Results of stress testing

Guidelines for results of open access exercise test

NEGATIVE

NEGATIVE SUBMAXIMAL

EQUIVOCAL

POSITIVE

ADVERSE POSITIVE

Max sensitivity of test is 70% - beware false negatives! Coronary ischaemia reasonably excluded Highly unrelaiable for exclusion of ischaemia Unreliable result

Specificity of test approx 90% so +ve test usually denotes definite coronary ischaemia

Aspirin 150mg daily
REVERSE RISK FACTORS

Reconsider symptoms and overall likelihood of CAD
Refer cardiologist if indicated

Increment medication:
Sublingual GTN or spray
+ Beta blocker
+/- Regular nitrate
+/- Calcium antagonist
+/- Nicorandil 		Maximise medication:
Sublingual GTN or spray
+ Beta blocker
+ Regular nitrate
+ Calcium antagonist
+ Nicorandil

Good anginal relief by <= 2 agents? All need assessment for angiography

Yes

No

GP review Refer to cardiologist


Some notes on exercise tests and reporting of results

Maximum HR with exercise:
Best reliability
Less reliable
Unreliable
Target is 220 minus age in years
Peak HR = 100% of max
Peak HR = 85-100% of max
Peak HR = <85% of max
Exercise time of standard Bruce: if <6mins = adverse feature
Limiting symptoms: did pt develop symptom in question (angina)?
Positive test if: planar or downsloping ST depression >= 1mm
Lead groups: II,III,aVF = inferior
I, aVL = high lateral
V1,V2,V3 = anteroseptal
V4,V5,V6 = anterolateral

Bradley Cheek 1999