Evaluating CAD with a pharmacologic stress test
George S. Fenimore MSN, RN

May 2010 
Volume 40  Number 5
Pages 51 - 52
  PDF Version Available!

CARDIAC STRESS TESTING helps clinicians evaluate patients with known or suspected coronary artery disease (CAD). Someone with a hemodynamically significant coronary artery stenosis may have minimal symptoms or an unremarkable ECG while at rest. But signs and symptoms may become evident as myocardial oxygen demand is increased during cardiac stress testing.An exercise stress test using a treadmill or stationary bicycle is the preferred testing method, but pharmacologic stress testing may be indicated for patients who can't exercise or increase their heart rate adequately for various reasons. This article will review indications for pharmacologic stress testing, describe the types of pharmacologic stress tests, and explain how to prepare your patient. For general indications for cardiac stress testing, see Stressing out.During a cardiac stress test, coronary arteries dilate to supply the heart with more oxygen. However, diseased or narrowed coronary arteries can't dilate as well as healthy arteries. Because of reduced vasodilation, less blood flows to areas of the heart supplied by narrowed arteries. The resulting myocardial ischemia leads to chest discomfort or anginal equivalent and identifiable ECG changes such as ST segment depression.Stress testing is performed by having the patient exercise or by administering pharmaceutical agents that raise the heart rate or trigger coronary vasodilation while the patient is at rest. During the test, the patient is closely monitored for signs and symptoms of cardiac ischemia via continuous ECG monitoring and serial BP measurements.Pharmacologic stress testing is usually reserved for patients who can't exercise maximally, because inadequate exercise may lead to an underestimation of the presence and extent of CAD. A patient may be unable to exercise adequately due to advanced age, poor coordination, poor balance, or various medical conditions such as severe chronic obstructive pulmonary disease (COPD) or osteoarthritis,

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