Exercise And Pharmacologic Stress Testing

Question 1

Duke treadmill score

Answer 1

Exercise time - 5xmax st depression - 4xangina score (0 none, 1 present, 2 reason for test termination)

Low risk >5
Intermediate risk -10 to +4
High risk

Question 2

Absolute contraindications for ETT

Answer 2

Acute MI <2 days
High risk UA
Uncontrolled, symptomatic arrhythmia 
Decompensated HF
Uncontrolled Htn, bp > 200/110
Symptomatic severe AS
Acute PE or pulmonary infarction 
Acute myocarditis or pericarditis 
Acute aortic dissection

Question 3

Relative contraindications ETT

Answer 3

Left main coronary stenosis 
Moderate valvular stenosis
Electrolyte abnormalities
High grade AV block
Hypertrophic cardiomyopathy or outflow tract obstruction
Significant tachy- or Brady arrhythmia 
Mental or physical impairment
Lbbb, pacemaker, or preexcitation

Question 4

Indications for pharmacologic vasodilator stress imaging

Answer 4

Inability to perform adequate exercise
Lbbb
Ventricular pacemaker
Concurrent use of medications that may blunt the HR response (ccb, bb)
Evaluation of pts very early after acute myocardial infarction (>= days), or following ED presentation with presumptive ACS

Question 5

Contraindications for pharmacologic stress testing

Answer 5

Asthma with ongoing wheezing (not for dobutamine)
Second or third degree AV block (adenosine, dipyridamole, regadenson)
Systolic bp< 90
Methylxanthine use (aminophylline, caffeine)(not for dobutamine
Known hypersensitivity of stress agent
For dobutamine only: recent ACS, severe AS, LVOT obstruction, svt with uncontrolled rate, history of vt, uncontrolled Htn, aortic dissection or large aneurysm, receiving beta blockers