EMed

Exercise Stress Testing in CAD

CUH Emergency Department

Patients should not be discharged to return for an EST.CNM Anna Dillon

Contraindications

Indications

  • Evaluate current anti anginal regimen
  • Evaluate patients post AMI
    • Sub-Max test at day 6 or full EST at week 6
  • Pre-op assessment high risk patients (esp if known IHD)

Use alternative test (cannot interpret ECG) if:

  • LBBB
  • Resting ECG ST depression (irrespective aetiology)
  • Digoxin
  • Paced rhythm
  • WPW

STOP test if

  • ST Elevation
  • Chest pain
  • Tachyarrhythmia
  • Hypotension
  • Excessive fatigue
  • Significant dizziness

Positive stress test

ST changes in Ischaemia

  • Positive test if 1.0 mm horizontal or down sloping ST depression in 2 or more contiguous leads

Critical stenosis suggested by

  • Stop at less than 6 METS
  • ST elevation
  • Drop SBP >10mmHg
  • ST depression at low workload
  • ST depression lasts > 4 minutes

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 7/02/23.