Holter monitoring is indicated if the likelyhood of arrhytmia causing a syncope is elevated. Monitoring devices should be choosen according to syncope frequency: Holter for daily symptoms, external loop recorder for weekly, and subcutaneous implantable device for...
In asymptomatic patients without risk factors, the likelihood of coronary heart disease is very low. The stress test increases risk of false positives and induces further diagnostic tests to rule out the doubts raised by the test.
Since during Holter monitoring the amount of stress could not be calibrated, sensitivity and specificity for detecting ischemia in patients with chest pain are low. In these conditions stress test is superior.
Since there are no RCT showing events’ reduction with tress test procedure after revascularization, stress test should only be performed to evaluate incomplete revascularizations or changes in clinical status.
Due to the slow evolution of mild to moderate valvular disease and the clinical uselessness of reevaluating left ventricular function in clinically stable patients, an echocardiogram is not recommended unless there is a change in clinical status.