Assessment of chest pain in a low risk patient: is the exercise tolerance test obsolete?

The coronary artery calcium score has high sensitivity for detecting coronary stenosis—so a negative result makes significant coronary stenosis unlikely—but low specificity, and 60% of those without coronary artery disease will also have a positive result

 

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Thus many low risk patients may be diagnosed with coronary artery disease using the calcium score, although they may have clinically insignificant or “bystander” disease. These patients may benefit little from investigation and treatment and may be harmed

 

The exercise tolerance test is a quick, functional investigation that measures maximum exercise tolerance. In low risk patients who are likely to achieve a high workload the test can identify patients with high relative survival without the need for further imaging

BMJ Learning latest modules

Scenario from BMJ Learning – what would you do?

A 6 week old baby is examined at his baby check. His legs appear to be the same length but he has asymmetrical leg creases. You perform Ortolani’s test and feel a clunk. What is likely to be going on? If you are not sure, then this module should help. Click on the link to complete it today:

How to do the infant physical examination at 6-8 weeks (baby check)

And here are our most popular modules in emergency medicine for you to complete:

Chest pain of recent origin – assessment and diagnosis: in association with NICE

Early management of adults with an uncomplicated first generalised seizure

Epilepsy – in association with NICE

Latest learning modules from BMJ Learning

 

 

 

 

BMJ Learning set this scenario:

You see a 40 year old woman with a two day history of left knee pain. She is unable to stand on the left leg due to this. Her knee is warm, swollen, and tender on examination. What is the most likely diagnosis? And what would you do? If you would like to learn more about this topic, then click on the link to complete this module today.

Knee pain in rheumatology

Additional emergency medicine for you to complete. They give an important update on a range of common dilemmas. 

Chest pain of recent origin – assessment and diagnosis: in association with NICE

Early management of adults with an uncomplicated first generalised seizure 

Epilepsy – in association with NICE

New modules from BMJ Learning

Some emergency medicine modules are now available for you to complete. They give an important update on a range of common dilemmas.