intropes

1. SCHOOL OF NURSING,DEPARTMENT OF CARDIOVASCULAR
NURSING
ADVANCEDCARDIOVASCULAR HEALTH ASSESSMENT AND
DIAGNOSTIC METHOD
BY:JIREGNA ETICHA 4247/14
SUBMITTED TO:MESTAWOT
MAY 14/2014

2. Inotrope
• An inotrope is an agent that alters the force or energy of muscular contractions.
Negatively inotropic agents weaken the force of muscular contractions.
• Positively inotropic agents increase the strength of muscular contraction.
• The term inotropic state is most commonly used in reference to various drugs
that affect the strength of contraction of heart muscle (myocardial contractility).
However, it can also refer to pathological conditions.
• For example, enlarged heart muscle (ventricular hypertrophy) can increase
inotropic state,
• whereas dead heart muscle (myocardial infarction) can decrease it.

3. CONTI....
• Both positive and negative inotropes are used in the management of various
cardiovascular conditions.
• The choice of agent depends largely on specific pharmacological effects of
individual agents with respect to the condition.
• One of the most important factors affecting inotropic state is the level of calcium
in the cytoplasm of the muscle cell.

4. CONTI....
• Positive inotropes usually increase this level, while negative inotropes decrease
it. However, not all positive and negative drugs affect calcium release, and,
among those that do, the mechanism for manipulating the calcium level can differ
from drug to drug.
• While it is often recommended that vasopressors are given through a central line
due to the risk of local tissue injury if the medication enters the local tissue, they
are likely safe when given for less than two hours in a good peripheral iv.

5. CONTI...
• While it is often recommended that vasopressors are given through a central line due
to the risk of local tissue injury if the medication enters the local tissue, they are
likely safe when given for less than two hours in a good peripheral iv.

6. Positive inotropic agents
• By increasing the concentration of intracellular calcium or increasing the sensitivity
of receptor proteins to calcium, positive inotropic agents can increase myocardial
contractility.
• Concentrations of intracellular calcium can be increased by increasing influx into the
cell or stimulating release from the sarcoplasmic reticulum.
• Once in the cell, calcium can pass through one of two channels: the L-type calcium
channel (long-lasting) and the T-type calcium channel (transient).

7. CONTI...
• These channels respond to voltage changes across the membrane differently: L-type
channels respond to higher membrane potentials, open more slowly, and remain open
longer than T-type channels.
• Because of these properties, L-type channels are important in sustaining an action
potential, while T-type channels are important in initiating them.
• By increasing intracellular calcium, via the action of the L-type channels, the action
potential can be sustained for longer and therefore, contractility increases.
• Positive inotropes are used to support cardiac function in conditions such as
decompensated congestive heart failure, cardiogenic shock, septic shock, myocardial
infarction, cardiomyopathy, etc.

8. CONTI...
• Examples of positive inotropic agents include:
• Digoxin
• Berberine
• Calcium
• Calcium sensitisers
Levosimendan

9. CONTI...
• Catecholamines
Dopamine
Dobutamine
Dopexamine
Adrenaline (epinephrine)
Isoproterenol (isoprenaline)
Noradrenaline (norepinephrine)

10. CONTI...
• Angiotensin II
Eicosanoids
• Prostaglandins[10]
Phosphodiesterase inhibitors
Enoximone
Milrinone
Amrinone
Theophylline
• Glucagon
• Insulin

11. Negative inotropic agents
• Negative inotropic agents decrease myocardial contractility
and are used to decrease cardiac workload in conditions such
as angina.
• While negative inotropism may precipitate or exacerbate
heart failure, certain beta blockers
• (e.g. carvedilol, bisoprolol and metoprolol) have been
believed to reduce morbidity and mortality in congestive
heart failure.

12. Examples of negative inotropic agents include:
• Beta blockers
• Non-dihydropyridine Calcium channel blockers
Diltiazem
Verapamil
• Class IA antiarrhythmics such as
 Quinidine
 Procainamide
 Disopyramide
• Class IC antiarrhythmics such as
 Flecainide
 Isovoacangine
 Voacristine

13. Dromotropic agent
• MA dromotropic agent is one which affects the conduction speed (in fact the
magnitude of delay in the AV node, and subsequently the rate of electrical impulses
in the heart.
• Positive dromotropy increases conduction velocity (e.g. epinephrine stimulation),
negative dromotropy decreases velocity (e.g. vagal stimulation).
• Agents that are dromotropic are often (but not always) inotropic and chronotropic.
• For instance, parasympathetic stimulation is usually negatively chronotropic and
dromotropic, but because the vagus nerve does not innervate ventricular
myocardium, there is no effect on inotropy.

14. CONTI...
• For instance, parasympathetic stimulation is usually negatively chronotropic and
dromotropic, but because the vagus nerve does not innervate ventricular
myocardium, there is no effect on inotropy.

15. CONTI...
• Non-dihydropyridine calcium channel blockers such as verapamil block the slow
inward calcium current in cardiac tissues, there by having a negatively
dromotropic, chronotropic and inotropic effect.
• This (and other) pharmacological effect makes these drugs useful in the
treatment of angina pectoris.
• Conversely, they can lead to symptomatic disturbances in cardiac conduction and
bradyarrhythmias, and may aggravate left ventricular failure.

16. Bathmotropic
• Bathmotropic often refers to modifying the degree of excitability specifically of
the heart; in general, it refers to modification of the degree of excitability
(threshold of excitation) of musculature in general, including the heart.
• It especially is used to describe the effects of the cardiac nerves on cardiac
excitability.
• Positive bathmotropic effects increase the response of muscle to stimulation,
whereas negative bathmotropic effects decrease the response of muscle to
stimulation.

17. CONTI...
• In a whole, it is the heart's reaction to catecholamines (norepinephrine,
epinephrine, dopamine).
• Conditions that decrease bathmotropy (i.e. hypercarbia) cause the heart to be less
responsive to catecholaminergic drugs.
• A substance that has a bathmotropic effect is known as a bathmotrope.
• While bathmotropic, as used herein, has been defined as pertaining to
modification of the excitability of the heart, it can also refer to modification of
the irritability of heart muscle, and the two terms are frequently used
interchangeably.

18. Increasing bathmotropy
• Hypocalcemia - calcium blocks sodium channels which prevents depolarization, so
decreases in calcium allow increased sodium passage and which lowers the threshold
for depolarization.
• Mild to moderate hyperkalemia - causes a partial depolarization of the resting
membrane potential
• Norepinephrine and sympathetic stimulation in general - raises the resting membrane
potential

19. CONTI...
• Digitalis - Converts the normal Purkinje action potential of heart muscle to the
automaticity type, which increases myocardial irritability
• Epinephrine - Also known as adrenaline, effects are similar to sympathetic
stimulation
• Mild hypoxia - causes a partial depolarization of the muscle membrane
• Ischaemia - causes a partial depolarization of the muscle membrane

20. Decreasing bathmotropy
• Hypercalcemia - decreases permeability to sodium, hyperpolarizes membrane.
• Propranolol
• Quinidine and other Class A Antiarrhythmic agents - block the voltage gated sodium
channels.
• Calcium channel blockers - in general have negative bathmotropic effects
• Parasympathetic stimulation - decreases excitability only of atrial muscle cells
• Hyponatremia - decreases external sodium concentration
• Hypokalemia - hyper polarization of the resting membrane potential
• Acetylcholine - same as parasympathetic stimulation
• Marked hypoxia - causes a marked depolarization of the resting membrane potential

21. Chronotropic
• Chronotropic drugs may change the heart rate and rhythm by affecting the electrical
conduction system of the heart and the nerves that influence it, such as by changing
the rhythm produced by the sinoatrial node.
• Positive chronotropes increase heart rate; negative chronotropes decrease heart rate.
• A dromotrope affects atrioventricular node (AV node) conduction.
• A positive dromotrope increases AV nodal conduction, and a negative dromotrope
decreases AV nodal conduction.
• A lusitrope is an agent that affects diastolic relaxation.
• Many positive inotropes affect preload and afterload.

22. CONTI....
• Chronotropes influence the sinoatrial node (SA node) to change the rhythm.
• Hence, they are administered to individuals with arrhythmias (abnormal heart
rhythms).
• There are two types of arrhythmias: tachycardia and bradycardia.
• Tachycardia occurs when the heart beats too quickly, and bradycardia occurs when
the heart beats too slowly.
• Positive chronotrope is provided to patients with bradycardia, to increase the heart
rate
• while negative chronotrope is given to patients with tachycardia to slow down the
heart rate.

23. M

24. CONTI...
• Chronotropic is a cardiac drug that affects the heart rate. Thus, these drugs are
chronotropes.
• Chronotropes affect the heart rate by influencing changes in the electrical conduction
system of the heart.
• Similar to inotropes, chronotropes are of two categories: positive chronotropes and
negative chronotropes.
• Positive chronotropes increase the heart rate .
• negative chronotropes decrease the heart rate.

25. Negative chronotropes
• Chronotropic variables in systolic myocardial left and right.
• Left sided systolic chronotropy can be appreciated as Aortic Valve open to close
time.
• Right sided variables are represented by pulmonary valve open to close time.
• Inverted as diastolic chronotropy, the variables are aortic valve close to open and
pulmonic close to open time.

26. CONTI....
• Pharmaceutical manipulation of chronotropic properties was perhaps first appreciated
by the introduction of digitalis, though it turns out that digitalis has an inotropic
effect rather than a chronotropic effect.
• Beta blockers such as metoprolol
• Acetylcholine
• Digoxin
• Pacemaker current (i.e. HCN channel) inhibitors (e.g. ivabradine)

27. Positive chronotropes
• Most Adrenergic agonists
• Atropine
• Dopamine
• Epinephrine
• Isoproterenol
• Milrinone
• Theophylline

28. Summary – Inotropic vs Chronotropic
• The key difference between inotropic and chronotropic is:
• Inotropic is a cardiac drug which affects cardiac contractions (heartbeat)
• chronotropic is a cardiac drug that affects the heart rate.
• Inotropes can treat hypertension, angina, and chronic heart failure
• chronotropes help in the treatment of arrhythmias.
• digoxin is an example of inotropic drugs
• while dopamine is an example of chronotropic drugs.

29. Summary – Inotropic vs Chronotropic
 Both inotropes and chronotropes have two sub-categories: positive and negative.
Positive drugs increase the heartbeat and heart rate,
whereas negative drugs reduce both heartbeat and rate.

30. CONTI...
• Moreover, inotropes are useful in treating disease conditions such as hypertension,
angina and chronic heart failure
• while chronotropes are useful in the treatment of arrhythmias.

31. What are the Similarities Between Inotropic and Chronotropic?
• Inotropes and chronotropes are two types of cardiac drugs.
• Both drugs directly affect the functioning of the heart.
• Moreover, both help to treat different disease conditions related to the heart.

32. References
1. "The Kanji Foundry Press - b". Archived from the original on 2008-03-12.
Retrieved 2008-05-14
2.Engelmann, Th. W. (January 1897). "Ueber den myogenen Ursprung der
Herzthätigkeit und über automatische Erregbarkeit als normale Eigenschaft
peripherischer Nervenfasern". Pflügers Archiv (in German). 65 (11–12): 535–578.
doi:10.1007/BF01795562. ISSN 1432-2013. S2CID 31891993.
3.Katz AM; Smith VE (1982). "Inotropic and lusitropic abnormalities in the genesis
of heart failure". Eur Heart J. 3 (Suppl D): 11–18. doi:10.1093/eurheartj/4.suppl_a.7.
PMID 6220901.

33. What Is a Cardiac Stress Test?
• A cardiac stress test (also known as a cardiac exercise test) is an in-office exam
used to measure the heart's response to physical exertion in a controlled environment.
• Performed commonly on a treadmill or a stationary cycle, the test is useful in
diagnosing coronary artery disease (CAD), a condition often missed when a person is
at rest.

34. conti...

35. Purpose of Test
• Is used to evaluate the status of your cardiovascular system, which comprises both
your heart and blood vessels.
• It does so by comparing your circulation at rest with the same measurements taken at
maximum exertion.
• While the primary aim of the test is to detect abnormalities suggestive of CAD, it can
also be used to monitor the health of people with other forms of heart disease.

36. Test Aims
• CAD occurs when the walls of a coronary artery (an artery that feeds the heart)
begin to harden, thicken, and accumulate plaque.
• This is a condition known as atherosclerosis.
• Over time, the blockage can impede blood flow and may eventually lead to a heart
attack or stroke.

37. CONTI...
• The challenge with CAD is that, even with a partial blockage, the heart may still
receive an ample supply of blood while at rest.
• It is only when the heart is placed under stress that the effects of the blockage may
be seen and felt.
• The cardiac stress test involves several elements, which can help reveal a blockage in
several ways:

38. CONTI...
• Blood oxygen level monitoring: When blood flow is obstructed (a condition known
as ischemia), the amount of oxygen delivered to the heart muscles is reduced.
• Pulse and blood pressure monitoring: These measures help doctors determine
whether the heart is working too hard to pump blood through narrowed vessels.
• Electrocardiogram (ECG): Exercise affects not only the heart rate but the heart
rhythm as well. With CAD, the changes are characteristic and may be identified with
an ECG.

39. CONTI...
• In addition to diagnosing CAD, a stress test can often reveal how significant the
blockage is (referred to as functional capacity evaluation).
• For instance, if signs of ischemia develop with little exercise, the blockage is likely
significant and in need of aggressive intervention.
• Ischemia occurring at higher levels of exercise is usually less significant and may
alter the approach to treatment.

40. CONTI...
• Periodic stress tests can also be used to monitor the progression of congestive heart
failure (where the heart is not pumping blood as it should) or assess how well you are
recovering from a heart attack.

41. Test Limitations
• It is important to note that, while useful in detecting blockages, a cardiac stress test
cannot tell how much an artery has hardened or thickened.
• The test is only a generalized measure of blood flow, which healthcare providers can
use to detect areas of restriction or diagnose the severity of CAD.
• To pinpoint the location of the arterial obstruction, your cardiologist may need to
perform a cardiac catheterization and coronary angiography test.

42. CONTI....
• The cardiac stress test is also unable to predict how stable an arterial plaque may be
or if and when a person may have a heart attack.
• In terms of accuracy, a cardiac stress test is often open to interpretation, and results
can vary based on the equipment used, the experience of the technician, and other
factors that can change from day to day (such as whether a characteristic symptom
occurs during the test or not).

43. CONTI...
• According to research from the American College of Cardiology, the sensitivity of a
cardiac stress test without imaging is 68%, while its specificity is 77%.
• When imaging is used during a stress test, sensitivity and specificity are close to
90%. (Sensitivity refers to a test's ability to render a correct positive diagnosis, while
specificity refers to its ability to render a correct negative diagnosis.)
• Clinical experience, therefore, plays a huge role in how accurately a test result is
rendered.

44. Risks and Contraindications
• While the cardiac stress test is a relatively safe and controlled procedure, it may pose
risks to people with advanced heart disease, including fainting, chest pains (angina),
irregular heartbeat (arrhythmia), and heart attack.
• The general risk of the test is considered low if your healthcare provider deems the
test appropriate for you.
• For safety reasons, a cardiac stress test would not be used if you have any of the
following conditions:

45. CO NTI...
• Unstable angina not yet stabilized with medication
• Severe pulmonary hypertension
• Uncontrolled arrhythmia
• Inadequately controlled congestive heart failure
• Pulmonary embolism (a clot in the arteries of a lung)
• Aortic dissection (a tear in the aorta)
• An acute illness of any sort

46. CONTI...
• If and when these conditions are controlled, stress testing may be considered.
• An inability to use your legs does not preclude you from getting a cardiac stress test;
a bicycle-like crank that you turn with your arms may be provided instead of a
treadmill.
• Others unable to exercise because of a physical disability may be given a short-acting
drug, usually regadenoson or adenosine, which can simulate the effects of exercise
on the heart.

47. Before the Test
• While the preparations for a cardiac stress test are relatively minimal, there are a few
things you should know before you arrive for the exam.
• Timing
• When scheduling a cardiac stress test, be prepared to set aside no less than 90
minutes of your day.
• While the test itself takes only about 10 to 20 minutes, it requires preparation and
time afterward to cool down.
• There may also be delays to account for.
• Try to arrive 30 minutes in advance of your appointment so that you can sign in,
relax, and not feel rushed.

48. CONTI...
• The equipment set-up is relatively straightforward and usually involves:
• A treadmill with an adjustable incline (or other pieces of appropriate equipment, if
needed
• An ECG machine with electrodes
• A blood pressure unit (sphygmomanometer)
• A pulse oximeter to measure blood oxygen levels
• The test will be overseen by a healthcare provider, nurse, or a trained technician.

49. What to Wear
• Be sure to wear a pair of comfortable walking shoes and a loose two-piece outfit
when arriving for your appointment.
• You should also be prepared to remove your shirt or blouse so that the EEG
electrodes can be attached to your chest.
• While the office may have lockers to store your wallet and cell phone, it is best to
leave jewelry and other valuables at home.

50. Food and Drink
• You will need to avoid eating or drinking anything with caffeine 24 hours prior to the
test.
• This includes coffee, tea, energy drinks, chocolate, and certain energy bars.
• Only plain water should be consumed in the four hours before the test.
• If you have diabetes or take medications for a chronic illness with meals (such a
certain HIV drugs), you may want to schedule your test later in the day so that you
eat when needed and still adhere to the four-hour restriction.
• Be sure to advise your healthcare provider of any such need.

51. Medications
• When scheduling the stress test, advise your cardiologist about any medications you
may be taking, whether they be prescription, over-the-counter, homeopathic,
traditional, or nutritional.
• In some cases, the drugs may interfere with the accuracy of the test.
• These include any medications containing caffeine, which can increase your heart
rate and blood pressure.
• Examples include weight loss pills, alertness tablets such as No-Doz or Vivarin, and
caffeine-bolstered pain relievers like Anacin or Excedrin.

52. CONTI...
• Chronic heart medications and nitrate drugs used to treat angina also need to be
stopped before the test.
• With that being said, do not stop any drug without direct instructions from your
healthcare provider
• If you take insulin to control your blood sugar, ask your cardiologist how much you
should take on the day of your test. Oftentimes, the insulin dose will need to be
decreased and any oral medications delayed until after the test is completed.
• On the other hand, if you use an inhaler for asthma or COPD, be sure to bring it with
you for safety's sake. If you use a glucose monitor, you should also bring that along
to test your blood sugar after you’ve completed the test.

53. What to Bring
• You may want to bring a towel, water bottle, and a change of clothing, as well as
anything else you might need to freshen up after exercising.
• Other Considerations
• While a cardiac stress test may leave you momentarily winded, it shouldn’t interfere
with your ability to drive home. However, if you are older, unaccustomed to exercise,
or experience frequent lightheadedness, angina, or acute respiratory symptoms, bring
a driving companion.

54. During the Test
• On the day of your test, after signing in and confirming your insurance information,
you may be asked to provide emergency contact information and to sign a liability
form stating that you are aware of the purpose and risks of the test.
• You are then taken to the stress lab.
• The test itself is performed by a lab technician or an attending healthcare provider.

55. Pre-Test
• Before the test, you will need to remove your shirt so that 10 individual electrodes
from the ECG machine can be attached to your chest with a sticky adhesive.
• If your chest is hairy, parts may need to be shaved.
• A modesty gown may be provided once the electrodes are securely in place.
• A blood pressure cuff is then wrapped around your arm, while a clothespin-like
sensor is clipped to your finger to connect you to the pulse oximeter.

56. CONTI...
• Before the exercise portion of the test begins, the technician will record your ECG,
pulse, blood pressure, and blood oxygen level at rest.
• These serve as baselines that your other results will be compared to.

57. Throughout the Testing
• After the resting results are obtained, the exercise portion of the test begins.
The exercise is graded, meaning that the intensity is increased every three
minutes by raising the speed of the machine and/or adjusting its resistance or
incline.

58. CONTI...
• At each three-minute interval, your pulse, blood pressure, blood oxygen, and ECG
are recorded along with any symptoms you may be experiencing.
• Do not grab tightly onto the handrails or handlebars as this may affect the results.
• During the test, you may breathe heavily, sweat, and feel your heart racing, but
should not feel any overt pain or distress.
• If you do, tell the technician.
• Your ECG will be monitored throughout the procedure so that the technician can see
if you are reaching your maximum heart rate (MHR) or approaching any real trouble.

59. CONTI...
• Depending on the aims of the test, you may undergo what is called a maximal stress
test or a submaximal stress test. By definition:
• Maximal stress testing involves increasing the intensity level until you can no longer
keep up, either because you are winded or the ECG indicates there is a cardiac
problem.
• A maximal stress test also requires the heart rate to reach at least 85% of the
maximum predicted heart rate.

60. CONTI...
• The goal of maximal testing is to provide evidence of CAD.
• The test can last from six to 15 minutes, sometimes less, depending on your
cardiovascular fitness level.
• Submaximal stress testing involves continuing exercise only until you reach 85% of
your MHR.
• The test is commonly used for people recovering from a heart attack to determine
how much exercise they can safely perform.
• The maximum time for this test is 27 minutes.

61. CONTI...
• Most people will reach eight to 10 minutes, according to research from the Cleveland
Clinic Journal of Medicine.
• You will be asked to stop the test at any time if you feel moderate to severe chest
pain, severe shortness of breath, dizziness, or fatigue.
• Similarly, the test will be stopped prematurely if the ECG indicates arrhythmia or
your blood pressure is abnormally high or low.

62. Post-Test
• Once the stress test is complete and the requisite measures obtained, you will cool
down gradually by continuing to walk or cycle at a slower pace for two to three
minutes.
• After that, the test is officially over.
• You will be given some water and will usually be monitored for at least 6 minutes
after the conclusion of the stress test.

63. CONTI...
• After the lab technician has determined that your pulse and blood pressure have
normalized, the blood pressure cuff, pulse oximeter, and ECG leads will be removed.
• You can then change back into your clothes and freshen up in the restroom.
• If you have diabetes, this is the time to use your glucose meter to measure your blood
sugar level.
• If it is abnormal, advise the technician, nurse, or attending healthcare provider.
• Similarly, if you do not feel well for whatever reason, do not leave the office.
• Tell someone on the medical staff and let them check you out to ensure you can
safely go home.

64. After the Test
• Generally speaking, there will be no adverse symptoms or lingering side effects if
your vital signs checked out after the stress test.
• If you are not used to exercise or live a sedentary lifestyle, you may feel exhausted or
experience muscle or joint pain a day or two following the exam.
• This is normal. Even the burning sensation in your legs (caused by the build-up of
lactic acid) will gradually subside.
• However, you need to go to your nearest emergency room if you experience the
following after returning home from a stress test:

65. CONTI...
• Chest pressure, tightness, or pain that lasts for a few minutes or keeps returning
• Pain in your jaw, neck, back, shoulders, stomach, or one or both arms
• Trouble breathing
• Fatigue or weakness
• A sudden cold sweat, often accompanied by lightheadedness or dizziness
• Interpreting Results

66. CONTI...
• A few days after the test is performed, your healthcare provider will review the
results with you. The results are sometimes confusing to understand but are based on
an evaluation of the following factors:
• A basic interpretation of your ECG reading
• Changes in ECG during exercise (particularly the ST-segment)
• Blood pressure changes (especially severe hypotension)

67. CONTI...
• Symptoms reported during testing
• The development of arrhythmia during exercise
• The reasons for ending the test prematurely, if applicable
• Your estimated exercise capacity based on metabolic equivalents (METS)
• The combination of specific values and subjective interpretations will form the basis
of the diagnosis, classified as being either positive, negative, equivocal (ambiguous),
or inconclusive.

68. Follow-Up
• If the results of the test are normal (negative), meaning that the none of diagnostic
values are suggestive of CAD, you may require no further testing.
• If the results are abnormal (positive), meaning that there is evidence of CAD, your
healthcare provider will want to speak with you about treatment options.

69. CONTI...
• Depending on what the tests say, further testing may be recommended, including a
coronary angiogram to pinpoint the exact location of the blockage.
• However, if the results are normal or inconclusive but your cardiac symptoms persist,
your cardiologist may recommend a more sophisticated form of stress testing, such as
an echocardiogram stress test or a nuclear perfusion study, in which a radioactive
tracer is injected into your vein during exercise to locate the blockage using a
specialized camera.

70. Other Considerations
• It is important to remember that a cardiac stress test is open to interpretation and may
only suggest rather than confirm a CAD diagnosis.
• To this end, you should speak freely and openly with your healthcare provider if the
test results don’t make sense to you. This is especially true if you’re experiencing
cardiovascular symptoms, but the tests say you are fine.

71. CONTI....
• In the end, your symptoms may not be related to CAD but still warrant investigation.
• Also, do not hesitate to get a second opinion if you are not getting the answers you
need, or to ask your cardiologist to forward your records to another specialist.
• You can also request a copy of the results for yourself, which can usually be
delivered in a digital format.

72. A Word From Verywell
• A cardiac stress test is a valuable tool for diagnosis.
• Despite its limitations, it can offer important insights that may lead to the early
diagnosis and treatment of CAD and atherosclerosis.
• Moreover, it is a relatively affordable test to which you are neither exposed to
radiation nor chemicals.

73. CONTI...
• To better ensure test accuracy, always follow your healthcare provider's instructions
without exception.
• Moreover, try to find a dedicated cardiology practice with its own stress lab or a
hospital with a dedicated cardiology unit.
• Finally, never be afraid to ask questions about a prospective healthcare provider's
background and experience:
• it is your right to know. In the end, when it comes to cardiac stress testing, experience
and expertise do matter.