From the Guidelines
After a positive treadmill stress test, patients should undergo further cardiac evaluation with imaging tests such as a nuclear stress test, stress echocardiogram, or coronary CT angiography to confirm the presence and severity of coronary artery disease, as recommended by the American College of Physicians and American College of Cardiology Foundation 1. The goal of these additional tests is to assess the risk and prognosis of patients with suspected ischemic heart disease, using methods like the Duke treadmill score, which calculates the exercise time in minutes minus (5 × ST-segment deviation, during or after exercise, in millimeters) minus (0 if there is no angina, 4 if angina occurs, and 8 if angina is the reason for stopping the test) 1. Some key points to consider after a positive treadmill test include:
- The occurrence of ST-segment depression at a reduced workload or persisting into recovery coupled with exertional symptoms is associated with a high risk for cardiovascular death 1
- Other prognostic factors include low exercise capacity, failure to increase systolic blood pressure to >120 mm Hg or a sustained >10 mm Hg drop during exercise, ST-segment elevation, complex ventricular ectopy or arrhythmias during stress or recovery, and delayed heart rate recovery 1
- Medications like aspirin, statins, and beta-blockers may be prescribed to reduce cardiac risk, and lifestyle modifications such as a heart-healthy diet, regular exercise, smoking cessation, and stress management are essential 1
- If significant blockages are found, interventional procedures such as angioplasty with stent placement or coronary artery bypass surgery may be necessary 1
From the Research
Treadmill Test Results
- A positive treadmill test indicates the presence of coronary artery disease (CAD) or other heart conditions 2
- The test results should be interpreted by a healthcare professional to determine the next course of action
Next Steps After a Positive Treadmill Test
- Further testing, such as echocardiography or myocardial perfusion imaging, may be ordered to confirm the diagnosis and assess the severity of the condition 2
- Medications, such as aspirin, beta blockers, and statins, may be prescribed to manage the condition and reduce the risk of cardiovascular events 3, 4, 5, 6
- Lifestyle modifications, such as regular exercise, a healthy diet, and stress reduction, may also be recommended to manage the condition and improve overall health
Importance of Medication Adherence
- Adherence to prescribed medications, such as aspirin, beta blockers, and statins, is crucial to managing CAD and reducing the risk of cardiovascular events 3, 4, 5, 6
- Combination therapy with aspirin, a statin, and blood pressure-lowering agents has been shown to be effective in reducing the risk of vascular morbidity and mortality in patients with CAD 5
Considerations for Older Adults
- Older adults with CAD may be at higher risk for cardiovascular events and may require more aggressive management of their condition 6
- Underutilization of evidence-based medications, such as aspirin, beta blockers, and statins, is common in older adults with CAD and should be addressed by healthcare providers 6