chest pain with recent negative stress test

27 Mar

EP MONTHLY EXCERPT:
–nice overview on stress tests from March 2011(see reference link)

DOES THE RECENT NEGATIVE STRESS MEAN THIS PATIENT CAN’T HAVE ACS?
–No.
–stress tests are good, not great

SOME ROUGH EXAMPLES:
–Sensitivity for single vessel CAD:

  • exercise ECG stress test ~68%
  • exercise nuclear stress test (thallium) 60-82%
  • exercise nuclear stress test (sestamibi) 82-97%
  • adenosine/dipyridamole nuclear stress 77-92%
  • dobutamine nuclear stress 80-100%

BOTTOM LINE:
–stress sensitivity is not perfect
–negative stress test does NOT rule out ACS

Reference(s): ep monthly article, picture

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