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Download Guidelines: Choosing a Cardiac Stress Test
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St. Joseph Mercy Hospital Ann Arbor, Michigan Guidelines: Choosing a Cardiac Stress Test Yes Able to Exercise Stress Imaging Contraindications Dobutamine Yes No Standard GXT Factors Favoring MPI Exercise Echo No Pharmacological Contraindications Adenosine Adenosine MPI Dobutamine Stress Exercise MPI Factors Favoring MPI No Yes Dobutamine MPI MPI= Nuclear Myocardial Perfusion Imaging October, 2004 Dobutamine Echo St. Joseph Mercy Hospital Ann Arbor, Michigan INDICATIONS AND CONTRAINDICATIONS FOR SPECIFIC STRESS TESTS Consider Stress Echo or Myocardial Perfusion Imaging Abnormalities on ECG Abnormal STT or Q waves LBBB LVH Female patient Digoxin use Ventricular pacemaker Factors Favoring Myocardial Perfusion Imaging Frequent ventricular ectopy Previous poor quality Echo images Morbidly obese patient Severe COPD Previous thallium test to compare Multiple previous MI’s or dilated cardiomyopathy LBBB or pacemaker (use adenosine) Factors favoring Stress Echo Suspected structural heart disease (e.g. murmur, LV thrombus) Dyspnea (assess LV function with stress) Previous stress Echo to compare Fertile women (avoid radiation) Less expensive Dipyramidole/Adenosine Myocardial Perfusion Imaging Stress Testing Contraindications Asthma or bronchospasm Hypotension (SBP < 80) Second or third degree heart block Sick sinus syndrome Methylxanthine use (aminphylline, caffeine, dipyrimadole) Dobutamine Stress Echocardiography Relative Contraindications LBBB Ventricular pacing Beta- blocker or calcium-channel blocker use Contraindications Ventricular arrhythmia Unstable angina Multiple previous MI’s or dilated cardiomyopathy Poor echo images Dobutamine Stress Myocardial Perfusion Imaging Relative Contraindications LBBB Ventricular pacing Beta- blocker or calcium-channel blocker use Contraindications Ventricular arrhythmia Unstable angina Factors Favoring Pharmacological Stress Testing Ventricular pacing or LBBB (use adenosine stress) Patients unable to achieve > 85% maximum predicted heart rate during exercise October, 2004
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