Exercise stress testing

Although exercise stress testing for cardiac patients has been in use for nearly 50 yr, widespread acceptance of the technique as an important diagnostic tool in cardiology has been accomplished only recently. This has occurred with the recognition that patients with cardiac disease, even in advanced degree, can perform exercise safely under controlled conditions, and that objective information regarding cardiac functional capacity and the presence or absence of myocardial ischemia can be determined. In addition, epidemiologic follow up studies and correlative studies comparing exercise electrocardiographic findings with coronary arteriograms have provided documentation of the sensitivity and specificity of the test in patients with coronary artery disease. In spite of considerable scientific input into this field in the last 10 yr, controversy regarding the usefulness and role of exercise stress testing in a variety of clinical settings persists. This review considers those aspects of exercise testing most relevant to the practicing physician. Several comprehensive monographs dealing with various aspects of this field have been published recently. The reader is referred to these sources for technical details or further discussion of some of the material covered here.