Unless high-risk markers are present, such as diabetes in patients aged over 40, peripheral arterial disease; or a risk of coronary heart disease greater than 2 percent yearly, most health societies do not recommend the test as a routine procedure.Absolute contraindications to cardiac stress test include:

Acute myocardial infarction within 48 hours
Unstable angina not yet stabilized with medical therapy
Uncontrolled cardiac arrhythmia, which may have significant hemodynamic responses (e.g. ventricular tachycardia)
Severe symptomatic aortic stenosis, aortic dissection, pulmonary embolism, and pericarditis
Multivessel coronary artery diseases that have a high risk of producing an acute myocardial infarction
Decompensated or inadequately controlled congestive heart failure
Uncontrolled hypertension (blood pressure>200/110mm Hg)
Severe pulmonary hypertension
Acute aortic dissection
Acutely ill for any reasonIndications for termination:
A cardiac stress test should be terminated before completion under the following circumstances:Absolute indications for termination include:

Systolic blood pressure decreases by more than 10 mmHg with increase in work rate, or drops below baseline in the same position, with other evidence of ischemia. Increase in nervous system symptoms: Dizziness, ataxia or near syncope
Moderate to severe anginal pain (above 3 on standard 4-point scale)
Signs of poor perfusion, e.g. cyanosis or pallor
Request of the test subject
Technical difficulties (e.g. difficulties in measuring blood pressure or EGC)
ST Segment elevation of more than 1 mm in aVR, V1 or non-Q wave leads
Sustained ventricular tachycardiaRelative indications for termination include:

Systolic blood pressure decreases by more than 10 mmHg with increase in work rate, or drops below baseline in the same position, without other evidence of ischemia. ST or QRS segment changes, e.g.
more than 2 mm horizontal or downsloping ST segment depression in non-Q wave leads, or marked axis shift
Arrhythmias other than sustained ventricular tachycardia e.g. Premature ventricular contractions, both multifocal or triplet; heart block; supraventricular tachycardia or bradyarrhythmias
Intraventricular conduction delay or bundle branch block or that cannot be distinguished from ventricular tachycardia
Increasing chest pain
Fatigue, shortness of breath, wheezing, claudication or leg cramps
Hypertensive response (systolic blood pressure > 250 mmHg or diastolic blood pressure > 115 mmHg)

Adverse effects
Side effects from cardiac stress testing may include
Palpitations, chest pain, myocardial infarction, shortness of breath, headache, nausea or fatigue. Adenosine and dipyridamole can cause mild hypotension. As the tracers used for this test are carcinogenic, frequent use of these tests carries a small risk of cancer. Pharmacological agents
Pharmacologic stress testing relies on coronary steal. Vasodilators are used to dilate coronary vessels, which causes increased blood velocity and flow rate in normal vessels and less of a response in stenotic vessels. This difference in response leads to a steal of flow and perfusion defects appear in cardiac nuclear scans or as ST-segment changes.The choice of pharmacologic stress agents used in the test depends on factors such as potential drug interactions with other treatments and concomitant diseases. Pharmacologic agents such as adenosine, Lexiscan (regadenoson), or dipyridamole is generally used when a patient cannot achieve adequate work level with treadmill exercise, or has poorly controlled hypertension or left bundle branch block.