CARDIAC STRESS TESTS-OVERVIEW

SUMMARY

1. Indication: detection of CAD (diagnostic tool) & stratification of risk (prognostic tool). Diagnostic testing is most valuable when pretest probability for CAD is intermediate.

2. Two types:
- Without imaging: exercise tolerance testing (treadmill or bicycle without imaging)
- With imaging: stress image testing (with echo or perfusion scan)

3. ETT: cornerstone of diagnostic testing for ischemia, functional capacity & determining prognosis. Usually on treadmill, uses Bruce protocol.

4. The increased demand for myocardial O₂ with exercise is the key factor in the use of exercise testing for CAD.

5. The level of maximal exercise achieved on the ETT is measured in metabolic equivalents (METS). Most ADLs in the home require < 4 METs.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].