![]() ![]() The heart rate and BP should be recorded at least every 3 minutes during exercise, at peak exercise, and for at least 4 minutes into the recovery phase. In addition, in case of abnormalities (e.g., arrhythmias, etc.) a 12-lead electrocardiogram should be obtained. A 12-lead electrocardiogram should be (automatically) obtained at every stage of exercise, at peak exercise, and at the termination of recovery phase. In addition, the resting heart rate should return to close to baseline and exercise-induced ST-segment changes and symptoms should resolve. The electrocardiogram should be monitored continuously during the exercise test and for at least 4 minutes into the recovery phase. Regularly taken medication should be recorded prior to testing.Īn intravenous (IV) cannula (larger size than 24-gauge is preferred) should be inserted for radiopharmaceutical injection. 8 Generally, discontinuation of these medicines is left to the discretion of the referring physician. ![]() ![]() If possible, insulin-dependent diabetics should be scheduled for the morning hours.īP medication(s) with antianginal properties (β-blocker, calcium channel blocker, and nitrates) will lower a stress test’s diagnostic utility. Caffeine should be avoided for at least 12 hours similar to vasodilatory stress testing because exercise stress tests, at times, need to be converted to a pharmacologic stress test. Patients scheduled for later in the morning or afternoon may have a light breakfast (e.g., cereal, fruit). ![]() Patient preparation: nothing should be eaten at least 3 hours before the test. Also, for a meaningful test evaluation, exercise should last at least 4 to 6 minutes. These patients should be considered for pharmacologic stress testing with myocardial perfusion imaging. If combined with imaging, patients with complete left bundle branch block (LBBB), permanent pacemakers, and ventricular pre-excitation should preferentially undergo pharmacologic vasodilator stress test (not a dobutamine stress test).Įxercise stress testing has a lower diagnostic value in patients who cannot achieve an adequate heart rate and BP response due to a noncardiac physical limitation, such as pulmonary, peripheral vascular or musculoskeletal abnormalities, or due to lack of motivation. Mental or physical impairment leading to inability to exercise adequately. Significant tachyarrhythmias or bradyarrhythmias. Hypertrophic obstructive cardiomyopathy or other forms of severe left ventricular outflow tract obstruction. Known significant left main coronary artery stenosis. Relative contraindications for exercise stress testing include the following: Uncontrolled cardiac arrhythmias (causing symptoms or hemodynamic compromise).Īcute myocardial infarction (less than 2 to 4 days), if clinically stable. Systolic BP at rest >200 mmHg or diastolic BP at rest >110 mmHg. However, patients with chest pain syndromes at presentation who are stable and without ECG evidence of ischemia and without serum biomarker evidence of myocardial injury can undergo exercise stress testing.ĭecompensated or inadequately controlled congestive heart failure (HF). 6Ībsolute contraindications for exercise stress testing include the following: Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the AHA 4Ģ014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines 5Ĭlinician’s Guide to cardiopulmonary exercise testing in adults: a scientific statement from the AHA. Recommendations for testing specific populations can be found in the following documents: Recommendations for performance of exercise testing by nonphysicians (clinical exercise physiologists, registered nurses, nurse practitioners, physician assistants, and physical therapists) as well as the role of supervising physician have been published recently. Performance of exercise testing describing normal and abnormal response to exercise, evaluation of the test results are described in detail in 2013 Exercise Standards for Testing and Training: a scientific statement from the American Heart Association. Exercise using an upright or recumbent bicycle uses standard speed with incremental resistance.ĭetailed recommendations for exercise testing performance including (1) testing environment, (2) equipment, (3) emergency preparation and protocols, (4) patient preparation (including informed consent), (5) test performance, and (6) personnel qualifications are described in detail in the 2009 Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association (AHA). ![]()
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