Learn
Short, practical lessons on the tests used to look for ischemic heart disease: what each one shows, where it falls short, how to think about choosing, and why the contraindications are what they are. Written for internal medicine and primary care clinicians, cardiology fellows, NPs and PAs. Each lesson starts with a 60-second take, with optional depth underneath.
Learn explains the ideas. For a specific patient, use the scenario builder, which shows how each test is rated in the published appropriate use criteria, with the reasons. Every claim here is cited, and every citation opens a card listed on the References page.
Part 1. Foundations
What stress testing is trying to answer, and how each stressor works.
The big picture
Why the clinical question comes before the test, and how anatomy and function differ.
4 min read
How stress testing works
Supply and demand, flow reserve, the ischemic cascade, and what positive and negative results do and do not mean.
4 min read
The stressors: exercise, vasodilators and dobutamine
How exercise, vasodilators and dobutamine provoke or reveal ischemia, and what makes an exercise test adequate.
5 min read
Part 2. The tests
One short chapter per test: what it shows, its strengths and weaknesses.
Exercise ECG (treadmill test)
What a treadmill test with ECG monitoring tells you, how to read capacity and the Duke score, and when the resting ECG rules it out.
5 min read
Stress echocardiography
How stress echo compares wall motion at rest and stress, the exercise and dobutamine options, contrast, and the limits of image quality and operator skill.
5 min read
Stress SPECT myocardial perfusion imaging
How SPECT shows relative blood flow at stress and rest, how to read reversible and fixed defects, and why balanced ischemia and attenuation matter.
5 min read
PET myocardial perfusion imaging and blood flow
What PET adds to perfusion imaging: image quality, absolute myocardial blood flow and flow reserve, lower radiation, and the limits of availability and exercise.
5 min read
Stress cardiac MRI
Stress perfusion or dobutamine wall motion plus scar imaging, with no radiation but real gadolinium and device questions.
5 min read
Coronary artery calcium score
A quick non-contrast CT that measures calcified plaque, not ischemia, and what a score of zero or a high score can and cannot tell you.
4 min read
Coronary CT angiography and CT-derived FFR
CT pictures of the coronary arteries, reported with CAD-RADS, plus what CT-FFR adds and the 2026 consensus on when to use it.
5 min read
Invasive coronary angiography and physiology
What angiography, FFR and iFR show, how the guidelines place it after noninvasive testing, and why a normal angiogram does not rule out microvascular disease.
5 min read
Part 3. Choosing
How the tests compare, and how to think about choosing one.
Side by side: comparing the tests
An interactive, cited comparison of what eight tests show, what they need and where they are limited.
4 min read
How to think about choosing a test
The patient-level questions that shape a choice, and why the same test is rated differently in different scenarios.
5 min read
Reading the ratings
What Appropriate, May Be Appropriate and Rarely Appropriate mean, and what the tool's other labels and confidence grades tell you.
5 min read
Testing before noncardiac surgery
The logic of the 2024 AUC for nonemergent noncardiac surgery: heart disease, symptoms, functional capacity and surgical risk.
4 min read
Part 4. Safety
Why the contraindications are what they are, and how to prepare the patient.
Why the contraindications are what they are
Contraindications grouped by mechanism, so you can reason about conditions you have not memorised.
5 min read
Preparing the patient
Caffeine, fasting, medicines, clothing, what the stressor feels like and what happens afterwards, as the guidelines state them.
5 min read
Part 5. Special situations
Populations and clinical settings where the choice changes.
Body habitus, sex and the choice of test
What the sources say about obesity, breast tissue and sex for image quality, radiation and test choice.
4 min read
Kidney disease and contrast
Iodinated and gadolinium contrast in reduced kidney function, which tests avoid contrast, and the one number the sources give.
4 min read
After PCI or CABG, and repeat testing
How the criteria treat symptomatic and asymptomatic patients after a stent or bypass, CCTA limits, and the warranty period of a normal test.
5 min read
Heart failure, arrhythmia and syncope
Why the AUC rates testing in patients with heart failure, arrhythmias, syncope or a transplant, and what the testing is meant to answer.
5 min read