Exercise stress testing

Abstract

Before performing stress testing, it is necessary to have a clear understanding of what question one wishes to answer. Although the exercise stress test can provide useful information to guide the physician in the management of patients, awareness of the limitations of this procedure and of the need for a probability approach to its interpretation is essential. In particular, one must ask whether stress testing will provide the information necessary to guide clinical decision-making. For example, although it is not necessary for diagnostic purposes to perform a stress test in a patient who has a high likelihood of coronary atherosclerotic disease, one might elect to obtain objective evidence of ischemia or diminished functional aerobic capacity before instituting medical or surgical therapy. This would provide reliable data for assessment of the effects of therapy. On the other hand, restricting attention to the ST segment response to exercise fosters neglect of other important diagnostic and prognostic information available from the exercise test. Attention to the blood pressure and heart rate response and to combinations of relevant variables, as described in this article, is necessary for more effective and enlightened clinical decision-making.