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Stress testing: The effect of medications and methylxanthines

Panithaya Chareonthaitawee, MD
J. Wells Askew, MD
Section Editors
Gary V Heller, MD, PhD, FACC, MASNC
Patricia A Pellikka, MD, FACC, FAHA, FASE
Deputy Editor
Brian C Downey, MD, FACC


For the majority of patients undergoing a stress test, the primary goal is to identify myocardial ischemia due to coronary heart disease (CHD). Depending on the stress test modality, ischemia may manifest in the form of symptoms, hemodynamic findings, electrocardiographic abnormalities, stress-induced perfusion defects, or regional wall motion abnormalities.

In patients with known or suspected CHD, the presence and extent of ischemia on stress testing are used to guide medical therapy and/or determine the need for further diagnostic and therapeutic procedures. Thus, factors that impact the sensitivity and specificity of stress testing for the detection of ischemia may lead to either patients not receiving appropriate therapy or to unnecessary procedures and treatment with their attendant risks and costs, respectively. Many factors (eg, pre-existing electrocardiographic abnormalities, sex, body habitus, etc) can affect a stress test’s ability to accurately identify myocardial ischemia.

The interaction between major cardiovascular medications, dietary factors, and stress testing and our recommendations for continuing or discontinuing the individual drug or dietary component will be discussed here. Indications and procedures for stress testing are discussed separately. (See "Selecting the optimal cardiac stress test" and "Stress testing for the diagnosis of obstructive coronary heart disease" and "Exercise ECG testing: Performing the test and interpreting the ECG results" and "Overview of stress radionuclide myocardial perfusion imaging" and "Overview of stress echocardiography".)


Before discussing the impact of medications and dietary factors on the detection of myocardial ischemia on stress testing, important concepts regarding stress testing for coronary heart disease (CHD) must be considered.

The manifestations of CHD identified following stress with exercise or dobutamine require the ability to increase myocardial oxygen demand by increasing heart rate, blood pressure, and/or left ventricular contractility above a certain threshold to provoke myocardial ischemia. Vasodilator-stress induced manifestations of CHD depend on a hyperemic coronary blood flow differential between normal and abnormal coronary arteries, and are not dependent on increasing heart rate, blood pressure, or contractility. (See "Exercise ECG testing: Performing the test and interpreting the ECG results" and "Overview of stress radionuclide myocardial perfusion imaging" and "Overview of stress echocardiography".)


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Literature review current through: Jul 2017. | This topic last updated: Aug 10, 2017.
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