Exercise Stress Testing in CAD
Contraindications
Indications
- CDU low risk chest pain patients (negative TnT x2)
- Evaluate chest pain unknown aetiology
- Evaluate current anti anginal regimen
- Evaluate patients post AMI
- SubMax test at day 6 or full EST at week 6
- Pre-op assessment high risk patients (esp if known IHD)
Use alternative test (cannot interpret ECG) if:
- LBBB
- Resting ECG ST depression (irrespective aetiology)
- Digoxin
- Paced rhythm
- WPW
Adequate stress test
- Greater than 90% of max heart rate (230-age)
- Greater than 6 METS (1 MET = 3.5ml O2/min/kg)
- Peak Double Produce> 20,000 (PDP= max SBP v HR)
STOP test if
- ST Elevation
- Chest pain
- Tachyarrhythmia
- Hypotension
- Excessive fatigue
- Significant dizziness
Critical stenosis suggested by
- Stop at less than 6 METS
- <ST elevation
- Drop SBP >10mmHg
- ST depression at low workload
- ST depression lasts > 4 minutes
Positive stress test
- Positive test if 1.0 mm horizontal or down sloping ST depression in 2 or more contiguous leads
