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Exercise Stress Testing
Exercise Stress Testing
INDICATIONS
• Detection of CAD
• Exercise prescription
• Always begin by assessing the patients probability of having IHD: Bayesian approach
• Probability that the test will reveal disease depends on the patients risk of actually having the
disease: Pre-test probability
- Identify patients with very low probability and very high probability of the disease.
CONTRAINDICATIONS
Absolute Contraindiactions
• Pulmonary embolism in acute phase
• Aortic dissection
• Severe aortic stenosis
• Acute MI within 48 hours
• Endocarditis
• Unstable angina
• DVT
• Presence of potentially serious arrhythmias
• All personnel's must be appropriately trained and laboratory must be equipped with defibrillators
and other emergency instruments
• Most recently recorded 12 lead ECG should be at hand before start of exercise
• Physical examination and anamnesis must be obtained before the start of the exercise
• In some circumstances it is necessary to with hold cardio-active medications during exercise test
• Treadmill and cycle ergometer are most frequently used test methods
Treadmill Training
• Cycle ergometer is cheaper than treadmill and it requires less space in laboratory
- Symptoms
- Exercise Performance
- Heart Rate
- BP reaction
- ECG reaction
- Cause of termination
Symptoms
• Perceived exertion
• Chest pain
• Dyspnea
• Leg fatigue
Exercise Performance
• Best Predictor for risk for future adverse events in healthy individuals
• Estimated using HR, Rate Pressure Product, Duration of the test, RPE
HR response
ECG reaction
- Ventricular Tachycardia
Absolute
• Dizziness, pre-syncope
• Cyanosis, Paleness
Relative
• Leg cramps
• Bradycardia
Recovery Period
• Duration : 6-8mins
• Test is completed when all parameters have returned to their baseline values.