Exercise stress testing and myocardial perfusion scans
What a positive exercise ECG looks like, the Duke treadmill score worked through, when the resting ECG makes the test uninterpretable, and how to read SPECT and PET perfusion (reversible versus fixed defects, balanced ischaemia, attenuation artefact).
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Exercise ECG measures exercise capacity, symptoms, blood pressure and heart rate response, and ST change. Its diagnostic accuracy is modest, so ESC 2024 keeps it for prognosis and symptom correlation, or when imaging isn't available.
- Myocardial perfusion imaging (MPI) with SPECT or PET compares tracer uptake at stress and rest. Reversible defect = ischaemia; fixed defect = scar.
- Functional testing suits patients with a higher clinical likelihood of coronary disease or known CAD; CTCA suits lower likelihood. The likelihood model is in stable IHD.
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Sources
- Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024;45:3415-537European Society of Cardiology, 2024
- Gulati M, Levy PD, Mukherjee D et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain. Circulation 2021;144:e368-e454American Heart Association and American College of Cardiology, 2021
- Fletcher GF, Ades PA, Kligfield P et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013;128:873-934American Heart Association, 2013
- Mark DB, Shaw L, Harrell FE et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med 1991;325:849-53New England Journal of Medicine, 1991
- Henzlova MJ, Duvall WL, Einstein AJ et al. ASNC imaging guidelines for SPECT nuclear cardiology procedures: stress, protocols, and tracers. J Nucl Cardiol 2016;23:606-39American Society of Nuclear Cardiology, 2016
- Brieger D, Cullen L, Briffa T et al. Comprehensive Australian Clinical Guideline for Diagnosing and Managing Acute Coronary Syndromes 2025. Heart Lung Circ 2025;34(4):309-397AU/NZNational Heart Foundation of Australia and CSANZ, 2025
- Last updated
- 14 November 2026
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