Oxford Handbook of Cardiology 2nd Edition PDF
A commonly used test involving a treadmill, blood pressure (BP) measurement, and continuous electrocardiograph (ECG) monitoring. Overall sensitivity for coronary heart disease is around 68 % and specifi city is 77 % . This increases when considering prognostically signifi cant disease, which has a sensitivity of 86 % . The test improves to have a predictive accuracy of > 90 % in intermediate- to high-risk patients (older men with ischaemic symptoms).
The test is of least value in populations that are least likely to be suffering from ischaemic heart disease; e.g. asymptomatic middle-aged women have a positive predictive value of <50 % . Indications • Diagnosis of ischaemic heart disease (IHD): intermediate- or high-probability IHD, vasospastic angina. • Post-myocardial infarction (MI): pre-discharge (submaximal test in days 4–7 to assess prognosis, decide upon exercise programme, and evaluate treatment), late post-discharge (symptom-limited 3–6 weeks). • Pre- and post-revascularization. • Evaluation of arrhythmias: optimizing rate-responsive pacemaker function, evaluation of known or suspected exercise-induced arrhythmias, and evaluation of treatment of above.