Echocardiography
Stress Testing/
Nuclear Cardiology
Cardiac Catheterization/
Interventional Cardiology
Arrhythmia Service
EECP
Peripheral
Vascular
Anti-Coagulation
(Coumadin) Clinic
Research

 

Patient Guide
and
Indications for Testing

Indications for Stress Testing

  • To rule out myocardial ischemia in a patient with
    • chest pain or anginal equivalent
    • abnormal EKG
    • known coronary artery disease
    • hypertensive heart disease
    • cardiomyopathy
    • congestive heart failure
    • arrhythmia (including atrial fibrillation)
  • After coronary artery bypass, angioplasty or stent especially if
    • enrolling in a cardiac rehab program
    • chest pain recurs
    • EKG changes
  • After an uncomplicated myocardial infarction
  • Preoperative assessment prior to noncardiac surgery especially if
    • chest pain or anginal equivalent
    • abnormal EKG
    • known coronary artery disease (if no recent cardiac cath or stress)
  • To evaluate arrhythmia

Indications for Stress Thallium

  • Unable to walk or exercise to targert heart rate (85% of 220-age) - consider pharmacologic stress (persantine)
  • Abnormal resting EKG
    • bundle branch block (RBBB, LBBB, left anterior hemiblock)
    • left ventricular hypertrophy
    • significant ST-T wave abnormalities
    • significant Q waves
    • Wolf-Parkinson-White syndrome or pre-excitation
  • Medications
    • digoxin (false + regular stress test)
    • quinidine (false +)
    • procainamide (false +)
    • nitrates (false -)
    • beta blocker (false -)
    • calcium channel blocker, especially diltiazem (false -)
  • Valvular heart disease
    • especially moderate to severe disease (may not be able to exercise)
    • mitral valve prolapse (can have false + regular stress)
  • Significant congential heart disease
  • Cardiomyopathy
  • Hypokalemia
  • Anemia
  • Hypertensive heart disease