1. Indication Contraindication Preparation
EXERCISE STRESS TEST
Indication
Contraindication
Preparation

2. Cardiovascular Risk Factors
Modifiable
Hypertension
Smoking
Diabetes
Hyperlipidemia
Sedentary life style
obesity
Non-modifiable
Age
Gender
Family History

3. Exercise Stress Testing
Pathophysiology:
At rest, there may be adequate coronary blood flow, with exercise, supply may not keep up with demand leading to characteristic ST segment changes and other end points due to obstruction.
At least a 70-80%occlucions is needed before coronary stenosis (obstruction) is reliably detected by this test.
Significant coronary artery disease can exist with a negative Exercise Stress Test.

4. Indications for Stress Testing
Evaluation of patients with suspected coronary artery disease (CAD).
Evaluation of patients with known coronary artery disease (CAD).
After myocardial infarction
After intervention
Evaluation of exercise capacity

5. Preparation for Stress Testing
History
Physical Examination
Laboratory Studies
Screening chemistry and hematologic profiles
Resting ECG
Medications
General Activity level

6. Contraindications to Stress Testing
Acute myocardial infarction
unstable angina
Acute cardiac inflammation( myocarditis)
Severe congestive heart failure(CHF)
Severe hypertension (>200/>100)
Poor candidate for exercise
Extreme obesity, usually can’t do over 175 KG.
Severe physical disabilities
Severe mental disabilities

7. Possible Contraindications to Stress Testing based on Resting ECG
ST-segment depression or elevation
Ventricular hypertrophy
T-wave inversions
Left bundle branch block
Right bundle branch block
Prolonged QT interval

8. Equipment for Stress Testing
Treadmill or bicycle
or steps
ECG machine
Blood Pressure Cuff
Statoscope

9. Normal Response to Stress Testing
Heart rate increases
Blood pressure increases
Cardiac output increases
Total peripheral resistance decrease
Oxygen consumption increases
(1MET = 3.5 ml O2/Kg./min =
1 metabolic equivalent)

10. Abnormal Response to Stress Testing
Heart rate fails to rise above 120
Blood pressure shows a drop in systolic
Patient physically unable to complete test
Marked hypertension, >260/115
Chest Pain
unusual shortness of breath

11. Normal ECG Response to Stress Testing
ECG Changes
QRS complex decreases in size
ST segment returns to baseline by 80 millisecond
R amplitude may decrease at rates
T wave decreases

13. Abnormal ECG Response to Stress Testing
ECG Changes
down sloping ST segments
ST segment depressed or elevated
ST segment does not return to baseline by 80 milliseconds
T wave inversion

14. Protocols Men: Predicted METs = 14.7 − 0.11 × age
Work load is expressed in METS (1 MET = 3.5ml O2 /Kg/min).
1 MET (3.5 ml) = basal O2 requirement
5 METS (17.5 ml) = activities of daily life
13 METS (45.5 ml) = good work out and excellent prognosis.
Men: Predicted METs = 14.7 − 0.11 × age
Women: Predicted METs = 14.7 – 0.13 × age
Classify functional capacity below normal if lower than 85% of the predicted value

15. Reasons to Terminate Test
Absolute
Patient requests to stop
Technical/mechanical difficulties
Suspected MI
CNS symptoms
Serious dysrhythmias
Drop in systolic BP
Severe Angina
ST elevation > 1mm
Relative
> 2mm of ST depression
Increasing chest pain
Tired or SOB
Wheezing
Claudication
SBP>260, DBP>115