Exercise tolerance testing

Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.

1. EXERCISE TOLERANCE TESTING INTRODUCTION

2. Introduction Exercise Tolerance Testing is defined as the observation and recording of patient’s cardiovascular response to exercise. Involves monitoring of HR, BP, ECG .

3. Clinical context for exercise testing for patients with suspected ischemic heart disease. *Electrocardiogram interpretable unless pre-excitation, electronically paced rhythm, left bundle branch block, or resting ST-segment depression >1 mm. Copyright © American Heart Association, Inc. All rights reserved.

4. Indications Patients who are candidates for exercise testing may have stable symptoms Chest pain, may be stabilized by medical therapy following symptoms of unstable chest pain, or may be post–myocardial infarction or post-revascularization patients. The clinician should first address whether the diagnosis of coronary artery diseases (CAD ) is certain, based on the patient’s history, electrocardiogram (ECG), an symptoms of chest pain . If not, treadmill exercise testing may be useful.

5. Indications The ACC/AHA classifications I, II, and III are used to summarize indications for exercise testing: Class I: Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective. Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment.

6. Contd… IIa: Weight of evidence/opinion is in favor of usefulness/efficacy. IIb: Usefulness/efficacy is less well established by evidence/opinion. Class III: Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful.

7. Contra-Indications

8. PROCEDURE Further changes are made accordingly Bruce Protocol.

9. Conducting the Test Explanation: Leaflets or illustrations before commencement Reasons and outcomes of testing Demonstration of procedure to relieve anxiety. Instruction for not to put excessive pressure on rails of treadmill Report any uncomforts pre, peri or post testing. Any medications. Patient preparation : Skin surface cleaned with alcohol and abraded by sandpapers to remove surface epidermis and oil. Position ECG electrodes according to the following order.

10. ECG Electrode Placement

11. ECG Electrode Placement

12. Measurements during ETT ECG Testing every 30 sec interval. Also recorded during rest, exercise and recovery phase of testing. Blood pressure is taken at rest, exercise and recovery phase in same intervals as of ECG. Heart beats are monitored continuously during all phases for recording and noting any abnormal rhythm or conduction rhythm. Heart beat and Blood Pressure need not be at same pre-exercise levels, but should be stable before test discontinued.

13. Treadmill Protocols

14. VO 2max Prediction by Bruce Protocol Where, ‘T’ is total time completed in minutes.

15. Duke Treadmill Score