Exercise Stress Testing

  • Jacqueline V. A. Dawson
  • Robert C. HendelEmail author
  • Robert C. Hendel


Non-invasive evaluation of myocardial ischemia remains a priority in cardiology. The preferred initial non-invasive test is exercise electrocardiography (ECG) in patients who are able to exercise to an adequate workload (of at least 85% of age-adjusted maximal predicted heart rate and five metabolic equivalents) because of its high accessibility and its low cost. It allows for a physiologic assessment of functional capacity, symptoms and hemodynamics. When compared to pharmacologic stress testing, exercise is associated with less extensive hepatic and gastrointestinal tracer uptake, which significantly improves image quality [1]. However, for several reasons plain exercise ECG may not be adequate and in such conditions it should be combined with an imaging modality (Table 9.1) to increase the sensitivity and specificity of diagnosis.


Myocardial Perfusion Imaging Perfusion Defect Improve Image Quality Exercise Stress Test Bruce Protocol 
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  1. 1.
    Henzlova MJ, Cerqueira MD, Hansen CL, et al. ASNC imaging guidelines for nuclear cardiology procedures: stress protocols and tracers. J Nucl Cardiol. 2009. Accessed 7 July 2009.
  2. 2.
    Esquivel L, Pollock SG, Beller GA, et al. Effect of the degree of effort on the sensitivity of the exercise thallium-201 stress test in symptomatic coronary artery disease. Am J Cardiol. 1989;63:160.PubMedCrossRefGoogle Scholar
  3. 3.
    Mark DB, Hlatky MA, Harrel Jr FE, et al. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. 1987;106:793.PubMedGoogle Scholar
  4. 4.
    Adapted from Klocke et al. and from Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol. 2007;50:1707–32.Google Scholar
  5. 5.
    Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 2002;40(8):1531–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Klocke FJ, Baird MG, Bateman TM, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines for the clinical use of radionuclide imaging. American College of Cardiology Website. Circulation. 2003;108(11):1404–18.Google Scholar
  7. 7.
    Myers J, Froelicher VF. Optimizing the exercise test for pharmacological investigations. Circulation. 1990;82:1839–46.PubMedCrossRefGoogle Scholar
  8. 8.
    Froelicher VF, Myers J. Exercise and the heart. 5th ed. Philadelphia: WB Saunders; 2006.Google Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Jacqueline V. A. Dawson
    • 1
  • Robert C. Hendel
    • 2
    Email author
  • Robert C. Hendel
    • 3
  1. 1.Cardiovascular DivisionUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Cardiac Imaging and Outpatient Services, Cardiovascular Division, Department of MedicineUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Cardiac Care UnitUniversity of Miami HospitalMiamiUSA

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