Week 3 : Stress testing

Cards (56)

  • Angina was first described in 1772 by the English Physician William Heberden.
  • The “cornerstone” of modern stress testing was the recognition of the importance of Stress Testing segment changes to predict the presence of Coronary Artery Disease (CAD) in 1918.
  • In 1928, ST changes during exercise were associated with chest pain and decreased cardiac blood flow by Feil and Siegel.
  • The Master’s Step Test, the first “standard” exercise protocol, was established in 1929 by Master.
  • In 1932, ST depression was present in only 75% of patients with angina during exercise, similar to the percentage today.
  • The first to use maximal exercise testing to test for CAD was Missal in 1938.
  • Continuous EKG monitoring, with a depression >1.0 mm being clinically significant, was established in 1941 by Riseman et al.
  • EKG changes after exercise can be useful to detect CAD, as noted in 1942 by Master and Jaffe.
  • The Harvard Step Test, used to assess fitness from HR during recovery, was established in 1942 by Johnson et al.
  • Maximal exercise (stair climbing) was more sensitive (88%) to detect CAD than submaximal exercise (39%) in 1950, as noted by Wood et al.
  • Treadmill testing was used with set criteria to screen for CAD in 1952 by Yu et al.
  • Cycle tests were used to predict fitness in 1956 by Astrand.
  • Bruce established the guidelines used today: treadmill with EKG, during exercise, in 1969.
  • The protocol for exercise stress testing should include a suitable recovery or cool-down period.
  • Exercise stress testing is used to diagnose coronary artery disease, heart rhythm problems (arrhythmias), and guide treatment of heart disorders.
  • Adenosine is used in nuclear exercise stress test to show how the heart works during physical activity.
  • Acute MI, high risk of unstable angina, uncontrolled cardiac arrhythmias, symptomatic severe aortic stenosis, pulmonaryinfarction, acute myocarditis, and acute aortic dissection are contraindications for exercise stress testing.
  • Drugs being taken should be determined before exercise stress testing.
  • Pre-test preparation for exercise stress testing includes asking about family history and general medical history, making note of any considerations that may increase the risk of sudden death, and avoiding unusual physical exertion before testing.
  • Exercise stress test usually involves walking on a treadmill or riding a stationary bike.
  • Safety precautions and equipment for exercise stress testing include a treadmill with front and side rails for subjects to steady themselves, an emergency stop button, and a brief physical examination prior to testing to rule out significant outflow obstruction.
  • In general, 6 to 12 minutes of continuous progressive exercise during which the myocardial oxygen demand is elevated to the patient’s maximal level is optimal for diagnostic and prognostic purposes.
  • Treadmill test usually involves walking on a treadmill at increasing levels of difficulty, while electrocardiogram, heart rate, and blood pressure are monitored.
  • Refined interpretation of ST changes, with V5 or CM5 most sensitive leads, was established in the 1970s and 1980s by Blackburn et al.
  • The probability of a “true” positive stress test depends on the pre-test risk of the patient.
  • Stress Testing is a test used in medicine to measure the heart’s response to external stress in a controlled clinical environment.
  • Types of Stress Testing include Exercise (Treadmill, Bicycle), Pharmacologic (Regenadonoson, Dobutamine).
  • Certain Changes in your Electrocardiogram
  • Make sure the patient knows that they should speak up if they experience any chest or arm pains, dizziness or other unusual symptoms
  • Monitor the ECG continuously and be prepared to stop the test immediately if any warning signs appear.
  • The chosen test cannot be performed readily with exercise
  • Severe shortness of breath
  • Ensure the patient has signed all relevant forms, followed preparation guidelines, and that their medical history was provided
  • Responsibilities of a Cardiology Technologist during Exercise Stress Tests
  • Scans are acquired with a gamma camera to capture images of the blood flow
  • CORNELL MACIP BALKE - WARE NAUGHTON ACIP WEBER BICYCLE ERGOMETER
  • The Nuclear Stress Test is usually done on TWO SEPARATE DAYS
  • A RADIOACTOR (Tc 99 sestamibi or thallium) is injected
  • Specificity : 77 %
  • Sensitivity : 68%