Perception of chest pain during exercise testing in patients with coronary artery disease

Psychophysical scaling of symptoms or discomfort during exercise testing has evolved as an important adjunct to the study of therapeutic interventions in heart disease. One of the major shortcomings of clinical exercise testing, however, has been the assessment of chest pain. Although the presence and characteristics of chest pain have important diagnostic, prognostic, and therapeutic implications, few studies in the literature adequately address chest pain responses to exercise. Clinical trials using exercise as an efficacy parameter frequently use only a single descriptive testing endpoint, such as "moderate" angina. Methods of scaling chest pain during exercise testing are underutilized. Of the several grading systems that have been used, the 0-10 scale developed by Borg has been the most common. It is preferable for patients to relate chest pain sensations during exercise testing to those experienced during daily activities, and treadmill experience improves the reliability and reproducibility of patient responses. This paper examines the methodology and clinical applications of quantifying chest pain during exercise.