Role of exercise stress testing in evaluation of patients presenting with chest pain

To evaluate and assess the accuracy of the clinical diagnosis of ischemic heart disease [IHD] with exercise stress testing in patients presenting with chest pain. All patients referred from outdoor and emergency department were sent to exercise tolerance test [ETT] room, after undergoing full clinical assessment including history, examination and resting ECG. The patients underwent exercise testing according to Bruce Protocol. One hundred and twenty patients underwent exercise stress testing between December 2002 and June 2003. Among these 86 [71.7%] were males and 34 [28.3%] were females. The mean age of males was 45.19+9.49 years and females 44+10.9 years. Out of 120 patients, 50[41.6%] and 70 [58.3%] patients had positive and negative stress testing results respectively. Out of 50 positive cases, 33 [66%] were males and 17 [44%] were females. The mean age of patients with positive test was 51.3+8.3 years and negative test was 40.4+8.5 years. Hypertension was the most prevalent risk factor 42[35%] followed by family history 36[30%]. Out of total diabetics [18/120] twelve [66%] had positive test. A significant number of patients [n=30/38, [79%] with no risk factors were negative on stress testing. This study concludes that exercise stress test is a cost effective tool to evaluate patients presenting with chest pain in out-patients department suggestive of ischemic heart disease, both typical / definite angina as well as atypical / probable angina. This also helps to stratify those with increased likelihood of IHD into high-risk group needing referral for invasive tests and low risk group that can be observed