Exercise testing in rapid-access clinics for assessment of chest pain

• Published in: The Lancet (British edition) Vol. 356; no. 9248; p. 2116
• Main Author: Reeder, Guy S
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 23.12.2000; Elsevier Limited
• Subjects: Algorithms; Ambulatory Care Facilities - organization & administration; Cardiovascular disease; Chest Pain - diagnosis; Coronary vessels; Exercise Test; Health Services Accessibility; Humans; Medical diagnosis; Medical screening; Pain; Thallium; Time Factors; United Kingdom
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(00)03487-5

The recent American Heart Association science advisory on exercise testing in emergency-room chest-pain centres' summarises experience of treadmill testing in the context of algorithms used in chest-pain centres. Most importantly, patients selected for exercise testing should, on assessment for clinical risk of acute coronary syndrome, be judged to have a low risk (less than 7% likelihood). Such patients will have characteristics such as atypical or now resolved chest discomfort, normal concentrations of serum cardiac markers on two occasions, no recurrence of chest pain during a 6-9 hour observation period, or if the pain persists it is atypical for ischaemia, and a resting electrocardiogram that shows neither ST-segment elevation nor depression. For such patients symptom-limited exercise testing is the preferred investigation as long as there are no electrocardiographic confounders, such as left bundlebranch block, left-ventricular hypertrophy with strain, or use of digitalis. If there are such confounders, some form of imaging stress test, with thallium, sestamibi or echocardiography, is recommended. With adherence to these guidelines, complications of treadmill testing are rare.