Stress testing in the elderly

The ever-increasing number of older patients requiring diagnostic and prognostic assessment for coronary artery disease has necessitated accurate, noninvasive techniques applicable to this age group. Exercise testing, either alone or with radionuclide or echocardiographic imaging, remains a useful tool in elderly patients capable of performing vigorous treadmill or cycle exercise. Fortunately, for the large elderly subset incapable of such exercise, pharmacologic stress testing with dipyridamole, adenosine, or dobutamine offers an excellent alternative. Choosing the most appropriate stress testing modality for a given patient from among the many choices available remains the clinician's challenge.