Exercise stress testing can be used for diagnosis, prognosis, and treatment assessment of coronary artery disease. It measures a patient's functional capacity and oxygen uptake during exercise to evaluate disability. Electrocardiographic measurements are taken during exercise to detect ischemia through ST segment changes. An abnormal response is 1mm or greater of ST segment depression in multiple leads, indicating myocardial ischemia. Exercise stress testing has reasonable sensitivity and specificity for detecting coronary artery disease when used in intermediate-risk patients.

1. Exercise stress testing Dr Shivanand Patil

5. ELECTROCARDIOGRAPHIC MEASUREMENTS

8. Mason –Likar modification

11. Normal

13. Abnormal

14. False-positive

16. Different ECG patterns

18. Ischemic exercise-induced ECG

26. ST SEGMENT ELEVATION

28. Pseudonormalization of T waves

30. NONELECTROCARDIOGRAPHIC OBSERVATIONS

39. Diagnostic use of Exercise testing

41. Sensitivity and Specificity 66% 53% 81% 86% Multivessel CAD Left main or TVD --- 25-71% LAD>RCA>LCx SVD 77% 68% In CAD (General) Specificity Sensitivity Patients

47. Exercise testing in determining prognosis

50. Cardiac Arrhythmias and conduction disturbances

62. Indications for terminating exercise testing

63. Indications for terminating exercise testing

70. Thank You

71. Work Capacity in METS-Women

72. Work Capacity in METS-Men

75. Pretest probability of CAD Low Very low Intermediate Very low Intermediate Low High Intermediate 40-49 Men Women Very low Very low Low Very low Intermediate Very low Intermediate Intermediate 30-39 Men Women Asymptomatic Nonanginal Chest pain Atypical or Probable angina Typical or Definite angina Age/ Sex

76. Pretest probability of CAD Low Low Intermediate Intermediate Intermediate Intermediate High High 60-69 Men Women Low Very low Intermediate Low Intermediate Intermediate High Intermediate 50-59 Men Women Asymptomatic Nonanginal Chest pain Atypical or Probable angina Typical or Definite angina Age/ Sex

77. Duke treadmill score

81. METABOLIC EQUIVALENT… 1 IV 2-3 III 4-6 II 6-10 I METS NYHA