Exercise Stress Test
The next laboratory evaluation that should be obtained in this patient is an exercise stress test.
Our patient's treadmill stress test was not carried out to define the diagnosis of angina pectoris. The diagnosis was made by the history.
A symptom - limited graded electrocardiographic treadmill stress test was performed in the office primarily for risk stratification, that is, to assess severity and prognosis. It was also carried out to guide initial management.
The study was performed without concomitant nuclear or echocardiographic imaging. In a patient with stable angina and a normal resting electrocardiogram, stress testing alone will usually provide the data required for risk stratification and patient management.
During his stress test our patient achieved 90% of his predicted maximum heart rate, or 150 beats per minute. He exercised for eight minutes when the test was stopped, as he developed substernal chest pain. His physical examination pre and post exercise revealed a fourth heart sound at the apex. His baseline blood pressure was 150/100 mmHg and at peak exercise was 220/90 mmHg. He had occasional atrial premature contractions throughout the study.