stress test Flashcards
Angina (chest pain) was first described in ______ by ______
1772 by William Heberden
it represents the interval
between ventricular depolarization and repolarization
Electrocardiogram (ecg)
ST depression first noted during angina
(Bousfield) in 1918
ST changes during exercise (sit ups) are associated with chest pain
& decreased cardiac blood flow
(Feil & Siegel) in 1928
Master’s Step test, first “standard” exercise protocol
Arthur Master in 1929
ST depression is present in only 75% of patients with angina during
exercise (similar to percentages today)
Goldhammer & Scherf in 1932
First to use maximal exercise testing to test for CAD → climbing stairs
(Morris Missal) in 1938
Support the study of Bousfield through ST segment
depression
Riseman et al. in 1940
Sensitivity of post-exercise ECG
Master & Jaffe in 1941
The Harvard Step Test used to assess fitness from HR during
recovery.
Measures endurance, develop during second world war.
Type of cardiac step test for detecting and diagnosing cardiovascular disease
(Johnson et al in 1942
Maximal exercise (stair climbing) was more sensitive (88%) to
detect CAD than submaximal exercise (39%) (
Wood et al in 1950
Treadmill testing used with set criteria to screen for CAD
(Yu et al. in 1952
Astrand test → a submaximal cycle ergometer aerobic fitness
test based on relationship between heart rate during work and
percentage of maximal aerobic capacity
Astrand, P.-O. & Ryhming in 1954
established the guidelines used today: treadmill, with
EKG, during exercise
* Exercise protocol to classify according to New York Heart
Association Criteria
* Initiate Contemporary era of exercise testing for diagnostic
and prognostic purposes
robert bruce in 1956
o measure heart’s ability to respond
to external stress in a controlled clinical environment
stress testing
Types of Stress Testing
- Exercise
- Pharmacologic
- nuclear
example of Pharmacologic
- regadenoson
- dobutamine
- persantine
- adenosine
most common test used
exercise stress test
it usually involves walking on a treadmill or riding a
stationary bike
exercise stress test
Indications of Exercise Testing
Diagnose coronary artery disease
Diagnose heart rhythm problems
risks of the test
low blood pressure
abnormal heart rhythm
heart attack
Used sticky patches (electrodes) on chest legs and
arms
treadmill test
Treadmill protocols
✓ Bruce
✓ Cornell
✓ Balke ware
✓ Acip
✓ mAcip
✓ Naughton
✓ Weber
commonly used treadmill protocols
bruce
it has 3-minute periods to allow achievement of a steady
state before work-load is increased for next stage
Bruce Protocols
Termination of Exercise Testing
o Moderate to severe chest pain
o Severe shortness of breath
o Abnormally high or low blood pressure
o An abnormal heart rhythm
o Dizziness
o Fatigue
o Certain changes in your electrocardiogram
A flat or down sloping depression of the ST
segment > 0.1 mV below baseline
positive test
▪ Target heart rate is not achieved
▪ 85% of maximal predicted heart for age and sex
is not achieve
negative test
limitation of treadmill stress test - Sensitivity
68%
limitation of treadmill stress test - Specificity
77%
if symptoms are normal, and results continue to worsen the
doctor might recommend
nuclear stress test
more accurate, but more expensive
nuclear stress test
Not used in cases in patient with asthma or Chronic
obstructive pulmonary disease
Vasodilators such as: Adenosine and Dipyridamole
Makes heart response as person is exercising
Dobutamine
NUCLEAR STRESS TEST also known as
“Myocardial perfusion imaging
what instrument is injected in the arm of the patient
radiotracer
