cardiac stress ECG testing
the low sensitivity and specificity of stress ECG testing for detection of significant coronary artery disease has resulted in it largely being displaced by other methods of cardiac stress testing
consider the patient's pre-test probability before stress testing
the positive predictive value is generally low (<10% for cardiac death and < 20% for cardiac death or AMI), and thus, they should only be performed on patients with a reasonable pre-test probability - ie. not on 30yr olds who are worried they might have heart disease but do not have clinical features to suggest cardiac disease.
patients with a high pre-test probability of ACS:
probably should be considered for invasive investigation rather than stress testing as even a negative test result will not lower the probability of ACS sufficiently to warrant avoiding an invasive test.
clinical risk markers are perhaps more reliable than stress testing in determining who should have invasive investigation such as coronary angiography.
patients with a low pre-test probability of ACS:
these patients probably should be counseled before embarking on stress testing as they are much more likely to have a false positive result than a true positive result and thus may end up having unnecessary and risky invasive testing.
for instance if sensitivity is 50% and specificity is 90% and the pre-test probability is only 5%, then of 1000 patients tested, 125 will have a positive result, but of these, 95 will have a false positive result.
timing and selection of stress test
exclusion factors for stress ECG testing
c_stressecg.txt · Last modified: 2013/08/01 17:21 (external edit)