This document provides information on exercise stress tests, including indications, contraindications, safety precautions, potential cardiac issues, and emergencies. It indicates that exercise stress tests are used to assess heart function and risk under physical stress. Absolute contraindications include recent heart issues or procedures, while relative contraindications involve risks that require caution. Safety precautions, monitoring of arrhythmias, and protocols for emergencies are described.

1. SEM 4
VCC 401
UNIT 2

2. Indications for the
Exercise Stress Test –
● To assess stress or exercise tolerance if patient have coronary artery disease (blocked arteries in
the heart)
● To determine limits for safe exercise before starting a cardiac rehab program or when recovering
from a cardiac event, such as myocardial infarction, or MI or heart surgery
● To assess heart rhythm and electrical activity during exercise
● To evaluate heart rate and blood pressure during exercise
● Assessment of cardiovascular risk in screening.
● Assessment of therapeutic response.
● Exercise testing can be used to evaluate the effect of interventions such as PCI, CABG and CRT
etc.
● Assessment of preoperative risk for non cardiac surgery.
● Exercise prescription.
● To determine degree of disability.

3. Contraindications for
exercise stress test
Absolute
contraindications:
means that event or
substance could
cause a life-
threatening situation.
Relative
contraindications:
means that caution
should be used
when two drugs
or procedures are
used together.

4. ● High-grade AV blocks
● Severe hypertension (systolic greater than 200 mmHg, diastolic greater than 110
mmHg, or both)
● Inability to exercise given extreme obesity or other physical/mental impairment.
● Left main coronary stenosis
● Moderate stenotic valvular heart disease
● Electrolyte abnormalities
● Tachyarrhythmias or bradyarrhythmias
● Hypertrophic cardiomyopathy and any other forms of outflow tract obstruction[13]
● Mental or physical impairment leading to an inability to exercise adequately
Relative contraindications
for exercise stress test

5. Absolute contraindications
for exercise stress test
● Acute myocardial infarction within 2 to 3 days.
● Unstable angina not previously stabilized by medical therapy.
● Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic
compromise.
● Symptomatic severe aortic stenosis.
● Uncontrolled symptomatic heart failure.
● An acute pulmonary embolus or pulmonary infarction.
● Severe pulmonary hypertension.
● Acute myocarditis or pericarditis, or endocarditis.
● Acute aortic dissection.

6. Absolute Contraindications for Exercise ECG Relative Contraindications for Exercise ECG
1. Aortic dissection – due to risk of progression and
rupture.
2. Acute myocardial infarction (AMI) within 48 hours – due
to risk of aggravating the infarction, as well as inducing
ventricular arrhythmias.
3. Unstable angina pectoris in acute phase (before
stabilization of symptoms) – due to risk of developing
acute myocardial infarction and inducing ventricular
arrhythmias.
4. Presence of potentially serious arrhythmias – due to risk
of circulatory collapse.
5. Decompensated heart failure – due to risk of circulatory
collapse and arrhythmias
6. Pulmonary embolism in acute phase – due to risk of
aggravation the condition.
7. Pulmonary infarction in acute phase – due to risk of
aggravating the condition.
8. Perimyocarditis (myocarditis) in acute phase – due to risk
of arrhythmias
9. Severe aortic stenosis – due to risk of syncope, ischemia
and arrhythmias
10. Endocarditis – due to risk of embolization
11. Deep venous thrombosis – due to risk of embolization
1. Severe hypertension (systolic blood pressure >200
mmHg or diastolic blood pressure >110 mmHg).
2. Left main coronary artery stenosis
3. Severe electrolyte imbalance
4. Severe hyperthyroidism
5. Moderate to severe aortic stenosis
6. Insufficiently
controlled arrhythmias which may
cause hemodynamic compromise
7. Obstructive hypertrophic cardiomyopathy
8. Second-degree AV block or third-degree AV
block (not caused by medications)
9. Stroke within 1 month

7. SAFETY PRECAUTIONS:
● Exercise testing appears safer today (<1 untoward event per 10,000 tests) than it did 20
years ago.
● The treadmill should have front and side rails to help subjects steady themselves.
● It should be calibrated monthly.
● A defibrillator must be instantly available.
● A complete trolley of cardiac resuscitation equipment should be on hand, including intubation
equipment and full range of cardiac drugs.
● Automate blood pressure measurement during exercise not recommended.
● The time-proven method of holding the subject's arm with a stethoscope placed over the
brachial artery remains the most reliable.

8. Cardiac arrhythmias and
conduction disturbances
during stress testing:
● Exertion may induce arrhythmias as a result of sympathetically enhanced depolarization of
ectopic foci or the induction of myocardial ischemia secondary to increased myocardial
oxygen demand.
● PVCs occurring prior to, during exercise, or during recovery all modestly increase the risk of
all-cause mortality in patients with and without known coronary artery disease (CAD).
● Ventricular tachycardia and premature ventricular complexes are often not reproducible on a
subsequent exercise test.
● Exercise induced left bundle branch block (LBBB) predicts increased risk of the presence of
CAD, all cause mortality, and often permanent LBBB.

9. Emergencies in
the stress testing Laboratory:
● Sudden blood pressure fall
● Syncope
● Cardiac arrest secondary to slow coronary flow.

11. THANK YOU