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Stress Testing Algorithm (from ED)

Stress Testing Algorithm (from ED) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Cardiovascular, Related


Discharge &
Follow-up with
PCP
Stress Test Ordered
(per Cardiology)
Consider coronary
revascularization.
Admit to CVM
Contraindications
to stress testing?
Patient able
to exercise?
No
Known CAD?
Yes
Perform Pharm Stress MPI
(AHA Class I, LOE B)
No
Resting ECG
interpretable?
No
Perform MPI with Exercise
(AHA Class I, LOE B)
Yes
Perform MPI with
Exercise
(AHA Class I, LOE B)
No
Review Test Result
Result:
High/Moderate risk
Result:
Low risk
References
1. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/
American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):e344-426.
2. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College
of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses
Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):e354-471.
UW Health Stress Testing (from ED) Algorithm
Last Revised: 04/2015
Contact CCKM for revisions.
UW Health Management of Non-ST Elevation Acute
Coronary Syndromes – Adult – Inpatient/Ambulatory
Clinical Practice Guideline
Consider CCTA
(AHA Class Iia, LOE C)
OR
Initiate Medical Therapy
Refer to UW Health Non-STE
ACS Medical Therapy
Algorithm
Yes
Use CAD Consortium 1 Risk Calculator
Low Pretest Probability (<20%):
Perform Standard Exercise ECG (AHA Class IIa, LOE C)
Intermediate/High Likelihood IHD (>20%):
Perform MPI with Exercise (AHA Class Iia, LOE B)
Yes
Note: Consider
Contraindications
for Stress Testing
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2015CCKM@uwhealth.org