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Table 121-1

Stress Testing Recommendations

SubgroupRecommended Study
Pt able to exercise
If baseline ST-T on ECG is normalStandard exercise test (treadmill, bicycle, or arm ergometry)
If baseline ST-T impairs test interpretation (e.g., LVH with strain, digoxin)

Standard exercise test (above) combined with either

Perfusion scintigraphy (thallium-201, 99mTc-sestamibi) or

Echocardiography
Pt not able to exercise (regardless of baseline ST-T abnormality)Pharmacologic stress test (IV dobutamine, dipyridamole, or adenosine) combined with imaging:
Perfusion scintigraphy [thallium 201, 99mTc-sestamibi, or PET (rubidium-82 or N-13 ammonia)] or
Echocardiography or
Cardiac MRI
LBBB on baseline ECGAdenosine (or dipyridamole) 99mTc-sestamibi or PET scintigraphy