ACS - Stress Testing

• Stress testing is recommended for pts w/ low-moderate pretest probability of CAD
  • Not helpful in pts w/ very low risk or high risk

ECG-Based Exercise Treadmill Testing

• 68% sn, 77% sp
• Contraindications to Exercise Testing
  • Absolute
    • MI (within 2days)
    • High-risk unstable angina
    • Uncontrolled cardiac dysrhythmias
    • Symptomaticaortic stenosis
    • Uncontrolled symptomatic heart failure
    • Acute pulmonary embolus or pulmonary infarction
    • Acute myocarditis or pericarditis
    • Acute aortic dissection
  • Relative
    • Baseline ST segment abnormalities
    • Left main coronary stenosis
    • Moderate stenotic valvular heart disease
    • Electrolyte abnormalities
    • Severe HTN (>200 sys, >110 dia)
    • Tachydysrhythmias or bradydysrhythmias
    • HOCM
    • Mental or physical impairment
    • High-degree atrioventricular block

Echocardiography

• Sn 80% sp 84%
• When used in low-risk pts, NPV 97-100%

Nuclear Medicine

• Consider if unable to exercise

Source

Tintinalli