Q: When considering exercise stress testing for risk stratification in your patients with symptoms suggestive of CAD,be sure to listen for a systolic ejection murmur in the aortic area. Such a murmur is indicative of hemodynamically significant aortic stenosis, which is an absolute contraindication to exercise stress testing. As an alternative, consider ordering an adenosine Myoview scan, or refer the patient directly to a cardiologist.
—Todd Christie, PA-C, MPAS, Centerville, Ohio

A: A systolic ejection murmur does not indicate hemodynamically significant aortic stenosis, but a late peaking systolic murmur in the aortic area radiating to the neck does. Although this latter finding is not an absolute contraindication in the asymptomatic patient, it would warrant consultation with a cardiologist prior to stress testing.
—Norma M. Keller, MD (98-19)