Important Heart Test Turns 83 This Year

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In the late 1920’s, medical researchers were just beginning to understand the significance of electrocardiograms and how they could be used in diagnosing heart conditions. One of the innovations at that time was the invention of the Exercise Stress Test that revealed ST and T segment changes in the electrocardiograms of patients under real-time conditions that accurately mimicked the angina conditions patients experience while at home or work away from the hospital. This year, the Exercise Stress Test turns 83 and according to a recent article in the journal Current Problems in Cardiology, it remains as one of the most important heart tests available today.

Coronary artery disease is a major health problem in the U.S., accounting for nearly one out of every four deaths annually. An important component of treating coronary artery disease is detecting and diagnosing the medical condition of the heart in individuals before the development of a fatal heart attack.

In the 1920’s, doctors were using electrocardiograms on patients, but typically not until after the patients had presented with a heart attack while away from the hospital. One limitation of this is that due to the delay between the time of the heart attack and arriving at a hospital, it provided a late picture of what was happening in the heart.

In 1928, medical researchers reported observing ST and T changes in the electrocardiograms of three patients following exercise who began to experience angina while at the hospital. One year later, Master and Oppenheimer developed a standardized exercise protocol that assessed the heart’s functional capacity and hemodynamic response when placed under physical stress. Today, the exercise stress test is one of the most important diagnostic and prognostic heart tests for coronary artery disease.

In a news release from the Ohio State University’s Wexner Medical Center, researcher and co-author Martha Gulati, MD discusses the importance of the development of the exercise stress test and how that in spite of its relative lack of technological sophistication in comparison to more modern technologies and tests, that it still plays an important role in healthcare.

One example she provides is the story of 73-year old Barbara Current who was experiencing chest pain of which modern heart imaging methods and machines failed to detect anything abnormal about her heart.

“I had this anxious feeling in my chest…it wasn’t anything big, but something I’d never felt before,” said Ms. Current.

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However, a simple and much less expensive exercise stress test performed afterward found that her heart was not okay.

“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.”

“I really didn’t think it had anything to do with my heart,” said Ms. Current. “I’m so very fortunate that I took a stress test.”

In her article, Dr. Gulati discusses how that in spite of the development of nuclear heart scans, MRIs and CT imaging where physicians can achieve remarkable internal views of the heart, that physicians need to remember that the lowly exercise stress test is sometimes the best test.

“In my practice I use a lot of advanced imaging 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.”

Dr. Gulati’s co-authored article can be found in the May issue of Current Problems in Cardiology.

Image Source: Courtesy of Wikipedia

Reference: “An Update on Exercise Stress Testing” Current Problems in Cardiology Vol. 37, Issue 5, pp. 177-202, May 2012; Kavita Sharma, MD et al.

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