Taking the stress out of choosing the right s...( Stress tests are good front-line tes...),Health

Stress tests are good front-line tests indicators of heart disease, but just how good depends on ordering the right one, researchers say.

Thirty percent of all women, for example, have a false positive exercise treadmill test, in which they walk for several minutes at a slightly increasing incline with an electrocardiogram measuring the electrical activity of the heart, they say.

So if you are female, I put you on a treadmill and the waves that measure the electrical activity of your heart drop. You say, Am I going to die? says Dr. Vincent J.B. Robinson, nuclear cardiologist at the Medical College of Georgia and the Veterans Affairs Medical Center in Augusta. That probably is not the case. But instead of then taking those 30 percent of women to the catheterization lab to look for blood vessel blockages, we put them back on the treadmill this time with a contrast medium so we can see the heart work and possibly with a pharmacologic stress agent as well.

To help ensure all physicians know the best strategy, a team of MCG cardiologists reviewed the literature on stress tests and wrote a comprehensive article for the October issue of Southern Medical Journal.

Coronary artery disease is a very, very prevalent condition and every physician, regardless of specialty, has to face the disease one way or the other, says Dr. Rakesh N. Patel, MCG research assistant who will start a cardiology fellowship in July. A lot of stress tests are available to help assess disease. To maximize the sensitivity and specificity, you have to choose the appropriate stress test. Dr. Patel is the papers first author.

The paper, complete with algorithms for doing just that, is followed by a quiz that offers continuing medical education credit.

Pharmacologic stressors, needed by about half of patients getting stress tests, dilate healthy blood vessels but not diseased vessels, which already are maximally dilated. The addition of a r
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