ACC/AHA Guidelines for Exercise Testing. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee on Exercise Testing).

The American College of Cardiology/American Heart Association Task Force on Practice Guidelines was formed to make recommendations regarding the appropriate use of testing in the diagnosis and treatment of patients with known or suspected cardiovascular disease. Exercise testing is widely available and relatively low in cost. For the purposes of these guidelines, exercise testing is a cardiovascular stress test using treadmill or bicycle exercise and electrocardiographic and blood pressure monitoring. Pharmacological stress testing and imaging modalities (radionuclide imaging, echocardiography) are beyond the scope of these guidelines. These guidelines have been endorsed by the American College of Sports Medicine, the American Society of Echocardiography, and the American Society of Nuclear Cardiology. This executive summary appears in the July 1, 1997, issue of Circulation. The guidelines in their entirety are published in the July 1997 issue of the Journal of the American College of Cardiology. Reprints of both the executive summary and the full text are available from both organizations. Exercise testing is a well-established procedure that has been in widespread clinical use for many decades. It is described in detail in previous publications of the AHA, to which interested readers are referred. Although exercise testing is generally a safe procedure, both myocardial infarction and death have been reported and can be expected to occur at a rate of up to 1 per 2500 tests. Good clinical judgment should therefore be used in deciding which patients should undergo exercise testing. Absolute and relative contraindications to exercise testing are summarized in Table 1⇓. View this table: Table 1. Contraindications to Exercise Testing The vast majority of treadmill exercise testing is performed in adults with symptoms of known or suspected ischemic heart disease. Special groups who are exceptions to this norm are discussed in detail in sections VI and VII. Sections II through IV illustrate the variety …