it does carry a risk of complications.

Potential complications include:

• Low blood pressure. Blood pressure may drop during or immediately after exercise, possibly causing you to feel dizzy or faint. The problem should resolve after you stop exercising.
• Abnormal heart rhythms (arrhythmias). Arrhythmias brought on by an exercise stress test usually go away shortly after you stop exercising.
• Heart attack (myocardial infarction). Although exceedingly rare, it's possible that an exercise stress test could provoke a heart attack.

When you arrive for your exercise stress test, your doctor asks you about your medical history and how often you usually exercise. This helps determine the amount of exercise that's appropriate for you during the test.

During an exercise stress test

A nurse or technician places sticky patches (electrodes) — which are connected by wires to an electrocardiogram (ECG or EKG) machine — on your chest, legs and arms to record your heart's electrical signals. A cuff on your arm checks your blood pressure during the test. You may be asked to breathe into a tube during the test to determine how well you breathe during exercise.

You then begin walking on the treadmill or pedaling the stationary bike slowly. As the test progresses, the speed and incline of the treadmill increases. You can use the railing on the treadmill for balance, but don't hang on tightly, as that may skew the results of the test. On a stationary bike, the resistance increases as the test progresses, making it harder to pedal.

You continue exercising until your heart rate has reached a set target or until you develop symptoms that don't allow you to continue. These signs and symptoms may include:

• Moderate to severe chest pain
• Severe shortness of breath
• Abnormally high or low blood pressure
• An abnormal heart rhythm
• Dizziness
• Certain changes in your electrocardiogram

You may stop the test anytime you're too uncomfortable to continue exercising.

After an exercise stress test

After you stop exercising, you may be asked to stand still for several seconds and then lie down for about five minutes with the monitors in place so that they can continue taking measurements as your heart rate and breathing return to normal.

When your exercise stress test is complete, you may return to your normal activities for the remainder of the day.

During the procedure

Surgery to implant the pacemaker is usually performed while you're awake and typically takes a few hours. You'll be given a sedative to relax, and the area where your pacemaker is inserted will be numbed.

During surgery, one or more flexible, insulated wires (leads or electrodes) are inserted into a major vein under or near your collarbone and guided to your heart with the help of X-ray images. One end of each wire is secured to the appropriate position in your heart, while the other end is attached to the pulse generator, which is usually implanted under the skin beneath your collarbone.

After the procedure

You'll usually stay in the hospital for one day after having a pacemaker implanted. Before you leave, your pacemaker is programmed to fit your particular pacing needs. A return visit is often scheduled to make sure your pacemaker's settings are correct.

After that, most pacemakers can be checked remotely using wireless technology. Using your cellphone or radiofrequency signals, your pacemaker transmits and receives information between you and your doctor's office, where your doctor can access the data — including your heart rate and rhythm, how your pacemaker is functioning, and remaining battery life. Remote transmissions can be made at scheduled intervals or at unscheduled times if your pacemaker sends an alert, or you can send a transmission if you have a concern. Remote technology means fewer trips to the doctor's office, but you'll still need to be seen by your doctor in person for scheduled checkups.

After your procedure to implant your pacemaker, your doctor may recommend that you avoid vigorous exercise or heavy lifting for about a month. You may have some aches and pains near the area where your pacemaker was implanted. These pains can be relieved with over-the-counter medicines, such as acetaminophen (Tylenol, others) or ibuprofen (Motrin IB, Advil, others), but talk to your doctor before taking any pain relievers.

Special precautions

It's unlikely that your pacemaker would stop working properly because of electrical interference. Still, you'll need to take a few precautions:

• Cellphones. It's safe to talk on a cellphone, but avoid placing your cell phone directly over your pacemaker implantation site when the phone is turned on. Although unlikely, your pacemaker could misinterpret the cellphone signal as a heartbeat and withhold pacing, producing symptoms, such as sudden fatigue.
• Security systems. Passing through an airport metal detector won't interfere with your pacemaker, although the metal in it may sound the alarm. But avoid lingering near or leaning against a metal-detection system. If security personnel insist on using a hand-held metal detector, ask them not to hold the device near your pacemaker any longer than necessary or ask for an alternative form of personal search. To avoid potential problems, carry an ID card stating that you have a pacemaker.
• Medical equipment. If a doctor is considering any medical procedure that involves intensive exposure to electromagnetic energy, tell him or her that you have a pacemaker. Such procedures include magnetic resonance imaging, therapeutic radiation for cancer treatment and shock wave lithotripsy, which uses shock waves to break up large kidney stones or gallstones. If you're having surgery, a procedure to control bleeding (electrocautery) also can interfere with pacemaker function.
• Power-generating equipment. Stand at least 2 feet (60 centimeters) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, your doctor can arrange a test in your workplace to determine whether it affects your pacemaker.

Devices that are unlikely to interfere with your pacemaker include microwave ovens, televisions and remote controls, radios, toasters, electric blankets, electric shavers, and electric drills.

If the information gathered during your exercise stress test shows your heart function to be normal, you may not need any further tests.

However, if the results are normal and your symptoms continue or become worse, your doctor may recommend that you have a nuclear stress test or another exercise stress test that includes an echocardiogram before and after exercise. These tests are more accurate and provide more information about your heart function, but they are also more expensive.

If the results of your exercise stress test suggest coronary artery disease or reveal an arrhythmia, the information gathered during the test will be used to help your doctor develop a treatment plan. You may need additional tests and evaluations, such as a coronary angiogram, depending on the findings.

If the purpose of your exercise stress test was to guide treatment for a heart condition, your doctor will use data from the test to establish or modify your treatment plan, as needed.