Ellestad's Stress Testing

The 6th edition of the textbook Ellestad’s Stress Testing: Principles and Practice was written for the new and veteran clinician alike performing stress testing. Thoroughly updated, referenced and interspersed with case examples, the book reviews how to get the most out exercise testing, without and with ancillary imaging. In addition to evaluation of ST segment depression, other powerful tools to detect ischemia and forecast the future are reviewed to increase the diagnostic accuracy and prognostic ability of exercise testing. The recognition and significance of exercise induced arrhythmias and conduction defects are examined. When to convert to pharmacologic stress or add ancillary imaging, including myocardial perfusion imaging, echocardiography, coronary calcium scoring, and magnetic reference imaging are reviewed. The use of stress testing in the management of obstructive and non-obstructive coronary artery disease (CAD), heart failure, cardiac rehabilitation, peripheral vascular disease, congenital heart and other cardiovascular diseases (CVD) is examined. Options to optimize the diagnostic capabilities of exercise and other diagnostic testing for women are highlighted. Strategic use of exercise testing in the face of a decreasing burden of CAD in the developed world, as well as the opportunity to rely on exercise testing as the first test to evaluate CVD in the developing world, are reviewed. The fundamentals of exercise physiology and myocardial ischemia that serve as the foundation for exercise testing in health and disease are explained.

2018 ◽  
pp. 199-228
Author(s):  
Gregory S. Thomas ◽  
Maryam Balouch

The chapter Rhythm and Conduction Disturbances in Stress Testing reviews the frequency and significance of arrhythmias and conduction abnormalities precipitated by exercise. Case examples are provided. PVCs occurring prior to, during exercise, or during recovery all modestly increase the risk of all-cause mortality in patients with and without known coronary artery disease (CAD). Ventricular tachycardia and premature ventricular complexes are often not reproducible on a subsequent exercise test. Exercise induced left bundle branch block (LBBB) predicts increased risk of the presence of CAD, all cause mortality, and often permanent LBBB. Differentiating wide complex tachycardia during exercise testing between supraventricular tachycardia and ventricular tachycardia can be challenging. The Wellens, Brugada, and Vereckei algorithms to distinguish between these arrhythmias are detailed and compared.


1992 ◽  
Vol 69 (4) ◽  
pp. 303-307 ◽  
Author(s):  
Cres P. Miranda ◽  
James Liu ◽  
Andras Kadar ◽  
Andras Janosi ◽  
Jeffrey Froning ◽  
...  

2018 ◽  
pp. 473-491
Author(s):  
Puja K. Mehta ◽  
Ijeoma Isiadinso ◽  
L. Samuel Wann

The chapter Stress Testing in Women reviews the clear sex-specific differences in the presentation and pathophysiology of ischemic heart disease (IHD). Women tend to have more atypical and more subtle symptoms such as dyspnea or fatigue than men. Symptomatic women are also more likely to have no obstructive coronary artery disease (CAD) on coronary angiography, but still have adverse clinical outcomes. Coronary microvascular dysfunction. Exercise testing is frequently the first test of choice to diagnose IHD in women. When resting electrocardiogram abnormalities precludes exercise testing or exercise testing is inconclusive, stress imaging with echocardiography or myocardial perfusion imaging can be added. Routine stress testing is designed to detect flow-limiting, obstructive CAD. When stress imaging is negative or “falsely positive” in a symptomatic patient, nonobstructive causes of IHD including coronary microvascular dysfunction should be considered.


2018 ◽  
pp. 543-546
Author(s):  
L. Samuel Wann ◽  
Gregory S. Thomas

The chapter Perspectives on the Future of Stress Testing forecasts changes in the ability to detect atherosclerosis in the form of obstructive and non-obstructive coronary artery disease and ischemia. These will continue to include low cost and widely available exercise testing as well as embracing new technology such as mobile sensors, biomarkers, and genetic testing. Continued advancements in positron emission tomography, cardiac computed tomography, and cardiac magnetic resonance imaging will create new opportunities for better definition of myocardial blood flow and prediction of prognosis. While we will continue to expand our ability to measure greater detail of aspects of cardiac structure, function and metabolism, the humanity of a clinician being at the side of the treadmill while our whole patients exercise to their individual capacity remains a valuable diagnostic, educational and bonding opportunity


ESC CardioMed ◽  
2018 ◽  
pp. 2836-2840
Author(s):  
Martha Gulati

The more atypical presentation of women makes the diagnostic evaluation of symptomatic women challenging and results in more frequent referral for diagnostic testing to improve the precision of the ischaemic heart disease likelihood estimate. The classification of ischaemic heart disease and myocardial infarction has moved beyond the diagnosis of obstructive coronary artery disease and encompasses ischaemia that can occur in the presence and absence of obstructive coronary artery disease. Consideration of the different pathophysiology of ischaemia that may occur in women needs to be considered in the evaluation and treatment of ischaemic heart disease in women.


2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hendrik Lapp ◽  
Marcel Keßler ◽  
Thomas Rock ◽  
Franz X. Schmid ◽  
Dong-In Shin ◽  
...  

An 87-year-old woman presenting with myocardial infarction and ST-segment elevation in the electrocardiogram suffered from pericardial effusion due to left ventricular rupture. After ruling out obstructive coronary artery disease and aortic dissection, she underwent cardiac surgery showing typical infarct-macerated myocardial tissue in situ. This case shows that even etiologically unclear and small-sized myocardial infarctions can cause life-threatening mechanical complications.


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