Exercise Stress TestExercise is the preferred stress modality in patients who are able to achieve at least 85% of age-adjusted maximal predicted heart rate (MPHR) and five metabolic equivalents.
Exercise stress testing is a powerful risk stratification tool, and is useful in assessing the efficacy of anti-ischemic drug therapy and/or coronary revascularization.
The treadmill is the most widely used stress modality. The most commonly employed treadmill stress protocols are the Bruce and modified Bruce.
IndicationsIndications for an exercise stress test are:
- Detection of coronary artery disease (CAD) in patients with an intermediate pretest probability of CAD based on age, gender, and symptoms, or in patients with high-risk factors for CAD (i.e diabetes mellitus, peripheral or cerebrovascular disease).
- Risk stratification of post-myocardial infarction patients.
- Risk stratification of patients with chronic stable CAD into a low-risk category that can be managed medically or a high-risk category that should be considered for coronary revascularization.
- Risk stratification of low-risk acute coronary syndrome patients (without active ischemia and/or heart failure) 6-12 hours after presentation or intermediate risk acute coronary syndrome patients 1-3 days after presentation.
- Risk stratification before non cardiac surgery in patients with known Coronary Artery Disease, Diabetes mellitus, peripheral or cerebrovascular disease.
- To evaluate the efficacy of therapeutic interventions (anti-ischemic drug therapy or coronary revascularization) and in tracking subsequent risk based on serial changes in myocardial perfusion in patients with known CAD.
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