Patients with new onset dyspnea or symptoms of angina should be evaluated by which test?

• A. Echocardiography at rest
• B. Chest X-ray
• C. Stress test
• D. Pulmonary function test

Answer: (C)

Testing for myocardial ischemia under stress best evaluates new dyspnea or anginal symptoms. A stress test pushes the heart to work harder, and if coronary arteries are narrowed, ischemia appears as exercise-induced chest pain, ECG changes, or abnormal imaging findings such as wall-motion abnormalities. This makes it the most informative initial test for suspected coronary artery disease and helps with diagnosis and risk stratification.

Chest X-ray and pulmonary function tests assess lungs and chest structure but don’t reveal inducible myocardial ischemia. Resting echocardiography shows anatomy and function at baseline, not the heart’s response to increased demand. Therefore, they don’t directly test for ischemia like a stress test does. If the patient cannot exercise, pharmacologic stress testing with imaging provides the same diagnostic information.