Recent Advances in Exercise Testing

Craig      Boyle; Sara      Partington; Natasha      Ahmed; Jonathan      Myers; Victor      Froelicher

Abstract

Exercise Testing still holds firm ground as a simple non-invasive investigative tool for the diagnosis of Coronary Artery Disease. It is a commonly used technique for evaluating patients with cardiac symptoms. Exercise Testing requires appropriate patient preparation and selection. Proper history and physical examination is imperative in order to identify possible contraindications to testing and to determine pretest probability. Manual blood pressure measurements are required to assess a patients condition during the test for safety. The test should be stopped if ominous signs and/or symptoms occur. Although there are several protocols in use, ramp testing is the preferred technique. Exercise capacity has the greatest prognostic value of all responses in all patient subgroups. There is a 2-10% decrease in mortality and a 5% decrease in health care costs per MET. The Duke Treadmill Score, the drop of heart rate in recovery and the “simple angiographic predictive scores” should to be part of every exercise test report.

Keywords: exercise testing, treadmill testing, st segment, ramp protocol, pre-test probability, sensitivity, specificity, predictive accuracy, exercise test scores, duke treadmill score