259:) may be injected during the test. After a suitable waiting period to ensure proper distribution of the radiotracer, scans are acquired with a gamma camera to capture images of the blood flow. Scans acquired before and after exercise are examined to assess the state of the coronary arteries of the patient. By showing the relative amounts of radioisotope within the heart muscle, the nuclear stress tests more accurately identify regional areas of reduced blood flow.
338:(CDC) common first systems of coronary artery disease is a heart attack. According to the American Heart Association, a significant percentage of individuals, approximately 65% of men and 47% of women, present with a heart attack or sudden cardiac arrest as their first symptom of cardiovascular disease. Consequently, stress tests performed shortly before these events may not be highly relevant for predicting infarction in the majority of individuals tested.
166:
639:) as adenosine and dipyridamole can cause acute exacerbation of these conditions. If the patient's asthma is treated with an inhaler then it should be used as a pre-treatment prior to the injection of the pharmacologic stress agent. In addition, if the patient is actively wheezing then the physician should determine the benefits versus the risk to the patient of performing a stress test especially outside of a hospital setting.
276:
3037:
327:, demonstrates a sensitivity range of around 73-90% and a specificity range of around 50-74%. Sensitivity refers to the percentage of individuals with the condition correctly identified by the test, while specificity denotes the percentage of individuals without the condition correctly identified as not having it. The nuclear stress test exhibits a sensitivity of 81% and a specificity ranging from 85 to 95%.
115:. Pulse rate, blood pressure and symptoms such as chest discomfort or fatigue are simultaneously monitored by attending clinical staff. Clinical staff will question the patient throughout the procedure asking questions that relate to pain and perceived discomfort. Abnormalities in blood pressure, heart rate, ECG or worsening physical symptoms could be indicative of
29:
1730:
Nuclear
Cardiology, North American Society for Cardiovascular Imaging, Society for Cardiovascular Angiography Interventions, Society for Cardiovascular Magnetic Resonance, Kramer CM, Berman, Brown, Chaudhry FA, Cury RC, Desai MY, Einstein AJ, Gomes AS, Harrington R, Hoffmann U, Khare R, Lesser, McGann, Rosenberg A (2010).
331:
estimate of the patient's post-test likelihood of disease. Stress tests have limitations in assessing the significance and nature of cardiac problems, they should be seen in context - as an initial assessment that can lead to a number of other diagnostic approaches in the broader management of cardiac diseases.
311:
The common approach for stress testing recommended by the
American College of Cardiology and the American Heart Association involves several methods to assess cardiac health. These methods provide information for diagnosing and managing heart-related conditions. Two primary stress tests utilized are
1771:
Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, Picard MH, Polk DM, Ragosta M, Ward RP, Douglas RB, Weiner RB, Society for
Cardiovascular Angiography Interventions, Society of Critical Care Medicine, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart
346:
Stress cardiac imaging is not recommended for asymptomatic, low-risk patients as part of their routine care. Some estimates show that such screening accounts for 45% of cardiac stress imaging, and evidence does not show that this results in better outcomes for patients. Unless high-risk markers are
330:
To arrive at the patient's post test likelihood of disease, the interpretation of the stress test result necessitates the integration of the patient's pretest likelihood with the test's sensitivity and specificity. This method, initially introduced by
Diamond and Forrester in the 1970s, provides an
559:. Vasodilators are used to dilate coronary vessels, which causes increased blood velocity and flow rate in normal vessels and less of a response in stenotic vessels. This difference in response leads to a steal of flow and perfusion defects appear in cardiac nuclear scans or as ST-segment changes.
262:
Stress and potential cardiac damage from exercise during the test is a problem in patients with ECG abnormalities at rest or in patients with severe motor disability. Pharmacological stimulation from vasodilators such as dipyridamole or adenosine, or positive chronotropic agents such as dobutamine
1729:
Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O'Gara P, Rubin GD, American
College of Cardiology Foundation Appropriate Use Criteria Task Force, Society of Cardiovascular Computed Tomography, American College Of R, American Heart A, American Society of Echocardiography, American Society of
283:
The
American Heart Association recommends ECG treadmill testing as the first choice for patients with medium risk of coronary heart disease according to risk factors of smoking, family history of coronary artery stenosis, hypertension, diabetes and high cholesterol. In 2013, in its "Exercise
103:
is a cardiological examination that evaluates the cardiovascular system's response to external stress within a controlled clinical setting. This stress response can be induced through physical exercise (usually a treadmill) or intravenous pharmacological stimulation of heart rate.
1772:
Failure
Society of America, Society for Cardiovascular Magnetic Resonance, Society of Cardiovascular Computed Tomography, American Heart Association, Heart Rhythm Society (2011). "ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography".
263:
can be used. Testing personnel can include a cardiac radiologist, a nuclear medicine physician, a nuclear medicine technologist, a cardiology technologist, a cardiologist, and/or a nurse. The typical dose of radiation received during this procedure can range from 9.4 to 40.7
134:. As with all medical diagnostic procedures, data is only from a moment in time. A primary reason stress testing is not perceived as a robust method of CAD detection — is that stress testing generally only detects arteries that are severely narrowed (~70% or more).
1807:
Hendel RC, Abbott BG, Bateman TM, Blankstein R, Calnon DA, Leppo JA, Maddahi J, Schumaecker MM, Shaw LJ, Ward RP, Wolinsky DG, American
Society of Nuclear Cardiology (2010). "The role of radionuclide myocardial perfusion imaging for asymptomatic individuals".
157:). After the target heart rate is achieved, 'stress' echocardiogram images are obtained. The two echocardiogram images are then compared to assess for any abnormalities in wall motion of the heart. This is used to detect obstructive coronary artery disease.
1111:"Reference Standards for Cardiorespiratory Fitness Measured With Cardiopulmonary Exercise Testing Using Cycle Ergometry: Data From the Fitness Registry and the Importance of Exercise National Database (FRIEND) Registry"
122:
Stress testing does not accurately diagnose all cases of coronary artery disease, and can often indicate that it exists in people who do not have the condition. The test can also detect heart abnormalities such as
181:, maximal oxygen consumption), the test is often referred to as a cardiopulmonary exercise test. Common indications for a cardiopulmonary exercise test include evaluation of shortness of breath, workup before
1307:"ACC/AHA Guidelines for Exercise Testing: Executive Summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing)"
565:
Pharmacologic agents such as adenosine, regadenoson (Lexiscan), or dipyridamole is generally used when a patient cannot achieve adequate work level with treadmill exercise, or has poorly controlled
149:
A resting echocardiogram is obtained prior to stress. The ultrasound images obtained are similar to the ones obtained during a full surface echocardiogram, commonly referred to as
2218:
1238:
Gerald F., Philip A., Kligfield P., et al., Exercise
Standards for Testing and Training A Scientific Statement From the American Heart Association. Circulation. 2013; 128: 873-934
643:
is usually held 24 hours prior to an adenosine stress test, as it is a competitive antagonist of the A2A adenosine receptor and can attenuate the vasodilatory effects adenosine.
1054:"Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association"
1305:
Gibbons RJ, Balady GJ, Beasley JW, Faafp, Bricker JT, Duvernoy WF, Froelicher VF, Mark DB, Marwick TH, McCallister BD, Thompson PD, Facsm, Winters WL, Yanowitz FG (July 1997).
665:
as an indicator of adverse outcomes. The factors influencing mortality risk have changed over time due to decreasing angina symptoms, increasing prevalence of conditions like
1687:
1052:
Ross R, Blair SN, Arena R, Church TS, Després JP, Franklin BA, Haskell WL, Kaminsky LA, Levine BD, Lavie CJ, Myers J, Niebauer J, Sallis R, Sawada SS, Sui X (2016-12-13).
279:
Stress-ECG of a patient with coronary heart disease: ST-segment depression (arrow) at 100 watts of exercise. A: at rest, B: at 75 watts, C: at 100 watts, D: at 125 watts.
490:
Systolic blood pressure decreases by more than 10 mmHg with increase in work rate, or drops below baseline in the same position, without other evidence of ischemia.
562:
The choice of pharmacologic stress agents used in the test depends on factors such as potential drug interactions with other treatments and concomitant diseases.
2276:
212:
and measured during a cardiopulmonary exercise test, be categorized as a clinical vital sign and should be routinely assessed as part of clinical practice.
130:
A "normal" stress test does not offer any substantial reassurance that a future unstable coronary plaque will not rupture and block an artery, inducing a
2985:
2311:
335:
1570:
Bilal M, Haseeb A, Arshad MH, Jaliawala AA, Farooqui I, Minhas A, Hussaini A, Khan AA, Ahmad S, Saleem Z, Awan O, Sabahat NU, Ayaz A, Rizwan H (2018).
2407:
2105:
Abidov A, Dilsizian V, Doukky R, Duvall WL, Dyke C, Elliott MD, Hage FG, Henzlova MJ, Johnson NP, Schwartz RG, Thomas GS, Einstein AJ (2018-12-20).
2227:
2805:
2395:
52:
2680:
2082:
2048:
1956:
1909:
990:
493:
ST or QRS segment changes, e.g. more than 2 mm horizontal or downsloping ST segment depression in non-Q wave leads, or marked axis shift
295:
stress test (with 99mTc labelled sestamibi) is appropriate for select patients, especially those with an abnormal resting electrocardiogram.
657:
Cardiac stress testing, used since the 1960s, has a history rooted in the diagnostic and prognostic assessment of patients with suspected
298:
Intracoronary ultrasound or angiogram can provide more information but is invasive and carries the risk of complications associated with
2215:
2107:"Aminophylline shortage and current recommendations for reversal of vasodilator stress: an ASNC information statement endorsed by SCMR"
2930:
2606:
2511:
546:
As the radioactive tracers used for this test are chemically carcinogenic, frequent use of these tests carries a small risk of cancer.
1654:
1377:
1189:
439:
decreases by more than 10 mmHg with increase in work rate, or drops below baseline in the same position, with other evidence of
2811:
497:
2269:
1705:
2818:
2625:
1352:
1280:
1515:"Comparison of Framingham, PROCAM, SCORE, and Diamond Forrester to predict coronary atherosclerosis and cardiovascular events"
3059:
2918:
2615:
1701:
1683:
875:"Extent and Direction of Arterial Remodeling in Stable Versus Unstable Coronary Syndromes: An Intravascular Ultrasound Study"
429:
Indications for termination: A cardiac stress test should be terminated before completion under the following circumstances:
573:. However, an exercise stress test may provide more information about exercise tolerance than a pharmacologic stress test.
527:
Hypertensive response (systolic blood pressure > 250 mmHg or diastolic blood pressure > 115 mmHg)
2940:
2441:
2925:
2913:
2794:
924:"Stress echocardiography in coronary artery disease: a practical guideline from the British Society of Echocardiography"
501:
248:
240:
178:
150:
146:. The echocardiography is performed both before and after the exercise so that structural differences can be compared.
3040:
2262:
348:
197:
2565:
922:
Steeds RP, Wheeler R, Bhattacharyya S, Reiken J, Nihoyannopoulos P, Senior R, Monaghan MJ, Sharma V (2019-03-28).
3064:
2872:
2762:
2516:
2306:
317:
201:
112:
2951:
2935:
2402:
2385:
1401:
404:
127:, and conditions affecting electrical conduction within the heart such as various types of fascicular blocks.
59:
2947:
2889:
2789:
2754:
2600:
658:
628:
480:
436:
299:
116:
2228:"A Simple Exercise Tolerance Test for Circulatory Efficiency with Standard Tables for Normal Individuals,"
2993:
1732:"ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography"
707:
682:
602:
417:
352:
288:
analysis during ECG treadmill test have useful test performance for detection of coronary heart disease.
3024:
2828:
2749:
182:
355:
greater than 2 percent yearly, most health societies do not recommend the test as a routine procedure.
1572:"Frequency and Determinants of Inappropriate Use of Treadmill Stress Test for Coronary Artery Disease"
1039:
Principles of
Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications
400:
Multivessel coronary artery diseases that have a high risk of producing an acute myocardial infarction
2998:
2555:
2368:
2363:
787:
697:
687:
256:
2855:
2541:
2380:
2353:
2166:"Assessment of lifestyle-related risk factors enhances the effectiveness of cardiac stress testing"
662:
570:
511:
108:
649:
may be used to attenuate severe and/or persistent adverse reactions to adenosine and regadenoson.
540:
Palpitations, chest pain, myocardial infarction, shortness of breath, headache, nausea or fatigue.
2860:
2773:
2769:
2715:
2710:
2651:
2572:
2480:
2429:
2343:
2195:
1833:
1217:
1138:
1110:
1091:
584:
451:
391:
285:
244:
2243:
776:"Appropriate Use of Cardiac Stress Testing with Imaging: A Systematic Review and Meta-Analysis"
750:
16:
Measures the heart's ability to respond to external stress in a controlled clinical environment
2903:
2849:
2779:
2687:
2675:
2536:
2526:
2521:
2424:
2375:
2286:
2248:
2187:
2146:
2128:
2078:
2072:
2044:
2038:
1988:
1952:
1905:
1899:
1825:
1789:
1753:
1611:
1593:
1552:
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1334:
1326:
1257:
1209:
1165:
1130:
1083:
1075:
986:
980:
961:
943:
904:
896:
850:
823:
805:
692:
387:
47:
673:, and the rise in pharmacologic testing for patients unable to exercise during stress tests.
188:
The test is also common in sport science for measuring athletes' maximal oxygen consumption,
3003:
2908:
2646:
2576:
2559:
2491:
2464:
2459:
2177:
2136:
2118:
1946:
1873:
1817:
1781:
1743:
1601:
1583:
1542:
1526:
1318:
1201:
1122:
1065:
951:
935:
886:
813:
795:
376:
143:
2254:
1483:
165:
2975:
2897:
2744:
2734:
2720:
2611:
2581:
2487:
2316:
2301:
2222:
2012:
1696:
1306:
1225:
702:
383:
220:
791:
2882:
2867:
2663:
2640:
2471:
2455:
2390:
2141:
2106:
1606:
1571:
1547:
1514:
956:
923:
818:
775:
556:
324:
275:
3053:
3019:
2739:
2358:
2199:
646:
33:
A male patient walks on a stress test treadmill to have his heart's function checked.
2235:
1837:
2784:
1630:
1221:
1142:
1095:
616:
612:
592:
580:
566:
521:
410:
395:
362:
236:
131:
1013:
726:
320:
metrics and nuclear testing, each have unique sensitivity and specificity values.
153:. The patient is subjected to stress in the form of exercise or chemically (often
79:
1126:
1070:
1053:
873:
Schoenhagen P, Ziada KM, Kapadia SR, Crowe TD, Nissen SE, Tuzcu EM (2000-02-15).
800:
379:, which may have significant hemodynamic responses (e.g. ventricular tachycardia)
239:
to image radioisotopes injected into the bloodstream. The best known example is
65:
2961:
2704:
2668:
2348:
2333:
620:
598:
505:
227:
max is 10% to 20% lower when using a cycle ergometer compared with a treadmill.
73:
2182:
2165:
1980:
1785:
1748:
1731:
1426:
1249:
1157:
842:
2956:
2823:
2728:
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2123:
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608:
154:
124:
2132:
1597:
1538:
1330:
1079:
947:
900:
891:
874:
809:
469:
Technical difficulties (e.g. difficulties in measuring blood pressure or EGC)
1322:
588:
292:
216:
170:
107:
As the heart works progressively harder (stressed) it is monitored using an
2236:"Optimal Medical Therapy with or without PCI for Stable Coronary Disease,"
2191:
2150:
1992:
1829:
1793:
1757:
1615:
1556:
1438:
1261:
1213:
1169:
1134:
1087:
965:
908:
854:
827:
774:
Ladapo JA, Blecker S, O'Donnell M, Jumkhawala SA, Douglas PS (2016-08-18).
2013:"Pharmacologic Stress Testing: Background, Indications, Contraindications"
1499:
1338:
1190:"Effective doses in radiology and diagnostic nuclear medicine: a catalog"
666:
640:
460:
440:
1588:
939:
111:(ECG) monitor. This measures the heart's electrical rhythms and broader
89:
28:
670:
264:
252:
205:
189:
2620:
2164:
Rozanski A, Sakul S, Narula J, Uretsky S, Lavie CJ, Berman D (2023).
632:
447:
369:
456:
Moderate to severe anginal pain (above 3 on standard 4-point scale)
2969:
2799:
2630:
2475:
2290:
636:
627:
Regadenoson or dobutamine is often used in patients with severe
2258:
1513:
Versteylen MO, Joosen IA, Shaw LJ, Narula J, Hofstra L (2011).
185:, and prognosis and risk assessment of heart failure patients.
1860:
Henzlova M, Cerqueira, Hansen, Taillefer, Yao (January 2009).
1041:(4th ed.). Philadelphia: Lippincott Williams and Wilkins.
1037:
Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ (2004).
496:
Arrhythmias other than sustained ventricular tachycardia e.g.
313:
514:
or that cannot be distinguished from ventricular tachycardia
284:
Standards for Testing and Training", the AHA indicated that
2244:
Stress test information from the American Heart Association
1014:"Stress echocardiography: MedlinePlus Medical Encyclopedia"
358:
Absolute contraindications to cardiac stress test include:
200:
published an official scientific statement advocating that
1188:
Mettler FA J, Huda W, Yoshizumi TT, Mahesh M (July 2008).
1948:
ACSM's Guidelines for Exercise Testing and Prescription
543:
Adenosine and dipyridamole can cause mild hypotension.
1688:"Five Things Physicians and Patients Should Question"
1484:"Ordering and Understanding the Exercise Stress Test"
536:
Side effects from cardiac stress testing may include
472:
ST Segment elevation of more than 1 mm in aVR, V
1402:"Stress Test: Purpose, Procedure, Risks and Results"
615:
such as dobutamine can be reversed by administering
595:(Persantine), which acts indirectly at the receptor.
347:
present, such as diabetes in patients aged over 40,
3012:
2984:
2841:
2696:
2592:
2332:
2325:
72:
58:
46:
38:
21:
1951:. Lippincott Williams & Wilkins. p. 131.
1109:Kaminsky LA, Imboden MT, Arena R, Myers J (2017).
551:Use of pharmacological agents to stress the heart
2077:. Jones & Bartlett Learning. pp. 198–.
446:Increase in nervous system symptoms: Dizziness,
1987:, Treasure Island (FL): StatPearls Publishing,
1433:, Treasure Island (FL): StatPearls Publishing,
1256:, Treasure Island (FL): StatPearls Publishing,
1164:, Treasure Island (FL): StatPearls Publishing,
849:, Treasure Island (FL): StatPearls Publishing,
605:, thus affecting the heart more than the lung.
486:Relative indications for termination include:
432:Absolute indications for termination include:
2270:
1774:Journal of the American College of Cardiology
1736:Journal of the American College of Cardiology
231:Stress testing using injected nuclear markers
8:
2111:Journal of Cardiovascular Magnetic Resonance
2074:Cardiovascular Imaging for Clinical Practice
1945:American College of Sports Medicine (2013).
413:(blood pressure > 200/110 mmHg)
342:Contraindications and termination conditions
177:While also measuring breathing gases (e.g.,
2043:. Elsevier Health Sciences. pp. 126–.
1855:
1853:
1851:
1849:
1847:
1678:
1676:
1674:
1459:"Stress Tests Part 3: Stress test accuracy"
982:The Cleveland Clinic Guide to Heart Attacks
601:(Lexiscan), which acts specifically at the
500:, both multifocal or triplet; heart block;
323:The treadmill test, employing the modified
2329:
2312:Cardiology diagnostic tests and procedures
2277:
2263:
2255:
1635:Centers for Disease Control and Prevention
336:Centers for Disease Control and Prevention
27:
2408:Transcatheter pulmonary valve replacement
2181:
2140:
2122:
1893:
1891:
1889:
1877:
1747:
1605:
1587:
1546:
1069:
955:
890:
817:
799:
403:Decompensated or inadequately controlled
2451:shunt from heart chamber to blood vessel
2230:American Journal of the Medical Sciences
2071:Nicholls SJ, Worthley S (January 2011).
727:"Stress Tests: MedlinePlus Medical Test"
520:Fatigue, shortness of breath, wheezing,
274:
164:
2551:shunt from blood vessel to blood vessel
1940:
1938:
1936:
1934:
1932:
1930:
1928:
718:
661:. It has evolved to evaluate inducible
555:Pharmacologic stress testing relies on
372:not yet stabilized with medical therapy
161:Cardiopulmonary exercise stress testing
2216:Preparing for the exercise stress test
1898:Weisman IM, Zeballos RJ, eds. (2002).
1695:Choosing Wisely: an initiative of the
169:Cardiopulmonary exercise test using a
18:
2681:Valve-sparing aortic root replacement
2420:enlargement of existing septal defect
510:Intraventricular conduction delay or
271:Recommended utility of this procedure
7:
2415:production of septal defect in heart
1353:"Why You May Not Need a Stress Test"
985:. Kaplan Publishing. pp. 113–.
142:A stress test may be accompanied by
1631:"Coronary Artery Disease | cdc.gov"
138:Stress testing and echocardiography
85:
2512:transposition of the great vessels
2437:creation of septal defect in heart
1158:"Dipyridamole Nuclear Stress Test"
611: – The effects of
498:Premature ventricular contractions
14:
2812:Cardiac resynchronization therapy
2037:Weissman NJ, Adelmann GA (2004).
3036:
3035:
2819:Left atrial appendage occlusion
2249:Nuclear stress test information
2238:New England Journal of Medicine
2011:Akinpelu D (17 October 2021).
1981:"Nuclear Medicine Stress Test"
1904:. Basel: Karger. p. 111.
1862:"Stress Protocols and Tracers"
1702:American College of Cardiology
1684:American College of Cardiology
576:Commonly used agents include:
459:Signs of poor perfusion, e.g.
334:According to data from the US
215:The CPX test can be done on a
1:
2941:Radionuclide ventriculography
1866:Journal of Nuclear Cardiology
1810:Journal of Nuclear Cardiology
1519:Journal of Nuclear Cardiology
1425:Vilcant V, Zeltser R (2023),
841:Vilcant V, Zeltser R (2023),
235:A nuclear stress test uses a
42:Cardiopulmonary exercise test
2926:Myocardial perfusion imaging
1457:Morgenstern J (2019-03-13).
1156:Gupta A, Samarany S (2023),
1127:10.1016/j.mayocp.2016.10.003
1071:10.1161/CIR.0000000000000461
801:10.1371/journal.pone.0161153
502:supraventricular tachycardia
241:myocardial perfusion imaging
223:. In untrained subjects, V̇O
151:transthoracic echocardiogram
1248:Rizk TH, Nagalli S (2023),
466:Request of the test subject
363:Acute myocardial infarction
349:peripheral arterial disease
3081:
2533:for univentricular defect
2183:10.1016/j.pcad.2023.03.004
1979:Gopal S, Murphy C (2023),
1786:10.1016/j.jacc.2010.11.002
1749:10.1016/j.jacc.2010.07.005
1427:"Treadmill Stress Testing"
1250:"Technetium 99m Sestamibi"
979:Rimmerman C (2009-05-05).
928:Echo Research and Practice
843:"Treadmill Stress Testing"
425:Acutely ill for any reason
198:American Heart Association
3033:
2873:Implantable loop recorder
2517:Arterial switch operation
2307:Interventional cardiology
2297:
2124:10.1186/s12968-018-0510-7
1901:Clinical exercise testing
1879:10.1007/s12350-009-9062-4
1822:10.1007/s12350-010-9320-5
1531:10.1007/s12350-011-9425-5
1488:American Family Physician
1281:"Cardiac Catheterization"
1206:10.1148/radiol.2481071451
202:cardiorespiratory fitness
86:
26:
2952:Coronary catheterization
2442:Blalock–Hanlon procedure
2403:Mitral valve replacement
2386:Aortic valve replacement
1482:Darrow MD (1999-01-15).
892:10.1161/01.CIR.101.6.598
755:British Heart Foundation
405:congestive heart failure
2948:Cardiac catheterization
2890:Electrophysiology study
2790:Radiofrequency ablation
2755:Alcohol septal ablation
2040:Cardiac imaging secrets
1323:10.1161/01.CIR.96.1.345
1285:www.hopkinsmedicine.org
1115:Mayo Clinic Proceedings
659:coronary artery disease
629:reactive airway disease
481:ventricular tachycardia
437:Systolic blood pressure
422:Acute aortic dissection
312:a treadmill test using
300:cardiac catheterization
117:coronary artery disease
2994:Impedance cardiography
2616:Coronary artery bypass
1655:"Exercise Stress Test"
1378:"Exercise Stress Test"
708:Wasserman 9-Panel Plot
683:Cardiac steal syndrome
603:adenosine A2A receptor
418:pulmonary hypertension
353:coronary heart disease
280:
174:
3060:Diagnostic cardiology
3025:Transcutaneous pacing
2829:Heart transplantation
2750:Ventricular reduction
2566:Blalock–Taussig shunt
517:Increasing chest pain
375:Uncontrolled cardiac
278:
257:thallous chloride 201
183:heart transplantation
168:
2999:Ballistocardiography
2556:systemic circulation
698:Metabolic equivalent
688:Duke Treadmill Score
2878:Cardiac stress test
2856:Electrocardiography
2795:Pacemaker insertion
2542:Kawashima procedure
2506:compound procedures
2381:Aortic valve repair
2354:Mitral valve repair
2170:Prog Cardiovasc Dis
1589:10.7759/cureus.2101
940:10.1530/ERP-18-0068
792:2016PLoSO..1161153L
663:myocardial ischemia
571:bundle branch block
512:bundle branch block
476:or non-Q wave leads
382:Severe symptomatic
101:cardiac stress test
22:Cardiac stress test
2931:Cardiovascular MRI
2861:Vectorcardiography
2716:Pericardial window
2711:Pericardiocentesis
2652:Drug-eluting stent
2481:Rastelli procedure
2430:Balloon septostomy
2221:2021-02-28 at the
2017:Medscape Reference
1629:CDC (2021-07-19).
587:agonists, such as
585:adenosine receptor
392:pulmonary embolism
286:high frequency QRS
281:
204:, quantifiable as
175:
3047:
3046:
2904:Angiocardiography
2850:Electrophysiology
2837:
2836:
2780:Catheter ablation
2763:Conduction system
2688:LeCompte maneuver
2676:Bentall procedure
2537:Norwood procedure
2527:Senning procedure
2522:Mustard procedure
2425:Atrial septostomy
2376:Valve replacement
2084:978-0-7637-5622-2
2050:978-1-56053-515-7
1958:978-1-4698-2666-0
1911:978-3-8055-7298-9
1742:(22): 1864–1894.
1064:(24): e653–e699.
992:978-1-4277-9968-5
693:Harvard step test
388:aortic dissection
318:electrophysiology
179:oxygen saturation
113:electrophysiology
109:electrocardiogram
97:
96:
3072:
3065:Nuclear medicine
3039:
3038:
3004:Cardiotocography
2972:
2936:Ventriculography
2909:Echocardiography
2900:
2852:
2768:Maze procedure (
2765:
2731:
2707:
2660:
2659:Obstacle removal
2647:Bare-metal stent
2643:
2603:
2560:pulmonary artery
2552:
2507:
2492:pulmonary artery
2465:Fontan procedure
2460:pulmonary artery
2452:
2416:
2330:
2279:
2272:
2265:
2256:
2204:
2203:
2185:
2161:
2155:
2154:
2144:
2126:
2102:
2096:
2095:
2093:
2091:
2068:
2062:
2061:
2059:
2057:
2034:
2028:
2027:
2025:
2023:
2008:
2002:
2001:
2000:
1999:
1976:
1970:
1969:
1967:
1965:
1942:
1923:
1922:
1920:
1918:
1895:
1884:
1883:
1881:
1857:
1842:
1841:
1804:
1798:
1797:
1780:(9): 1126–1166.
1768:
1762:
1761:
1751:
1726:
1720:
1719:
1718:
1716:
1710:
1704:, archived from
1692:
1680:
1669:
1668:
1666:
1665:
1651:
1645:
1644:
1642:
1641:
1626:
1620:
1619:
1609:
1591:
1567:
1561:
1560:
1550:
1510:
1504:
1503:
1479:
1473:
1472:
1470:
1469:
1454:
1448:
1447:
1446:
1445:
1422:
1416:
1415:
1413:
1412:
1406:Cleveland Clinic
1398:
1392:
1391:
1389:
1388:
1374:
1368:
1367:
1365:
1364:
1357:Cleveland Clinic
1349:
1343:
1342:
1302:
1296:
1295:
1293:
1292:
1277:
1271:
1270:
1269:
1268:
1245:
1239:
1236:
1230:
1229:
1224:. Archived from
1185:
1179:
1178:
1177:
1176:
1153:
1147:
1146:
1106:
1100:
1099:
1073:
1049:
1043:
1042:
1034:
1028:
1027:
1025:
1024:
1010:
1004:
1003:
1001:
999:
976:
970:
969:
959:
919:
913:
912:
894:
870:
864:
863:
862:
861:
838:
832:
831:
821:
803:
771:
765:
764:
762:
761:
747:
741:
740:
738:
737:
723:
506:bradyarrhythmias
307:Diagnostic value
144:echocardiography
90:edit on Wikidata
82:
68:
31:
19:
3080:
3079:
3075:
3074:
3073:
3071:
3070:
3069:
3050:
3049:
3048:
3043:
3029:
3008:
2980:
2976:Phonocardiogram
2968:
2898:Cardiac imaging
2896:
2848:
2833:
2761:
2745:Septal myectomy
2735:Cardiomyoplasty
2727:
2721:Pericardiectomy
2703:
2692:
2658:
2639:
2599:
2593:Cardiac vessels
2588:
2582:Glenn procedure
2550:
2505:
2488:right ventricle
2450:
2414:
2336:
2321:
2317:Cardiac imaging
2302:Cardiac surgery
2293:
2283:
2223:Wayback Machine
2212:
2207:
2163:
2162:
2158:
2104:
2103:
2099:
2089:
2087:
2085:
2070:
2069:
2065:
2055:
2053:
2051:
2036:
2035:
2031:
2021:
2019:
2010:
2009:
2005:
1997:
1995:
1978:
1977:
1973:
1963:
1961:
1959:
1944:
1943:
1926:
1916:
1914:
1912:
1897:
1896:
1887:
1859:
1858:
1845:
1806:
1805:
1801:
1770:
1769:
1765:
1728:
1727:
1723:
1714:
1712:
1708:
1697:ABIM Foundation
1690:
1682:
1681:
1672:
1663:
1661:
1653:
1652:
1648:
1639:
1637:
1628:
1627:
1623:
1569:
1568:
1564:
1512:
1511:
1507:
1481:
1480:
1476:
1467:
1465:
1456:
1455:
1451:
1443:
1441:
1424:
1423:
1419:
1410:
1408:
1400:
1399:
1395:
1386:
1384:
1376:
1375:
1371:
1362:
1360:
1351:
1350:
1346:
1304:
1303:
1299:
1290:
1288:
1279:
1278:
1274:
1266:
1264:
1247:
1246:
1242:
1237:
1233:
1187:
1186:
1182:
1174:
1172:
1155:
1154:
1150:
1108:
1107:
1103:
1051:
1050:
1046:
1036:
1035:
1031:
1022:
1020:
1018:medlineplus.gov
1012:
1011:
1007:
997:
995:
993:
978:
977:
973:
921:
920:
916:
872:
871:
867:
859:
857:
840:
839:
835:
786:(8): e0161153.
773:
772:
768:
759:
757:
749:
748:
744:
735:
733:
731:medlineplus.gov
725:
724:
720:
716:
703:Robert A. Bruce
679:
655:
553:
534:
532:Adverse effects
475:
384:aortic stenosis
365:within 48 hours
351:, or a risk of
344:
309:
273:
249:Tc-99 sestamibi
243:. Typically, a
233:
226:
221:cycle ergometer
209:
196:. In 2016, the
193:
163:
140:
93:
78:
64:
34:
17:
12:
11:
5:
3078:
3076:
3068:
3067:
3062:
3052:
3051:
3045:
3044:
3034:
3031:
3030:
3028:
3027:
3022:
3016:
3014:
3010:
3009:
3007:
3006:
3001:
2996:
2990:
2988:
2986:Function tests
2982:
2981:
2979:
2978:
2973:
2965:
2964:
2959:
2954:
2945:
2944:
2943:
2933:
2928:
2923:
2922:
2921:
2916:
2906:
2901:
2893:
2892:
2887:
2886:
2885:
2883:Bruce protocol
2875:
2870:
2868:Holter monitor
2865:
2864:
2863:
2853:
2845:
2843:
2839:
2838:
2835:
2834:
2832:
2831:
2826:
2821:
2815:
2814:
2809:
2803:
2797:
2792:
2787:
2782:
2777:
2766:
2758:
2757:
2752:
2747:
2742:
2737:
2732:
2724:
2723:
2718:
2713:
2708:
2700:
2698:
2694:
2693:
2691:
2690:
2684:
2683:
2678:
2672:
2671:
2666:
2664:Endarterectomy
2661:
2655:
2654:
2649:
2644:
2641:Coronary stent
2636:
2635:
2634:
2633:
2628:
2623:
2609:
2604:
2596:
2594:
2590:
2589:
2587:
2586:
2585:
2584:
2570:
2569:
2568:
2553:
2547:
2546:
2545:
2544:
2539:
2531:
2530:
2529:
2524:
2519:
2508:
2502:
2501:
2500:
2499:
2485:
2484:
2483:
2472:left ventricle
2469:
2468:
2467:
2453:
2447:
2446:
2445:
2444:
2434:
2433:
2432:
2427:
2417:
2411:
2410:
2405:
2400:
2399:
2398:
2393:
2391:Ross procedure
2383:
2378:
2373:
2372:
2371:
2366:
2356:
2351:
2346:
2340:
2338:
2327:
2323:
2322:
2320:
2319:
2314:
2309:
2304:
2298:
2295:
2294:
2289:involving the
2284:
2282:
2281:
2274:
2267:
2259:
2253:
2252:
2251:at NIH MedLine
2246:
2241:
2233:
2225:
2211:
2210:External links
2208:
2206:
2205:
2156:
2097:
2083:
2063:
2049:
2029:
2003:
1971:
1957:
1924:
1910:
1885:
1843:
1799:
1763:
1721:
1670:
1646:
1621:
1562:
1525:(5): 904–911.
1505:
1494:(2): 401–410.
1474:
1449:
1417:
1393:
1369:
1344:
1317:(1): 345–354.
1297:
1272:
1240:
1231:
1228:on 2014-08-04.
1180:
1148:
1121:(2): 228–233.
1101:
1044:
1029:
1005:
991:
971:
934:(2): G17–G33.
914:
885:(6): 598–603.
865:
833:
766:
751:"Exercise ECG"
742:
717:
715:
712:
711:
710:
705:
700:
695:
690:
685:
678:
675:
654:
651:
625:
624:
606:
596:
557:coronary steal
552:
549:
548:
547:
544:
541:
533:
530:
529:
528:
525:
518:
515:
508:
494:
491:
484:
483:
477:
473:
470:
467:
464:
457:
454:
444:
427:
426:
423:
420:
414:
407:
401:
398:
380:
373:
366:
343:
340:
325:Bruce protocol
308:
305:
304:
303:
296:
272:
269:
232:
229:
224:
207:
191:
162:
159:
139:
136:
95:
94:
87:
84:
83:
76:
70:
69:
62:
56:
55:
50:
44:
43:
40:
36:
35:
32:
24:
23:
15:
13:
10:
9:
6:
4:
3:
2:
3077:
3066:
3063:
3061:
3058:
3057:
3055:
3042:
3032:
3026:
3023:
3021:
3020:Cardioversion
3018:
3017:
3015:
3011:
3005:
3002:
3000:
2997:
2995:
2992:
2991:
2989:
2987:
2983:
2977:
2974:
2971:
2967:
2966:
2963:
2960:
2958:
2955:
2953:
2949:
2946:
2942:
2939:
2938:
2937:
2934:
2932:
2929:
2927:
2924:
2920:
2917:
2915:
2912:
2911:
2910:
2907:
2905:
2902:
2899:
2895:
2894:
2891:
2888:
2884:
2881:
2880:
2879:
2876:
2874:
2871:
2869:
2866:
2862:
2859:
2858:
2857:
2854:
2851:
2847:
2846:
2844:
2840:
2830:
2827:
2825:
2822:
2820:
2817:
2816:
2813:
2810:
2807:
2804:
2801:
2798:
2796:
2793:
2791:
2788:
2786:
2783:
2781:
2778:
2775:
2771:
2767:
2764:
2760:
2759:
2756:
2753:
2751:
2748:
2746:
2743:
2741:
2740:Dor procedure
2738:
2736:
2733:
2730:
2726:
2725:
2722:
2719:
2717:
2714:
2712:
2709:
2706:
2702:
2701:
2699:
2695:
2689:
2686:
2685:
2682:
2679:
2677:
2674:
2673:
2670:
2667:
2665:
2662:
2657:
2656:
2653:
2650:
2648:
2645:
2642:
2638:
2637:
2632:
2629:
2627:
2624:
2622:
2619:
2618:
2617:
2613:
2610:
2608:
2605:
2602:
2598:
2597:
2595:
2591:
2583:
2580:
2579:
2578:
2575:to the right
2574:
2571:
2567:
2564:
2563:
2561:
2557:
2554:
2549:
2548:
2543:
2540:
2538:
2535:
2534:
2532:
2528:
2525:
2523:
2520:
2518:
2515:
2514:
2513:
2509:
2504:
2503:
2498:
2495:
2494:
2493:
2489:
2486:
2482:
2479:
2478:
2477:
2473:
2470:
2466:
2463:
2462:
2461:
2457:
2454:
2449:
2448:
2443:
2440:
2439:
2438:
2435:
2431:
2428:
2426:
2423:
2422:
2421:
2418:
2413:
2412:
2409:
2406:
2404:
2401:
2397:
2396:Transcatheter
2394:
2392:
2389:
2388:
2387:
2384:
2382:
2379:
2377:
2374:
2370:
2367:
2365:
2362:
2361:
2360:
2359:Valvuloplasty
2357:
2355:
2352:
2350:
2347:
2345:
2342:
2341:
2339:
2335:
2331:
2328:
2324:
2318:
2315:
2313:
2310:
2308:
2305:
2303:
2300:
2299:
2296:
2292:
2288:
2280:
2275:
2273:
2268:
2266:
2261:
2260:
2257:
2250:
2247:
2245:
2242:
2240:
2239:
2234:
2232:
2231:
2226:
2224:
2220:
2217:
2214:
2213:
2209:
2201:
2197:
2193:
2189:
2184:
2179:
2175:
2171:
2167:
2160:
2157:
2152:
2148:
2143:
2138:
2134:
2130:
2125:
2120:
2116:
2112:
2108:
2101:
2098:
2086:
2080:
2076:
2075:
2067:
2064:
2052:
2046:
2042:
2041:
2033:
2030:
2018:
2014:
2007:
2004:
1994:
1990:
1986:
1982:
1975:
1972:
1960:
1954:
1950:
1949:
1941:
1939:
1937:
1935:
1933:
1931:
1929:
1925:
1913:
1907:
1903:
1902:
1894:
1892:
1890:
1886:
1880:
1875:
1871:
1867:
1863:
1856:
1854:
1852:
1850:
1848:
1844:
1839:
1835:
1831:
1827:
1823:
1819:
1815:
1811:
1803:
1800:
1795:
1791:
1787:
1783:
1779:
1775:
1767:
1764:
1759:
1755:
1750:
1745:
1741:
1737:
1733:
1725:
1722:
1711:on 2012-06-24
1707:
1703:
1699:
1698:
1689:
1685:
1679:
1677:
1675:
1671:
1660:
1659:www.heart.org
1656:
1650:
1647:
1636:
1632:
1625:
1622:
1617:
1613:
1608:
1603:
1599:
1595:
1590:
1585:
1581:
1577:
1573:
1566:
1563:
1558:
1554:
1549:
1544:
1540:
1536:
1532:
1528:
1524:
1520:
1516:
1509:
1506:
1501:
1497:
1493:
1489:
1485:
1478:
1475:
1464:
1460:
1453:
1450:
1440:
1436:
1432:
1428:
1421:
1418:
1407:
1403:
1397:
1394:
1383:
1382:www.heart.org
1379:
1373:
1370:
1358:
1354:
1348:
1345:
1340:
1336:
1332:
1328:
1324:
1320:
1316:
1312:
1308:
1301:
1298:
1286:
1282:
1276:
1273:
1263:
1259:
1255:
1251:
1244:
1241:
1235:
1232:
1227:
1223:
1219:
1215:
1211:
1207:
1203:
1200:(1): 254–63.
1199:
1195:
1191:
1184:
1181:
1171:
1167:
1163:
1159:
1152:
1149:
1144:
1140:
1136:
1132:
1128:
1124:
1120:
1116:
1112:
1105:
1102:
1097:
1093:
1089:
1085:
1081:
1077:
1072:
1067:
1063:
1059:
1055:
1048:
1045:
1040:
1033:
1030:
1019:
1015:
1009:
1006:
994:
988:
984:
983:
975:
972:
967:
963:
958:
953:
949:
945:
941:
937:
933:
929:
925:
918:
915:
910:
906:
902:
898:
893:
888:
884:
880:
876:
869:
866:
856:
852:
848:
844:
837:
834:
829:
825:
820:
815:
811:
807:
802:
797:
793:
789:
785:
781:
777:
770:
767:
756:
752:
746:
743:
732:
728:
722:
719:
713:
709:
706:
704:
701:
699:
696:
694:
691:
689:
686:
684:
681:
680:
676:
674:
672:
668:
664:
660:
652:
650:
648:
647:Aminophylline
644:
642:
638:
634:
630:
622:
618:
617:beta-blockers
614:
613:beta-agonists
610:
607:
604:
600:
597:
594:
590:
586:
582:
579:
578:
577:
574:
572:
568:
563:
560:
558:
550:
545:
542:
539:
538:
537:
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2607:Angioplasty
2349:Valvulotomy
1964:26 November
1917:26 November
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1311:Circulation
1058:Circulation
879:Circulation
621:propranolol
599:Regadenoson
302:procedures.
245:radiotracer
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3054:Categories
2957:Cardiac CT
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2729:Myocardium
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2287:procedures
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1664:2023-11-10
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1363:2023-11-08
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1267:2023-11-10
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1162:StatPearls
1023:2023-11-09
860:2023-11-09
847:StatPearls
760:2023-11-09
736:2023-11-09
714:References
609:Dobutamine
583:acting as
479:Sustained
377:arrhythmia
155:dobutamine
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2133:1097-6647
2117:(1): 87.
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1539:1071-3581
1463:First10EM
1331:0009-7322
1194:Radiology
1080:0009-7322
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901:0009-7322
810:1932-6203
589:adenosine
463:or pallor
368:Unstable
293:Perfusion
217:treadmill
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819:4990235
788:Bibcode
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2291:heart
2196:S2CID
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