83yo Father/10y-post 4 CAB/Chest Pain/? Stress Test

Parents just moved to Jacksonville, Fl....Father who is 83, had 4-jump bypass, 10yrs ago, by Dr. Guyton in Atlanta...had chest pain 2 wks ago...relieved with nitro x1....has appt with Dr. Blackshear @ Mayo/Jax in Sept....so sister took him to another doc to see as he could not get in to see earlier at Mayo.

Dr. today ordered stress test on Monday.  I am CV nurse, question whether wise to do stress test on my Father.  Echo scheduled for Tuesday....and Halter monitor afterwards.  Gave Rx for Metoprolol to lower B/P of 140/90.....Father had 7 brothers die of heart disease and his Father @ age 35....

What are your thoughts????

Thanks...

Pam Battistella RN

[CCF HeartMD6]

Your father already has documented coronary artery disease with a 4-vessel bypass (if that is what 4-jumpt means).  Given his symptoms, it would not be unreasonable to obtain further data such as an echocardiogram (to evaluate his ejection fraction, wall motion, valves, etc) as well as a functional study to assess whether there is evidence of ischemia. A viability study might also be indicated at the time of his stress test to help evaluate whether or not there is any viable myocardium that would be worth revascularizing either by percutaneous intervention or by re-do bypass surgery. His grafts are 10-years old which puts them at risk for further disease in addition to progression of other disease in his native coronary system.

Reasons not to perform a stress test at this time would be if there is evidence of having an ongoing heart attack or ongoing chest pain.