5.2.0.0 Car­diac Test­ing

Can­di­dates for ad­vanced or in­va­sive car­diac test­ing in­clude those with 1) typ­i­cal or atyp­i­cal car­diac symp­toms and 2) an ab­nor­mal rest­ing elec­tro­car­dio­gram (ECG). Ex­er­cise ECG test­ing with­out or with echocar­dio­g­ra­phy may be used as the ini­tial test. In adults with di­a­betes ≥40 years of age, mea­sure­ment of coro­nary artery cal­ci­um is also rea­son­able for car­dio­vas­cu­lar risk as­sess­ment. Phar­ma­co­log­ic stress echocar­dio­g­ra­phy or nu­cle­ar imag­ing should be con­sid­ered in in­di­vid­u­als with di­a­betes in whom rest­ing ECG ab­nor­malities pre­clude ex­er­cise stress test­ing (e.g., left bun­dle branch block or ST-T ab­nor­malities). In ad­di­tion, in­di­vid­u­als who re­quire stress test­ing and are un­able to ex­er­cise should un­der­go phar­ma­co­log­ic stress echocar­dio­g­ra­phy or nu­cle­ar imag­ing.