Majelle L. Gagtan

DefinitionIndications/

ContraindicationsRunning the Exercise TestProtocols

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

Patients with s/sx suggestive of CADPatients with significant risk factors for CADTo evaluate exercise tolerance in patients with

unexplained fatigue and shortness of breathTo evaluate BP response to exercise in patients

with borderline hypertensionTo look for exercise-induced serious irregular

heart beats

Recent acute MIUnstable anginaVentricular

tachycardiaDissecting aortic

aneurysmAcute CHF

Severe aortic stenosisActive myocarditisThrombophlebitis or

intracardiac thrombiRecent pulmonary

embolusAcute infection

Uncontrolled severe hypertension

Moderate aortic stenosisSevere subaortic stenosisSupraventricular

dysrhythmiasVentricular aneurysm

Complex ventricular ectopyCardiomyopathyUncontrolled metabolic

diseaseRecurrent infectious

diseaseComplicated pregnancy

HR and BP are recorded at rest12L ECG is recordedStart 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 minuteStopped 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 Protocol2 3-min warm-up stages at 1.7mph and 0% grade

and 1.7mph and 5% gradeFor 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

ST Depression → or ↓ ≥ 1mm at

60msec↑ ≥ 1.5mm at

80msec

ST Elevation≥ 1mm at 60msec

No changeST depression doesn’t

fulfill no.2T wave inversion w/o ST

segment changesST elevatoin in a Q

wave lead

Dyspnea, fatigue, chest painSystolic blood pressure dropTechnical difficulties ECG--ST changes, arrhythmiasSigns of poor perfusion (cyanosis/pallor)Px’s desire to stopAchievement of maximal exercise