Professional Documents
Culture Documents
• Vagal withdrawl-increased HR
• Symp activation-increased venous return
• -increased ventilation
• -increased HR
• Increase in CO, BP
MET Values
13 METs = Excellent prognosis, regardless of
other exercise responses
16 METs = Aerobic master athlete
20 METs = Aerobic athlete
Calculation of METs on the Treadmill
Chest discomfort
Chest discomfort usually occurs after the onset of ST segment
abnormality
1.Sensitivity in patients with CAD is 68% and specificity is
77%
2.In SVD -- sensitivity is 25-71%
3.In multivessel CAD-- sensitivity is 81%, specificity is 66%
4.Left main or 3vd -- sensitivity is 86%, specificity is 53%
Asymptomatic population
Prevalence of abnormal TMT in asymptomatic middle
aged men ranges from 5-12%.
Appropriate asymptomatic subjects would be those with an
estimated annual risk greater than 1 or 2% per year.
Symptomatic patients
Exercise should be routinely performed in patients with
chronic ischemic heart disease before CAG.
Patients who have excellent effort tolerance (>10 METS)
have excellent prognosis regardless of anatomical
extent of CAD.
Salient myocardial ischemia
In patients with documented CAD, exercised induced ST
segment depression confers increased risk of subsequent
cardiac events
Acute coronary syndrome
Incidence of angina or ST segment abnormalities in these
patients ranges from 30-40%.
Diabetes mellitus
In patients with autonomic dysfunction and sensory
neuropathy anginal threshold is increased and abnormal heart
rate and BP response is common
Probability of adverse cardiac outcome is increased
Valvular heart disease
Exercise test can provide information on timing of operative
intervention and to estimate degree of incapacitation
Hypotension during test in asymptomatic patients with AS is
sufficient to consider for valve replacement.
In patients with MS, excessive HR response to relatively low
levels of exercise, reduction of cardiac output, and chest pain
are indicators that favour earlier valve repair.
In MVP without regurgitation at rest, exercise induced MR is
associated with subsequent development of progressive MR.