Coronary Artery Disease Screening Tests (CAD) (cont.)
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- What is coronary artery disease?
- What is the purpose of screening tests for CAD?
- What are common initial screening tests for CAD?
- Exercise cardiac stress test (treadmill stress test or ECST)
- Radionuclide stress test
- Stress echocardiography
- Pharmacologic stress test
- Are there other tests for CAD that are noninvasive?
- What is the most accurate method of defining CAD?
- Coronary angiography
- Find a local Cardiologist in your town
Radionuclide stress test
Radionuclide stress testing involves injecting a radioactive isotope (typically thallium or cardiolite) into the patient's vein after which an image of the patient's heart becomes visible with a special camera. The radioactive isotopes are absorbed by the normal heart muscle. Nuclear images are obtained in the resting condition, and again immediately following exercise. The two sets of images are then compared. During exercise, if a blockage in a coronary artery results in diminished blood flow to a part of the cardiac muscle, this region of the heart will appear as a relative "cold spot" on the nuclear scan. This cold spot is not visible on the images that are taken while the patient is at rest (when coronary flow is adequate). Radionuclide stress testing, while more time-consuming and expensive than a simple ECST, greatly enhances the accuracy in diagnosing CAD.
Another supplement to the routine ECST is stress echocardiography. During stress echocardiography, the sound waves of ultrasound are used to produce images of the heart at rest and at the peak of exercise. In a heart with normal blood supply, all segments of the left ventricle (the major pumping chamber of the heart) exhibit enhanced contractions of the heart muscle during peak exercise. Conversely, in the setting of CAD, if a segment of the left ventricle does not receive optimal blood flow during exercise, that segment will demonstrate reduced contractions of heart muscle relative to the rest of the heart on the exercise echocardiogram. Stress echocardiography is very useful in enhancing the interpretation of the ECST, and can be used to exclude the presence of significant CAD in patients suspected of having a "false-positive" ECST.
What if patients are unable to exercise adequately for an ECST?
Many patients are unable to exercise maximally for stress testing due to a variety of conditions including arthritis, severe lung disease, severe cardiac disease, orthopedic conditions, and diseases of the nervous system. In such patients, pharmacological stress testing is often employed.
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