Referring Doctors
Which Stress Test Should I Order For My Patient?
This is a frequently asked question. Ordering the most appropriate stress test for your patient provides the most accurate information for clinical decision making, and avoids delays in completing the examinations and minimizes the chances of repeat tests/return visits.
1. Standard Exercise Treadmill Test: Is a good test for young patients with normal EKGs. Women and patients with abnormal EKGs should not have this test (i.e. nonspecific ST-T-wave changes, (L) BBB, LVH with repolarization abnormalities). These patients should have additional imaging performed (see stress echo or nuclear testing).
2. Nuclear Stress Testing: This test can be done with exercise or pharmacologic agents. (Adenosine is used for the majority of cases, while Dobutamine is reserved for patients with reactive airway disease currently using bronchodilators). This test provides extensive cardiac perfusion data including EF measurement.
3. Stress Echo: This test can be done with exercise or pharmacologic agents (i.e. Dobutamine infusion). This test improves diagnostic accuracy in those patients with potentially false positive EKGs. It allows direct visualization of left ventricular function at rest and at peak heart rate.
Important Points:
- There is no single, perfect stress test with 100% predictive accuracy
- Exercise (when possible) is preferred to pharmacologic stress
- Use of Dobutamine in patients at risk for, or a chronic history of dysrhythmia (i.e. chronic afib/Paroxysmal Atrial Fibrilation or frequent PVCs) is not appropriate
We are always happy to consult with you in determining the best test for your patient. Please feel free to call us with any questions.