Using physiologic and pharmacologic stress testing in the evaluation of coronary artery disease.

: Evaluating and treating coronary artery disease (CAD), the leading cause of death in the United States, are priorities for primary care practitioners. Stress testing is a noninvasive, cost-effective technique to help diagnose CAD and evaluate its extent. The test can also be used to clarify the etiology of chest pain, evaluate a medical regimen, identify arrhythmias, risk-stratify patients preoperatively, and determine exercise tolerance. Myocardial perfusion imaging and echocardiography can increase the test's sensitivity and specificity. Pharmacologic testing is available to evaluate patients who are unable to exercise adequately. Test selection is based on the patient's ability to exercise, concurrent illnesses (for example, reactive airway disease), and desired findings. The evaluation of results should be based on history and the pretest probability of cardiovascular disease. A cardiologist should evaluate any results that fall to correlate with the patient's presentation or pretest likelihood of disease for possible coronary angiography.