Stress Test EKG

Guidelines for EKG stress tests are being updated, mostly to integrate more and better data with new work structures.  Diagnosis of coronary artery disease is still the principal indication for stress testing.  Interpretation needs to be multivariate, providing the probability of the existence of lesions in light of the various risk factors, and age, sex, and symptoms.  There are new indications for the test, and new contraindications too. These are defined according to population subgroups, like athletes, women, children, the elderly, asymptomatic patients, diabetics, hypertensive patients, PAD patients, or patients in the context of a non-cardiac surgery pre-op visit. The advice is to use complementary testing for all the various cardiac pathologies – congenital, ischemic, valvular, cardiomyopathies, congestive heart failure, rhythm and conduction disorders, pacemaker fine-tuning, or pulmonary hypertension.  The usefulness of an EKG stress test, in other words, now extends to all cardiovascular disease. 

Stress Test EKG Questions & Answers

True. It’s been found that more women have positive stress test results than positive CT results. But fewer women with positive stress tests go on to have a future heart event compared to women with positive imaging tests.
Men, on the other hand, are more likely to have a positive imaging test than stress test. Among men with positive results, risk for future heart events was similar regardless of which test was used.
Yes, in general, and it predicts future heart events better in women, for some reason. But those findings don’t change current guidelines for assessing heart disease. Stress tests and imaging tests are both useful, and which test is most appropriate depends on the characteristics of each patient.
Measures of ischemia obtained with echocardiographic or radionuclide imaging are more sensitive indicators than EKG measures; they occur at a lower intensity of ischemia, and so they precede EKG changes.
Silent ischemia that is identified electrocardiographically often occurs at a lower ischemic threshold than that needed for the symptomatic expression of ischemia. So you should use it.
No. Nor does it negate the need for comprehensive testing.
It’s been shown that terminating exercise stress testing before exhaustion (and an RPE score of 17) limits the test’s ability to detect cardiovascular abnormalities.