Here is the link to Journal Jam 15 Cardiac Stress Testing After Negative ED Workup for MI [Link is to the Podcast and Notes].
Here is the introduction:
Robert Bruce, an American Cardiologist, is considered the founder of exercise cardiology. He created the Bruce Protocol in the early 1960s. Sixty years later, cardiac stress testing has been pretty much the standard for screening low risk chest pain patients for coronary disease after a visit to the ED. It makes intuitive sense. If someone has narrowing of their coronaries and you get their heart rate up with a bit of exercise, you’re increasing demand; and if you see some ST changes or the person develops angina, well – they probably have a coronary lesion that needs to be fixed or medicated to prevent them from having an MI – right?
Well, it turns out that this 60 year long belief, that has led hundreds of thousands of people to angiograms, cardiac stents and CABGs, may be wrong. In this Journal Jam podcast we do a deep dive into the hugely complex literature of cardiac stress testing and see whether or not stress testing portends any benefit for patients who we assess in the ED for chest pain. The problem is – if stress testing doesn’t benefit our patients and isn’t a good screening test for preventing MIs, then what do we do with our low risk chest pain patients we see in the ED?
(1) Helman, A. Morgenstern, J., Spiegel R. Cardiac Stress Testing After Negative Workup for MI. Emergency Medicine Cases. April, 2019. https://emergencymedicinecases.com/cardiac-stress-testing/. Accessed 4-10-2019
Dr. Morganstern has posted the following outstanding resources on his blog First 10EM [These posts cover the same ground as in his lecture above and are a great review along with the podcast]:
(5) Stress Tests Part 3: Stress test accuracy by Dr. |Published
(6) Stress Tests Part 4: Revascularization and the Value of Stenting by Dr. |Published
(7) Stress Tests Conclusion: Putting it all together by Dr. Justin Morgenstern|Published March 15, 2019