Treadmill Stress Testing for the Primary Care Physician. Francis G. O’Connor, MD, FACSM Primary Care Sports Medicine. Objectives. Review essential Exercise Test Terminology Describe the Performance of the Exercise Stress Test Discuss Interpretation of the Exercise Stress Test
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Francis G. O’Connor, MD, FACSM
Primary Care Sports Medicine
(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)
ACSM. Lippincott, Williams & Wilkins
6th Edition 2000
Recent acute MI and Age
Dissecting aortic aneurysm
Severe aortic stenosis
Thrombophlebitis or intracardiac thrombi
Recent pulmonary embolus
Acute infectionContraindications to GXT Testing: Absolute
Uncontrolled severe hypertension and Age
Moderate aortic stenosis
Severe subaortic stenosis
Complex ventricular ectopy
Uncontrolled metabolic disease
Recurrent infectious disease
Complicated pregnancyContraindications to GXT Testing: Relative
The MET and AgeMETS
Nishime EO, et al: JAMA, September 20, 2000.
Vo 284, No 11, 2000.
Must Contain Following Elements:
ST Depression and at a grade of 2.5%.
→ or ↓ ≥ 1mm at 60msec
↑ ≥ 1.5mm at 80msec
≥ 1mm at 60msec
→ or ↓ 0.5 - 1mm at 60msec
↑ 0.7 - 1.5mm at 80msec
0.5 – 1mm at 60msecPositive vs Suggestive
Above criteria not met and pt exercised to at least 85% MPHR and at a grade of 2.5%.
Pt did not reach 85% MPHR, but no evidence of ischemia (B-Blocker??)Negative vs Inconclusive
METs - 5 X [mm E-I ST Depression] - 4 X [Treadmill Angina Index]
E-I = Exercise Induced
Duke Treadmill Score (uneven lines, elderly?) and at a grade of 2.5%.
954 patients - clinical/ETT reports
Sent to 44 expert cardiologists, 40 cardiologists and 30 internists
Scores did better than all three but was most similar to the experts
Low Risk and at a grade of 2.5%.
NecessaryACSM Recommendations for Medical Examination and Exercise Testing Prior to Participation
“Positive” Risk Factor: High serum HDL (>60)
“Positive” Risk Factor:
“Positive” Risk Factor:
Not and at a grade of 2.5%.
NecessaryWho Needs a GXT?
Chris and at a grade of 2.5%.