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Expired CME Article

Stress Test: A Primer for Primary Care Physicians

Ishak A. Mansi, MD
Volume: 101 Issue: 8 August, 2008

Abstract:

Although stress testing is generally a safe procedure, complications may occur. Types of stress tests include electrocardiographic exercise stress test, myocardial imaging exercise stress test, and myocardial imaging pharmacological stress tests. Nuclear imaging stress test is a preferable modality in women. Exercise-based stress tests provide evaluations of functional capacity, as well as their blood pressure and heart rate recovery rate, which offer additional diagnostic and prognostic information. Exercise-based stress tests should be considered before using a pharmacological-based test. Different exercise protocols are available, dependent on patients’ clinical status. Patients incapable of achieving 5 metabolic equivalent units (METs) of exercise should have a pharmacological stress test. Different pharmacological agents are available for stress tests, and the agents’ choice depends on the patients’ characteristics and their medications. Some markers may indicate a highly positive stress test, which warrants immediate attention. Indications, contraindications, and precautions for stress test modalities are discussed in this article.


Key Points


* Although stress testing is generally a safe procedure, complications may occur.


* Physicians performing exercise testing should entertain good clinical judgment in identifying indications and contraindications for the test, and deciding which patients should undergo which type of stress test.


* Several types of stress tests, performed by primary care physicians, are available, including electrocardiographic exercise stress test, myocardial imaging exercise stress test, and myocardial imaging pharmacological stress tests.


* Exercise-based stress tests provide evaluations of the functional capacity of patients, as well as their blood pressure and heart rate recovery rate, which offer additional diagnostic and prognostic information. Exercise-based stress tests should be considered before using a pharmacological-based test. Different pharmacological agents are available for stress tests, and the agents’ choice depends on the patients’ characteristics and medications.

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