Graded Exercise

StressTesting

Abeer Saeed Alqahtani

439804339
 Definition

Exercise testing is a noninvasive tool to

evaluate the cardiovascular system’s response
to exercise under carefully controlled
conditions.
 Indicationsofexercisetesting

To evaluate specific symptoms or signs induced by exercise

To assess the effectiveness of medical or surgical
interventions
Shortness of breath on exertion
Determination of functional capacity
Exercise-induced asthma
Maximum oxygen consumption studies
Evaluation of patients with cardiovascular disease
Evaluation of patients with respiratory disease
 Contraindicationofexercisetesting

Absolute contradiction
Acute myocardial infarction (MI), within 2 days
• Ongoing unstable angina
• Uncontrolled cardiac arrhythmia with hemodynamic compromise
• Active endocarditis
• Symptomatic severe aortic stenosis
• Decompensated heart failure
• Acute pulmonary embolism, pulmonary infarction, or deep vein thrombosis
• Acute myocarditis or pericarditis
• Acute aortic dissection
• Physical disability that precludes safe and adequate testing
 Relative Contraindication
• Known obstructive left main coronary artery stenosis
• Moderate to severe aortic stenosis with uncertain relation to
symptoms
• Tachyarrhythmias with uncontrolled ventricular rates
• Acquired advanced or complete heart block
• Hypertrophic obstructive cardiomyopathy with severe resting
gradient
• Recent stroke or transient ischemic attack
• Mental impairment with limited ability to cooperate
• Resting hypertension with systolic or diastolic blood pressures
>200/110 mm Hg
• Uncorrected medical conditions, such as significant anemia,
important electrolyte imbalance, and hyperthyroidism
 Differenttreadmillstresstestprotocols

01.Bruce protocol
• The Bruce Test is commonly used treadmill exercise stress test.
• It was developed as a clinical test to evaluate patient with suspected CHD ,though it can as
be used to estimate cardiovascular fitness.
• This is the most commonly used test on heart problem patients, in supervision of
appropriately trained medical staff.
• AIMS: To evaluate cardiac function and fitness.
• Equipments required: treadmill, stopwatch, 12 leads ECG machine, sticking tape, clips.
• Procedure:
• Exercise is performed on a treadmill
• Leads of ECG are placed on chest wall • The treadmill starts at a speed of 2.74 km/hr and at
gradient of 10%
• At every three minutes of interval the inclination of treadmill is increased by 2% and
speed also increased
• The test to be stopped when the subject cannot continue due fatigue or pain, or due to
many other medical indications.
 02.Modified bruce protocol
• There is commonly used modified Bruce protocol,
which starts at a lower workload than the standard
test, and is typically used for elderly or sedentary
patients.
• First two stages of modified Bruce test are
performed at a 1.7mph and 0% grade and 1.7mph and
5% grade ,
• And the third stage corresponds to the first stage of
the standard Bruce test protocol as listed above.
 03. Naughton protocol
• The naughton method used for measuring coronary health of
subject. • As the subject walks on the traedmill,ECG sensors are
attached to his chest to measure the heart electrical activity.
• IDENTIFICATION: This is a submaximal exercise test
designed to keep you in a heart rate zone that is lower than
your maximal heart rate. Your HR gradually increases
throughout the test with an endpoit target zone that is 80-90%
of your maximum HR.
• FUNCTION: This is conform rhythm abnormalities and other
heart condition,such as ischemia.
 IndicationsforTerminationofExerciseTesting

Absolute Indications
• ST-segment elevation (>1.0 mm) in leads without preexisting Q waves because of prior MI (other than
aVR, aVL, and V1)
• Drop in systolic blood pressure >10 mm Hg, despite an increase in workload, when accompanied by
any other evidence of ischemia
• Moderate-to-severe angina
• Central nervous system symptoms (eg, ataxia, dizziness, near syncope)
• Signs of poor perfusion (cyanosis or pallor)
• Sustained ventricular tachycardia (VT) or other arrhythmia, including second- or third-degree
atrioventricular (AV) block, that interferes with normal maintenance of cardiac output during exercise
• Technical difficulties in monitoring the ECG or systolic blood pressure
• The subject’s request to stop
 Relative indication
• Marked ST displacement (horizontal or downsloping of >2 mm, measured 60 to 80 ms after the J
point [the end of the QRS complex]) in a patient with suspected ischemia
• Drop in systolic blood pressure >10 mm Hg (persistently below baseline) despite an increase in
workload, in the absence of other evidence of ischemia
• Increasing chest pain
• Fatigue, shortness of breath, wheezing, leg cramps, or claudication
• Arrhythmias other than sustained VT, including multifocal ectopy, ventricular triplets,
supraventricular tachycardia, and bradyarrhythmias that have the potential to become more
complex or to interfere with hemodynamic stability
• Exaggerated hypertensive response (systolic blood pressure >250 mm Hg or diastolic blood
pressure >115 mm Hg)
• Development of bundle-branch block that cannot immediately be distinguished from VT
Thank you