In 2013, in its "Exercise Standards for Testing and Training", the AHA indicated that high frequency QRS analysis during ECG treadmill test have useful test performance for detection of coronary heart disease. Perfusion stress test (with 99mTc labelled sestamibi) is appropriate for select patients, especially those with an abnormal resting electrocardiogram. Intracoronary ultrasound or angiogram can provide more information at the risk of complications associated with cardiac catheterization. Diagnostic value
The common approach for stress testing by American College of Cardiology and American Heart Association indicates the following:
Treadmill test: sensitivity 73-90%, specificity 50-74% (modified Bruce protocol)
Nuclear test: sensitivity 81%, specificity 85-95%(Sensitivity is the percentage of people with the condition who are correctly identified by the test as having the condition; specificity is the percentage of people without the condition are correctly identified by the test as not having the condition). To arrive at the patients posttest likelihood of disease, interpretation of the stress test result requires integration of the patients pretest likelihood with the tests sensitivity and specificity. This approach, first described by Diamond and Forrester in the 1970s, results in an estimate of the patients post-test likelihood of disease. The value of stress tests has always been recognized as limited in assessing heart disease such as atherosclerosis, a condition which mainly produces wall thickening and enlargement of the arteries.
In contrast, in 1993, the 
Eleventh Circuit Court of Appeals upheld the Atlanta fire departments "no-beard" policy because it was justified by a "business necessity", in that case the fact that even short beards interfered with firefighters use of self-contained breathing apparatus. See also
Laser hair removal
List of cutaneous conditions

References


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