The exercise treadmill test for diagnosis and prognosis of coronary artery disease

After more than 50 years of refinement, the exercise test remains a useful device for diagnosis and prognosis of coronary artery disease. In addition, it is within the range of skills of primary care physicians. Understanding that the exercise test is not a noninvasive angiogram, and that angiography primarily defines anatomy, emphasizes the complementary nature of the tests. The addition of thallium scintigraphy to the exercise test brings enhanced sensitivity and specificity in certain clinical settings. The use of exercise testing with or without thallium scintigraphy is not currently recommended for evaluation of dysrhythmias, pre-operative clearance, or screening of asymptomatic individuals.