title: Update on pharmacological cardiac stress testing: efficacy, risk stratification and patient selection.
abstract: Despite greater control of risk factors and improved treatments, coronary heart disease (CHD) remains a significant cause of mortality with 1 in every 4 deaths in the United States due to this disorder.(1) Cardiac stress tests have long been one of the most often utilized testing modalities used to identify patients suspected of having CHD, specifically coronary artery disease (CAD). These tests allow for noninvasive assessment of the coronary circulation and its ability to augment flow in response to physiologic demand. As with any diagnostic testing however, potential health risks as well as the financial burden of cardiovascular stress testing, must be weighed against the benefits and utility of the data procured. Given the rapidly evolving field of cardiac stress testing with respect to new risk stratification guidelines, new agents, and new assessment methods, it is difficult for physicians to remain up to date on the latest research and the benefits and risks of different testing modalities. A recent survey of primary care physicians and cardiologists conducted by the Elsevier Office of Continuing Medical Education found that approximately one-quarter of the cardiologists and primary care physicians surveyed do not feel confident identifying the factors which should be considered before ordering a cardiac stress test as part of pre-operative screening for a patient. Additionally, this survey also reported that primary care physicians reported a high degree of confidence in ordering the appropriate cardiac screening tests for patients yet, cardiologists reported that they frequently/somewhat frequently felt the need to change the test ordered by the internist. This educational intervention focuses on patient selection, exercise vs. pharmacologic stress testing, pharmacologic agents, and the importance of patient and doctor communication in ensuring the right test is recommended for the right patient. This CME Multimedia Activity is also available through the Website of The American Journal of Cardiology (www.amjmed.com). Click on the Multimedia button in the navigation bar for full access. Or access: http://elseviercme.com/538.
authors.affiliation: Co-Director, Non-invasive Cardiovascular Imaging Training Program, Cardiovascular Division & Department of Radiology, Brigham and Women's Hospital, Assistant Professor Medicine and Radiology, Harvard Medical School, Boston, MA.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Senior Physician, Brigham and Women's Hospital, Professor of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cannon
authors.affiliation: Chief, Division of Cardiology, Director, Nuclear Cardiology Laboratory, Professor, Tufts University School of Medicine, Boston, MA.
authors.forename: James
authors.initials: J
authors.lastname: Udelson
mesh_terms: D002316:Cardiotonic Agents; D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis*; D025401:Echocardiography, Stress; D005080:Exercise Test; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment
chemical_list: D002316:Cardiotonic Agents