The decision to perform exercise or pharmacologic stress testing or coronary CT angiography is based on the patient's:
• pretest likelihood of CAD
• baseline ECG
• ability to exercise
• comorbid illnesses that limit pharmacologic testing
Stress testing is most useful in patients at intermediate pretest likelihood of CAD (10% to 90%).
• In patients with low pretest probability, a normal test result only confirms that the patient is low risk (an abnormal stress test result is most likely a false-positive).
• In patients with a high pretest likelihood, the use of stress testing for diagnostic purposes is not indicated (an abnormal result confirms the presence of disease and a normal result likely to indicate a false-negative).
Contraindications and Situations Where Use Is Not Advised
• All Forms of Stress: Active ischemic CP, ACS, Recent STEMI, DecompensatedCHF, Aortic dissection, Severe arrhythmias
• Exercise: Inability to exercise, poor conditioning, instability, claudication, COPD, Myocarditis, pericarditis
• Dobutamine; Severe hypertrophy or HOCM, Severe ventricular arrhythmias, severe hypertension
• Dipyridamole/Adenosine: Reactive airways dz, Wheezing, Hypotension (SBP<95), Advanced AV block, Allergy, Recent caffeine