Optimize your use of stress tests: a Q&A guide.
Order exercise stress testing without imaging for patients with a low to intermediate probability of coronary artery disease (CAD), unless preexisting electrocardiographic (EKG) changes would render such a test nondiagnostic. Order stress testing with imaging for patients with preexisting EKG changes and/or a high probability of CAD. Do not use stress testing to screen asymptomatic patients for CAD. Consider pharmacologic testing for patients who are unable to exercise to an appropriate cardiac workload; it has the same predictive value as a nuclear exercise stress test.
Knox
Mark A
MA
UPMC Shadyside Family Medicine Residency, Pittsburgh, PA, USA. knoxma@upmc.edu
D000241:Adenosine; D000075202:Contraindications; D003324:Coronary Artery Disease / Q000175:diagnosis*; D048909:Diabetes Complications; D004176:Dipyridamole; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods*; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D015637:Gated Blood-Pool Imaging; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine