Guidelines for stress testing

Investigations

• Check FBC/U&E (and lipids)

Guidelines for an exercise test

• Diagnosis of coronary ischaemia
  • Anginal pains - seeking objective proof
  • Exertional SOB - ?ischaemic in origin
    

  NB: seek objective proof of coronary ischaemia in all patients with "angina".

• Assessment of known coronary disease
  • Patients with inadequate medical control.
  • Patients not well controlled on two regular anti-ischaemic agents.
  • Patients with residual angina on 3-4 regular agents.
  • Patients with previous revasacularisation - refer.
  • Patients with complications - refer.
• 6 weeks post MI

Checklist - ECG exclusions

• Left bundle branch block
• LV hypertrophy with ST-T change
• WPW syndrome
• Unexpected acute MI/ischaemia

Checklist - contraindications

• On digoxin
• Aortic stenosis
• Other severe valve stenosis
• Hypertrophic cardiomyopathy
• Severe heart failure
• Unstable angina
• Uncontrolled hypertension (>200/100)
• Unstable cardiac rhythm (AFis OK off digoxin if rate <120)
• Myocarditis or pericarditis
• Intercurrent illness/pneumonia
• Limiting Arthritis/COAD/claudication

Bradley Cheek 1999