Stress Testing

Stress Test – Indications

• chest pain
• provocation of ischaemia
  • evaluation of angina management
• provocation of arrhythmia
  • evaluation of arrhythmia management
• risk assessment after AMI
• functional assessment in patient with heart disease

If equivocal exercise test or if querying whether a stenotic vessel on angiography may represent a clinically significant lesion that would confer ischaemic areas upon exercise ⇒ myocardial perfusion scan (MPS).

If the MPS is normal after exercise or, failing exercise, after pharmacologic stress (adenosine, dipyridamole, or dobutamine), significant CAD is unlikely.

Options after equivocal stress test:

• Nuclear MPI, SPECT and PET
• Coronary CT angiography (CTA)
• Stress Echocardiography
• Cardiac Magnetic Resonance Imaging (MRI)

Stress Test – Contraindications

• recent AMI (within 1 week) → 2 weeks
• Unstable Angina Pectoris (UAP)
• uncompensated heart failure
• severe aortic stenosis (AS)
• malignant hypertension

Reference

1. Blankstein, Ron and DeVore, Adam D. “Selecting a Noninvasive Imaging Study After an Inconclusive Exercise Test.” Circulation 122; 2010: 1514–18. https://doi.org/10.1161/CIRCULATIONAHA.109.903351.
2. Lee, Joseph C., West, Malcolm J. and Khafagi, Frederick A. “Myocardial perfusion scans.” Aus Fam Phys 42(8); August 2013. Available at https://www.racgp.org.au/afp/2013/august/myocardial-perfusion-scans/.