Exercise testing for the primary care physician

In the primary care setting, exercise testing is frequently used to evaluate patients with known or suspected coronary artery disease. Appropriate utilization requires knowledge of the indications as well as the contraindications and interpretation of the variables generated by the test. While ST segment changes are widely regarded as the most important variable generated by the exercise test, other variables including ventricular arrhythmias, blood pressure response, ischemic symptoms, workload, and exercise capacity are also important and useful in interpretation. Consideration of the question being addressed, the clinical context, and the test adequacy are all important for proper interpretation. Interpretation concerning both diagnostic and prognostic questions should employ principles of both the categorical and probability approaches.