ACS - stress testing - Revision history

Danbot: Danbot moved page ACS - Stress Testing to ACS - stress testing: Naming convention: first word capitalized, subsequent words lowercase

2026-03-22T02:37:28Z

Danbot moved page ACS - Stress Testing to ACS - stress testing: Naming convention: first word capitalized, subsequent words lowercase

← Older revision	Revision as of 02:37, 22 March 2026
(No difference)

SuperD: /* ECG-Based Exercise Treadmill Testing */

2020-01-05T11:58:34Z

ECG-Based Exercise Treadmill Testing

← Older revision		Revision as of 11:58, 5 January 2020
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	***High-risk unstable angina		***High-risk unstable angina
	***Uncontrolled cardiac dysrhythmias		***Uncontrolled cardiac dysrhythmias
	***~~Symptomaticaortic~~ stenosis		***Symptomatic aortic stenosis
	***Uncontrolled symptomatic heart failure		***Uncontrolled symptomatic heart failure
	***Acute pulmonary embolus or pulmonary infarction		***Acute pulmonary embolus or pulmonary infarction

Rossdonaldson1: Text replacement - ">" to ">"

2017-01-23T17:43:58Z

Text replacement - ">" to ">"

← Older revision		Revision as of 17:43, 23 January 2017
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	***Moderate stenotic valvular heart disease		***Moderate stenotic valvular heart disease
	***Electrolyte abnormalities		***Electrolyte abnormalities
	***Severe hypertension (~~>~~200 sys, ~~>~~110 dia)		***Severe hypertension (>200 sys, >110 dia)
	***Tachydysrhythmias or bradydysrhythmias		***Tachydysrhythmias or bradydysrhythmias
	***HOCM		***HOCM

Rossdonaldson1: Text replacement - "troponin " to "troponin "

2016-12-04T14:24:05Z

Text replacement - "troponin " to "troponin "

← Older revision		Revision as of 14:24, 4 December 2016
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	*PATIENTS WITH ACUTE CHEST PAIN: APPROPRIATE INDICATIONS		*PATIENTS WITH ACUTE CHEST PAIN: APPROPRIATE INDICATIONS
	**Patients with acute chest pain with possible acute coronary syndrome: a) ECG shows no ischemic changes, LBBB, or electronically ventricular paced rhythm; and b) negative to borderline elevated troponin levels.		**Patients with acute chest pain with possible acute coronary syndrome: a) ECG shows no ischemic changes, LBBB, or electronically ventricular paced rhythm; and b) negative to borderline elevated [[troponin]] levels.
	**In this setting, nuclear imaging is considered appropriate in both low-risk TIMI score and high-risk TIMI score patients		**In this setting, nuclear imaging is considered appropriate in both low-risk TIMI score and high-risk TIMI score patients

Rossdonaldson1: Text replacement - "MI " to "Myocardial infarction "

2016-09-24T14:28:12Z

Text replacement - "*MI " to "*Myocardial infarction "

← Older revision		Revision as of 14:28, 24 September 2016
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	*Contraindications to Exercise Testing		*Contraindications to Exercise Testing
	**Absolute		**Absolute
	***MI (within 2 days)		***[[Myocardial infarction]] (within 2 days)
	***High-risk unstable angina		***High-risk unstable angina
	***Uncontrolled cardiac dysrhythmias		***Uncontrolled cardiac dysrhythmias

Neil.m.young: Text replacement - " ==" to "=="

2016-08-03T15:43:02Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 15:43, 3 August 2016
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	==Background ==		==Background==

	*Stress testing is recommended for patients with low-moderate pretest probability of CAD		*Stress testing is recommended for patients with low-moderate pretest probability of CAD
	**Not helpful in patients with very low risk or high risk		**Not helpful in patients with very low risk or high risk

	==ECG-Based Exercise Treadmill Testing ==		==ECG-Based Exercise Treadmill Testing==

	*68% sn, 77% sp<ref>Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A, McArthur D, Froelicher V. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989 Jul;80(1):87-98.</ref>		*68% sn, 77% sp<ref>Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A, McArthur D, Froelicher V. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989 Jul;80(1):87-98.</ref>
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	**ETT does not have prognostic value for patients who return to the ED with concerning symptoms or ECG changes		**ETT does not have prognostic value for patients who return to the ED with concerning symptoms or ECG changes

	==Stress Echocardiography ==		==Stress Echocardiography==

	*Sn 80% sp 84%		*Sn 80% sp 84%
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	**The decision regarding stress nuclear versus stress echo is usually made based upon availability of local expertise.		**The decision regarding stress nuclear versus stress echo is usually made based upon availability of local expertise.

	==See Also ==		==See Also==
	*[[Acute Coronary Syndrome (Main)]]		*[[Acute Coronary Syndrome (Main)]]

Rossdonaldson1: Text replacement - "HTN" to "hypertension"

2016-07-31T12:17:17Z

Text replacement - "HTN" to "hypertension"

← Older revision		Revision as of 12:17, 31 July 2016
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	***Moderate stenotic valvular heart disease		***Moderate stenotic valvular heart disease
	***Electrolyte abnormalities		***Electrolyte abnormalities
	***Severe ~~HTN~~ (>200 sys, >110 dia)		***Severe hypertension (>200 sys, >110 dia)
	***Tachydysrhythmias or bradydysrhythmias		***Tachydysrhythmias or bradydysrhythmias
	***HOCM		***HOCM

Heston at 03:08, 25 July 2016

2016-07-25T03:08:57Z

← Older revision		Revision as of 03:08, 25 July 2016
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	Nuclear myocardial perfusion imaging is generally appropriate in patients with acute chest pain in which the diagnosis of acute coronary syndrome is unclear, to determine whether or not cardiac catheterization is indicated, or to determine prognosis. Appropriate Use Criteria (AUC) has been developed by the American College of Cardiology and is updated regularly. <ref>Hendel RC, Berman DS, Di Carli MF et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. [http://content.onlinejacc.org/article.aspx?articleid=1139755 J Am Coll Cardiol. 2009 Jun 9;53(23):2201-29.]</ref>. Absolute contraindications to stress testing include acute myocardial infarction (within 2 days), unstable angina, and symptomatic heart failure. <ref>Gibbons RJ, Balady GJ, Beasley JW et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). [http://circ.ahajournals.org/content/96/1/345.long Circulation. 1997 Jul 1;96(1):345-54.]</ref>. The decision to perform nuclear myocardial perfusion imaging or stress echo imaging generally depends upon local expertise. The benefit of nuclear imaging is that it can be performed in nearly 100% of patients, whereas echo stress testing is more limited by body habitus and the ability to obtain good imaging windows quickly after stressing the patient. The benefit of echo stress testing is lower costs and no radiation exposure. The amount of radiation exposure from a stress-rest nuclear myocardial perfusion scan is typically 10 mSv or less for gamma camera based imaging (similar to a chest CT), and under 5 mSv for PET imaging.		Nuclear myocardial perfusion imaging is generally appropriate in patients with acute chest pain in which the diagnosis of acute coronary syndrome is unclear, to determine whether or not cardiac catheterization is indicated, or to determine prognosis. Appropriate Use Criteria (AUC) has been developed by the American College of Cardiology and is updated regularly. <ref>Hendel RC, Berman DS, Di Carli MF et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. [http://content.onlinejacc.org/article.aspx?articleid=1139755 J Am Coll Cardiol. 2009 Jun 9;53(23):2201-29.]</ref>. Absolute contraindications to stress testing include acute myocardial infarction (within 2 days), unstable angina, and symptomatic heart failure. <ref>Gibbons RJ, Balady GJ, Beasley JW et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). [http://circ.ahajournals.org/content/96/1/345.long Circulation. 1997 Jul 1;96(1):345-54.]</ref>. The decision to perform nuclear myocardial perfusion imaging or stress echo imaging generally depends upon local expertise. The benefit of nuclear imaging is that it can be performed in nearly 100% of patients, whereas echo stress testing is more limited by body habitus and the ability to obtain good imaging windows quickly after stressing the patient. The benefit of echo stress testing is lower costs and no radiation exposure. The amount of radiation exposure from a stress-rest nuclear myocardial perfusion scan is typically 10 mSv or less for gamma camera based imaging (similar to a chest CT), and under 5 mSv for PET imaging.


	*PATIENTS WITH ACUTE CHEST PAIN: APPROPRIATE INDICATIONS		*PATIENTS WITH ACUTE CHEST PAIN: APPROPRIATE INDICATIONS

Heston at 03:08, 25 July 2016

2016-07-25T03:08:40Z

← Older revision		Revision as of 03:08, 25 July 2016
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	*PATIENTS WITH ACUTE CHEST PAIN: APPROPRIATE INDICATIONS		*PATIENTS WITH ACUTE CHEST PAIN: APPROPRIATE INDICATIONS
	**Patients with acute chest pain with possible acute coronary syndrome		**Patients with acute chest pain with possible acute coronary syndrome: a) ECG shows no ischemic changes, LBBB, or electronically ventricular paced rhythm; and b) negative to borderline elevated troponin levels.
	**Imaging is considered appropriate in both low-risk TIMI score and high-risk TIMI score patients when the ECG shows no ischemic changes, LBBB, or electronically ventricular paced rhythm; and negative to borderline elevated troponin levels.		**In this setting, nuclear imaging is considered appropriate in both low-risk TIMI score and high-risk TIMI score patients

	*PATIENTS WITH ACUTE CHEST PAIN: INAPPROPRIATE INDICATIONS		*PATIENTS WITH ACUTE CHEST PAIN: INAPPROPRIATE INDICATIONS
	**Patients with definite acute coronary syndrome		**Patients with definite acute coronary syndrome
	**Early stress testing contraindicated		**Early stress testing contraindicated within 2 days after myocardial infarction

	*THE BOTTOM LINE		*THE BOTTOM LINE

Heston at 03:06, 25 July 2016

2016-07-25T03:06:26Z

← Older revision		Revision as of 03:06, 25 July 2016
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	==Cardiac Radionuclide Imaging==		==Cardiac Radionuclide Imaging==

	Nuclear myocardial perfusion imaging is generally appropriate in patients with acute chest pain in which the diagnosis of acute coronary syndrome is unclear, to determine whether or not cardiac catheterization is indicated, or to determine prognosis. Appropriate Use Criteria (AUC) has been developed by the American College of Cardiology and is updated regularly. <ref>Hendel RC, Berman DS, Di Carli MF et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. [http://content.onlinejacc.org/article.aspx?articleid=1139755 J Am Coll Cardiol. 2009 Jun 9;53(23):2201-29.]</ref>. Absolute contraindications to stress testing include acute myocardial infarction (within 2 days), unstable angina, and symptomatic heart failure. <ref>Gibbons RJ, Balady GJ, Beasley JW et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). [http://circ.ahajournals.org/content/96/1/345.long Circulation. 1997 Jul 1;96(1):345-54.]</ref>. The decision to perform nuclear myocardial perfusion imaging or stress echo imaging generally depends upon local expertise. The benefit of nuclear imaging is that it can be performed in nearly 100% of patients, whereas echo stress testing is more limited by body habitus and the ability to obtain good imaging windows quickly after stressing the patient. The benefit of echo stress testing is lower costs and no radiation exposure. The amount of radiation exposure from a stress-rest nuclear myocardial perfusion scan is typically 10 mSv or less for gamma camera imaging, and ~~well~~ under 5 mSv for PET imaging.		Nuclear myocardial perfusion imaging is generally appropriate in patients with acute chest pain in which the diagnosis of acute coronary syndrome is unclear, to determine whether or not cardiac catheterization is indicated, or to determine prognosis. Appropriate Use Criteria (AUC) has been developed by the American College of Cardiology and is updated regularly. <ref>Hendel RC, Berman DS, Di Carli MF et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. [http://content.onlinejacc.org/article.aspx?articleid=1139755 J Am Coll Cardiol. 2009 Jun 9;53(23):2201-29.]</ref>. Absolute contraindications to stress testing include acute myocardial infarction (within 2 days), unstable angina, and symptomatic heart failure. <ref>Gibbons RJ, Balady GJ, Beasley JW et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). [http://circ.ahajournals.org/content/96/1/345.long Circulation. 1997 Jul 1;96(1):345-54.]</ref>. The decision to perform nuclear myocardial perfusion imaging or stress echo imaging generally depends upon local expertise. The benefit of nuclear imaging is that it can be performed in nearly 100% of patients, whereas echo stress testing is more limited by body habitus and the ability to obtain good imaging windows quickly after stressing the patient. The benefit of echo stress testing is lower costs and no radiation exposure. The amount of radiation exposure from a stress-rest nuclear myocardial perfusion scan is typically 10 mSv or less for gamma camera based imaging (similar to a chest CT), and under 5 mSv for PET imaging.

	*PATIENTS WITH ACUTE CHEST PAIN: APPROPRIATE INDICATIONS		*PATIENTS WITH ACUTE CHEST PAIN: APPROPRIATE INDICATIONS

ACS - stress testing - Revision history

Danbot: Danbot moved page ACS - Stress Testing to ACS - stress testing: Naming convention: first word capitalized, subsequent words lowercase

SuperD: /* ECG-Based Exercise Treadmill Testing */

Rossdonaldson1: Text replacement - ">" to ">"

Rossdonaldson1: Text replacement - "troponin " to "troponin "

Rossdonaldson1: Text replacement - "*MI " to "*Myocardial infarction "

Neil.m.young: Text replacement - " ==" to "=="

Rossdonaldson1: Text replacement - "HTN" to "hypertension"

Heston at 03:08, 25 July 2016

Heston at 03:08, 25 July 2016

Heston at 03:06, 25 July 2016

Rossdonaldson1: Text replacement - "MI " to "Myocardial infarction "