Cardiologist Has Arsenal of Stress Test to Select From
Your doctor is sending you to a cardiologist for a stress test. But the stress test you have may be very different from the one your neighbor takes, says Matthew Lyons, MD, a MetroHealth cardiologist who sees patients seeking care for a wide range of heart conditions.
Consider these three very different patients.
Sam, 40, has had no major health problems in the past. He's experiencing some chest pain and has a normal electrocardiogram, or ECG. The most appropriate test for Sam is an exercise stress test conducted while Sam is walking on a treadmill.
Jill, 55, has asthma and severe osteoarthritis in her knees. She is increasingly short of breath when doing anything physical. Because of her asthma and osteoarthritis, a pharmaceutical-induced test — called a dobutamine stress echocardiogram — is appropriate. Using dobutamine is preferred because of her history of asthma and her shortness of breath, which may be due to some type of heart problem.
Robert, 80, has chest pain. He has a history of coronary artery disease following a heart attack, complicated by reduced heart-pumping, peripheral vascular disease and cardiac arrhythmia. The preferred stress test for Robert is a pharmaceutical-induced test called an adenosine nuclear stress test. The adenosine is preferred due to the cardiac arrhythmia, which could become uncontrolled with dobutamine, and the nuclear stress test is more appropriate due to the previous heart attack.
"If the patient can exercise, I'll have them do that for the stress test because you can get more information about them," says Dr. Lyons. "And if a patient has had a heart attack in the past, the nuclear scan is probably better because damage is easier to see."
Above all, says Dr. Lyons, "I want this to be time-saving and cost effective for patients. I want to use the best test for them the first time in order to avoid having to do a second type of test."