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Treadmill Stress Test. Majelle L. Gagtan. Performance of the Exercise Stress Test. Definition Indications/Contraindications Running the Exercise Test Protocols. Treadmill Stress Test.

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treadmill stress test

Treadmill Stress Test

Majelle L. Gagtan

performance of the exercise stress test
Performance of the Exercise Stress Test
  • Definition
  • Indications/Contraindications
  • Running the Exercise Test
  • Protocols
treadmill stress test1
Treadmill Stress Test
  • Non-invasive procedure providing information about changes in rate, rhythm, conductionn and ventricular repolarization as the heart responds to exertion
  • Exposes the heart to the stress of exercise thus unmasking s/sx of heart disease, and the ECG may produce characteristic abnormalities
indications for exercise testing
Indications for Exercise Testing
  • Patients with s/sx suggestive of CAD
  • Patients with significant risk factors for CAD
  • To evaluate exercise tolerance in patients with unexplained fatigue and shortness of breath
  • To evaluate BP response to exercise in patients with borderline hypertension
  • To look for exercise-induced serious irregular heart beats
absolute contraindications to exercise setting
Absolute Contraindications to Exercise Setting:
  • Recent acute MI
  • Unstable angina
  • Ventricular tachycardia
  • Dissecting aortic aneurysm
  • Acute CHF
  • Severe aortic stenosis
  • Active myocarditis
  • Thrombophlebitis or intracardiac thrombi
  • Recent pulmonary embolus
  • Acute infection
relative contraindications to exercise setting
Relative Contraindications to Exercise Setting:
  • Uncontrolled severe hypertension
  • Moderate aortic stenosis
  • Severe subaortic stenosis
  • Supraventricular dysrhythmias
  • Ventricular aneurysm
  • Complex ventricular ectopy
  • Cardiomyopathy
  • Uncontrolled metabolic disease
  • Recurrent infectious disease
  • Complicated pregnancy
running the stress test
Running the Stress test
  • HR and BP are recorded at rest
  • 12L ECG is recorded
  • Start at a relatively slow “warm up” speed then its speed and inclination are increased every 3 mins. according to a preprogrammed protocol
  • BP is recorded every minute
  • Stopped when the patient achieves target HR, or if he develops chest discomfort, dyspnea, dizziness etc., or if the ECG showed significant changes
  • It may also be stopped if BP rises or falls beyond acceptable limits
  • Maximum HR = 220 – age of patient

BRUCE Protocol

  • multi stage maximal treadmill protocol with 3-min periods to allow achievement of steady state before workload is increased

Modified BRUCE Protocol

  • 2 3-min warm-up stages at 1.7mph and 0% grade and 1.7mph and 5% grade
  • For older individuals or those with exercise capacity is limited by cardiac disease

Naughton and Weber protocols

  • 1 2-min stages with 1 MET increments between stages
  • More suitable for patients with limited exercise tolerance

Asymptomatic Cardiac Ishemia Pilot Trial (ACIP) and modified ACIP protocols

  • For pxs with established CAD
  • Results in linear increase in HR and VO2
  • Modified ACIP – similar aerobic demand; well suited for short or elderly who can’t keep up with a walking speed of 3mph
positive negative
Positive Negative
  • ST Depression
    • → or ↓ ≥ 1mm at 60msec
    • ↑ ≥ 1.5mm at 80msec
  • ST Elevation
    • ≥ 1mm at 60msec
  • No change
  • ST depression doesn’t fulfill no.2
  • T wave inversion w/o ST segment changes
  • ST elevatoin in a Q wave lead
when to stop
When to stop!

Dyspnea, fatigue, chest pain

Systolic blood pressure drop

Technical difficulties

ECG--ST changes, arrhythmias

Signs of poor perfusion (cyanosis/pallor)

Px’s desire to stop

Achievement of maximal exercise