n CME : Your SA Journal of CPD - Using and interpreting exercise stress testing in clinical practice : main aricle




Exercise may be used to discover the presence of cardiovascular disease and aid in the assessment of the patient's prognosis, functional capacity and the evaluation of therapeutic effects. <BR>Exercise stress testing refers to the performance of a preselected exercise protocol which may employ an exercise apparatus such as a motorised treadmill or bicycle ergometer, before, during and after which assessments of symptoms, haemodynamic parameters and the ECG are carried out. <BR>An exercise test protocol should be tailored to the patient's physical capabilities, to ensure that the exercise stress will last long enough to bring out any abnormality of cardiac function and yet not long enough to test endurance rather than functional capacity. <BR>The Bruce protocol has the largest database and has been the most widely used. the Bruce protocol has been modified for elderly patients and those with limited physical capacity by adding 2 warm-up phases that precede the protocol. <BR>The most frequent use of exercise stress testing by far is the detection and monitoring of coronary artery disease. For this purpose, observations are directed at finding evidence of myocardial ischaemia during and after exercise - this includes effort-induced ischaemic chest pain or anginal-equivalent symptoms, abnormal heart rate and blood pressure responses and the detection of ischaemic changes in the 12-lead ECG. <BR>Even advanced coronary atherosclerosis may not be accompanied by coronary stenosis. <BR>The interpretation of the stress ECG is beset by certain difficulties that include patient selection and the pre-test probability of disease as well as the nature of the electrocardiographic changes observed with exercise. <BR>The stress ECG should be carefully evaluated for the presence of st-segment depression during and after exercise. typical ischaemic st-segment depression may start during exercise and persist into the post-exercise period. <BR>It is a normal response for the systolic blood pressure to rise during exercise. a sustained fall of > 10 mmHg during <BR>Exercise, particularly when coupled with symptoms or signs of myocardial ischaemia, suggests the induction of left ventricular dysfunction. exercise testing has an excellent safety record.


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