majelle l. gagtan. definition indications/contraindications running the exercise test protocols
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Majelle L. Gagtan
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DefinitionIndications/
ContraindicationsRunning the Exercise TestProtocols
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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
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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
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Recent acute MIUnstable anginaVentricular
tachycardiaDissecting aortic
aneurysmAcute CHF
Severe aortic stenosisActive myocarditisThrombophlebitis or
intracardiac thrombiRecent pulmonary
embolusAcute infection
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Uncontrolled severe hypertension
Moderate aortic stenosisSevere subaortic stenosisSupraventricular
dysrhythmiasVentricular aneurysm
Complex ventricular ectopyCardiomyopathyUncontrolled metabolic
diseaseRecurrent infectious
diseaseComplicated pregnancy
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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
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BRUCE Protocol multi stage maximal treadmill protocol with 3-min
periods to allow achievement of steady state before workload is increased
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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
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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
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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
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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