Which test is commonly used to assess ischemia in suspected unstable angina?

• A. Coronary angiography
• B. Exercise stress test / Nuclear Stress Test
• C. Echocardiography at rest
• D. Holter monitoring

Answer: (B)

Ischemia is best detected by showing how the heart handles increased demand. After initial stabilization in suspected unstable angina, a noninvasive stress test with imaging evaluates for inducible ischemia. An exercise treadmill test with nuclear perfusion imaging measures blood flow to the heart muscle during exercise; areas with reduced perfusion indicate ischemia from underlying coronary obstruction. Nuclear imaging improves sensitivity by separately assessing perfusion, not just electrical activity. This test helps risk-stratify patients and decide between medical therapy or further invasive evaluation. Resting echocardiography can show wall-motion abnormalities but does not assess ischemia under stress, coronary angiography reveals anatomy without functional ischemia, and Holter monitoring detects arrhythmias rather than ischemia.