STRESS TESTING - Dr. Dahlquist

Dr. Dahlquist

1. Sensitivity and specificity of treadmill, echo, and myocardial perfusion stress testing:

  *   Treadmill Sn: 68%, Sp 77%.
  *   Dobutamine Stress Echo: Sn 81%, Sp 80%.
  *   Myocardial Perfusion: Sn 87%, Sp 73%.

2. 50% of the plaques that rupture and cause AMI/ACS are <50% stenoses, and are generally not detected on stress testing.  A NEGATIVE STRESS TEST DOES NOT RULE OUT ACS!

  *   For this reason, if the clinical history is concerning, no prior stress test should be reassuring, regardless of how recent.

3. AHA recommendations on stress testing are based on "very limited" evidence. Particular populations where utility is limited:

  *   Patients <40 years old.
  *   Patients with recent (last 14 days) cocaine use.  Journal of EM 2004 (Littmann) - All stress tests were positive, but all of their caths were normal. Deemed false positive stress test for up to 2 weeks.

---