Why doctors still rely on century-old heart test

A nurse at Ohio State University Wexner Medical Center gives a woman an exercise stress test. Credit: Ohio State University Wexner Medical Center

Most people might assume that technology first developed in 1928 would be obsolete by now. But from air conditioned buildings to sliced bread, many inventions of that era are still essential to our lives today. That includes the exercise stress test, which is still the most widely used medical test for coronary artery disease.

Doctor Martha Gulati MD, of The Ohio State University's Wexner Medical Center, co-authored a paper in the journal Current Problems in Cardiology, touting the benefits of exercise , particularly in this age of high-tech medicine. Today, using things like nuclear heart scans, MRIs and , doctors can see inside the body like never before, peering deep into the heart with remarkable clarity.

"Even though they've been around for nearly a century, they can not only tell us if you currently have heart disease, but can also predict your risk for it in the future," said Martha Gulati. "By today's standards these tests may seem low-tech, but they can be highly effective and very efficient in diagnosing ."

Just because those tests are available, doesn't always make them the right choice.

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"In my practice I use a lot of when it's appropriate," said Dr. Gulati, "but I think we need to get away from just doing the most expensive test because we can."

Doctor Gulati says while high-tech imaging can be effective, it is expensive and often involves radiation, which, in some cases, can lead to other health complications. "We need to be doing the right test for our patients, and when the guidelines are strictly followed, for almost all patients who can exercise, the right test, initially, will be the exercise stress test."

During these tests, doctors simply attach small to your body, which monitor your heart during exercise, charting everything from beats per minute to blood pressure, and can even measure things like capacity, blood flow and recovery times. The test is non-invasive and can be administered in doctor's offices. "We sometimes get caught up in the latest technology in our society, and often what gets ignored is the simple stuff," said Dr. Gulati.

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It was that simple test that saved the life of 73-year old Barbara Current. "I had this anxious feeling in my chest," she said, "it wasn't anything big, but something I'd never felt it before."

Having already survived one heart attack, she immediately went to see Dr. Gulati. To their surprise, tests involving high-tech imaging showed that Barbara's heart was normal.

But the told a different story.

"We found very significant disease," said Dr. Gulati. "In fact, it required having a stent placed in one coronary artery immediately and, subsequently, required another one placed just recently."

Given the subtlety of her symptoms, Barbara was surprised at the extent of her disease. "I really didn't think it had anything to do with my heart," she said, "I'm so very fortunately I took that stress test."

More information: An Update on Exercise Stress Testing, Current Problems in Cardiology, Volume 37, Issue 5, May 2012. Online: www.cpcardiology.com/article/S0146-2806(11)00258-1/abstract

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