Exercise Stress Test (EST)

Last updated 20.09.12

 

Definition

-  ECG performed whilst exercising to detect presence of myocardial ischaemia

 

Features

-  If patients are unable to exercise sufficiently (85% predicted maximal heart rate) or have ECG changes making interpretation difficult (LBBB, paced rhythm, Digoxin, LVH criteria) then consider pharmacological stress test of angiography

 

Indications

-  Investigation of chest pain

- Dyspnoea work up

- Risk assessment post AMI

 

Contraindications

Absolute

-  AMI within 2 days

- Hish risk unstable angina

- Uncontrolled cardiac arythmias with haemodynamic compromise

- Endocarditis (active)

- Symptomatic severe aortic stenosis

- Decompensated systemic heart failure

- Acute PE or pulmonary infarction

- Medical conditions aggravated by exercise

- Acute myocarditis or pericarditis

- Physical disability which preclused safe and adequate test performance

- Acute aortic dissection

- Relative

-  Left main coronary stenosis

- Moderate stenotic vavlular heart disease

- Electrolye abnormalities

- Tachyarythmias or bradyarythmias

- AF with uncontrolled ventricular rate

- Hypertrophic cardiomyopathy

- High degree AV block

- Severe arterial hypertension

 

Equipment

- ECG 12 lead

- BP monitor

- Defibrilator

- Electronic treadmill

- Gradient 0-22%

- Speed 1.6-12.8km/h, gradient 0-22%

 

Procedure

-  Explanation & consent

- Place ECG with limb leads on torso

- Determine protocol for test

- BP measures

- Prior to starting

- At each stage of exercise

- At peak exercise level

- At least twice during recovery period

- Continue ECG

- Monitor for 6-8 minutes post ceasing test

 

Leads

 

 

Indications to Terminate Exercist Test

-  ST segment elevation >1mm in leads without Q waves (other than V1 or aVR)

- Drop in SBP >10mmHg

- Moderate to severe angina

- Dizziness, ataxia, presyncope

- Cyanosis, pallor

- Sustained SVT

- Patient request

- Relative indications

- ST or QRS changes

- Fatigue, SOB, wheeze, leg cramps, claudication

- Arythmia

- SBP >250mmHg or DBP >115mmHg

- Increasing chest pain

 

 

 

References

 

Queensland Health: EST Nov 2012