Exercise Stress Test. Apiwan Nuttamonwarakul The Supreme Patriarch Center on Aging Ministry of Public Health. Objectives. Review essential Exercise Stress Test (EST) background, resources and terminology. Describe the performance of the EST.
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Exercise Stress Test
The Supreme Patriarch Center on Aging
Ministry of Public Health
(220 - Age)
Sinus Node Dysfunction
Drugs (e.g., B - blockers)
Hgb [ ]
Genetic Factors (Heart Size)
Conditioning Factors Contractility/Afterload/Preload
Wall Motion/Ventricular Fxn Valve Stenosis or Regurgitation
VO2max = (HRmax X SVmax) X (CaO2max - CvO2max)
Performance of the Exercise Stress Test
CAD Risk Factors
FH: MI in 1st degree male relative before 55; female before 65.
Smoker or quit within 6 months.
Hypercholesterolemia: TCHOL > 200; HDL <35; LDL > 130.
Impaired fasting glucose: >110.
Obesity: BMI >30.
HDL >60 is a negative risk factor.
Pain in the chest, neck, jaw, arms that may be due to ischemia
SOB at rest or exertion
Dizziness or syncope
Known heart murmur
Unusual fatigue or SOB with usual activities
12 lead ECG supine and standing.
BP supine and standing.
12 lead last 15 sec of each stage.
BP and RPE at the end of each stage.
12 lead ECG immediately after exercise, then every 1 to 2 minutes until return to baseline.
BP: immediately after exercise, then every 1 to 2 minutes until return to baseline.
Borg RPE Scale
7 Very, very light
9 Very light
11 Fairly light
13 Somewhat hard
17 Very hard
19 Very, very hard
Heart Rate Recovery and Treadmill Exercise Score as Predictors of Mortality in Patients Referred for Exercise ECG Nishime EO, et al: JAMA, September 20, 2000.Vo 284, No 11, 2000.
Diagnostic of Myocardial Ischemia
Horizontal or downsloping ST depression >1.0 mm at 60ms past the J point
ST elevation >1.0 mm at 60ms past the J point
Upsloping ST depression >1.5 at 80 ms past the J point
Negative for Myocardial Ischemia
Patient has exercised to atleast 85% of maximal predicted heart rate and none of the above are present.
Suggestive of Myocardial Ischemia
Horizontal or downsloping ST depression 0.5 – 1.0
ST elevation 0.5 – 1.0
Upsloping ST depression >.7 <1.5
Chest pain that seems like angina
High grade ventricular ectopy
A new third heart sound
Patient does not achieve 85% of maximum HR and has no ischemia.
Failure to reach an adequate workload
Insufficient number of leads
Single vessel disease
Good collateral circulation
Technical or observer error
Pre-existing abnormal ECG
WPW and other conduction abnormalities
Mitral valve prolapse
METs - 5 X [mm Exercise-Induced ST Depression] - 4 X [Treadmill Angina Index]
Duke Treadmill Score Nomogram
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