Core IM | Internal Medicine Podcast #39 Stress Testing: 5 Pearls Segment
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Apr 24, 2019 Dr. Evan Harmon, a cardiology resident at UVA, gives a concise clinical perspective. He walks through when to use stress testing, how to pick exercise versus pharmacologic stress, and how to choose imaging modalities. Short, focused pearls on interpretation and patient communication round out the discussion.
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When To Use Stress Testing
- Stress tests are most useful for intermediate pretest probability and for prognostication, not for very low or already very high risk patients.
- Use testing to clarify “iffy” chest pain and to quantify ischemia severity to guide risk reduction and possible revascularization.
Clinician Confusion Illustrated With Mr Neri Case
- Shreya recounts being confused ordering stress tests with many protocol options and fearing cardiology judgment.
- The hosts use Mr Neri (60-year-old with risk factors and exertional indigestion) to illustrate test selection decisions.
Prefer Exercise Stress When Possible
- Always prefer exercise stress when the patient can reasonably achieve target heart rate because it reproduces real-life symptoms and provides prognostic data.
- If exercise is limited, choose pharmacologic stress: dobutamine for inotropy or adenosine/regadenoson vasodilators, mindful of contraindications.