This house believes that exercise tolerance tests should

be scrapped

Steve Leslie

Consultant Cardiologist (NHS Highland)

ETT

Sensitivity Comparison of Different Testing Modalities

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10

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1 vessel 2 vessel 3 vessel All CAD

Stress ECG

Stress ECHO

Nuclear

NICE guideline 95Chest pain of recent onset

• Clinical diagnosis• If risk >90% - just treat• Don’t not use ETT to exclude stable

angina

EBM

OMG

A tale of two hearts

Patient 1 with chest pain

• Male born 1964

• Smoker, family history• Chest pain

• ETT – 10 mins ‘normal’

• Admitted to hospital 2 years later, initial ECG ‘normal’

• 12 hour troponin >50 repeat ECG ST elevation.

Blocked RCA, distal LMS

PCI (angioplasty) with BMS (bare metal stent)

Too little, too late

Patient 2 with chest pain

• Male born 1970

• No family history• Chest pain

• No ETT – straight to CT

Severe LAD (left anterior descending)

CT → Cardiology

• ‘not sure I like the look of this’• ‘looks a bit nasty’

Coronary angiogram

PCI to LAD

Tests used in our RACPC

Opinion

• This cardiologist (and NICE) believe that ETT should be avoided in patients with undiagnosed coronary disease.

Rebuttal

ETT are not obsolete

Lunchtime exercise for our physiologists?

Thank you