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Provocative Testing

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Short Stay Management of Chest Pain

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Most patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome (ACS) have a benign condition. However, management of this population remains a major challenge. An important contemporary approach to this problem has been the development of chest pain units (CPU) in which low-risk patients are managed by accelerated diagnostic protocols. If the initial evaluation is nondiagnostic, patients receive provocative testing and the safety of stress testing in this context has been well established. Negative provocative testing allows direct discharge with outpatient follow-up, while a positive test results in admission for further evaluation. The most frequently applied test is treadmill electrocardiography but stress (exercise or pharmacologic) myocardial perfusion imaging or stress echocardiography is also utilized in many institutions. Test selection depends on physician and institutional preference, the patient’s ability to exercise, and interpretability of the electrocardiogram. Each method of provocative testing has advantages and limitations in terms of logistics, complexity, cost, ease of interpretation, and accuracy. However, each has clearly demonstrated its utility in contributing to safe, accurate, and efficient assessment of low-risk patients with possible ACS.

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Authors and Affiliations

  1. Department of Emergency Medicine, University of California, Davis, Medical Center, 4150 V Street, PSSB Suite 2100, Sacramento, CA 95817, USA

    J. Douglas Kirk

  2. Departments of Internal Medicine (Cardiology), Emergency Medicine, and Radiology, Virginia Commonwealth University, Richmond, VA, USA

    MD Michael C. Kontos

  3. Department of Internal Medicine (Cardiology), University of California, Davis, Medical Center, Sacramento, CA, USA

    MD Ezra A. Amsterdam

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  1. J. Douglas Kirk
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    Kirk, J.D., Kontos, M.C., Amsterdam, E.A. (2009). Provocative Testing. In: Cannon, C., Peacock, W. (eds) Short Stay Management of Chest Pain. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-60327-948-2_12

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