The ECG in cardiac stress testing: a valuable, but unappreciated source of clues

1998 ◽  
Vol 7 (4) ◽  
pp. 320-327
Author(s):  
LG Futterman ◽  
L Lemberg
Keyword(s):  
Emergency Department ◽  
Clinical Features ◽  
Stress Testing ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Accurate Diagnosis ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Cardiac Stress Testing ◽  
Ecg Abnormalities

The ECG exercise stress test is a very potent aid to the clinical diagnosis of CAD. Thorough knowledge of the ECG abnormalities and clinical features related to the stress test are required for an accurate diagnosis. The ECG exercise stress test is not a substitute for clinical acumen. Proper evaluation of the stress test is a clinical art of the skilled clinician. ECG exercise stress testing can be done efficiently and effectively by trained emergency department physicians. As a result, the diagnosis of CAD can be greatly accelerated.

scholarly journals Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Adam S. Weinstein ◽  
Martin I. Sigurdsson ◽  
Angela M. Bader
Keyword(s):  
Cardiac Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Metabolic Equivalents ◽  
Cardiac Stress Testing ◽  
Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

Blood pressure and risk of cognitive impairment. The role of vascular disease in neurodegeneration.

2019 ◽  
Author(s):  
Mar Carmona-Abellan ◽  
Malwina Trzeciak ◽  
Miriam Recio-Fernandez ◽  
Beatriz Echeveste ◽  
Laura Imaz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Stress Testing ◽  
Cardiovascular Response ◽  
Stress Test ◽  
Peak Exercise ◽  
Cardiac Stress ◽  
Cardiac Stress Testing

Abstract Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after the cardiac stress testing.Methods: This is a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015 and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period.Results: From this cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic and mean blood pressure than controls (p<0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise and both systolic and diastolic blood pressures increased significantly more during exercise. Conclusion: The results from this study suggest that differences in cardiovascular response to stress are present in the preclinical phase of cognitive decline, serving as a potential risk factor for cognitive impairment. These findings challenge the potential use of blood pressure and heart rate variability at rest and during cardiac stress assessment as a risk factor for cognitive impairment.

scholarly journals Evaluation of Outpatient Cardiac Stress Testing After Emergency Department Encounters for Suspected Acute Coronary Syndrome

2019 ◽  
Vol 74 (2) ◽  
pp. 216-223 ◽  
Author(s):  
Shaw Natsui ◽  
Benjamin C. Sun ◽  
Ernest Shen ◽  
Yi-Lin Wu ◽  
Rita F. Redberg ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Stress Testing ◽  
Cardiac Stress ◽  
Coronary Syndrome ◽  
Cardiac Stress Testing

The Influence of Referral Source on Characteristics of Patients Undergoing Cardiac Stress Testing: Emergency Department versus Outpatient Office

2011 ◽  
Vol 123 (2) ◽  
pp. 36-41
Author(s):  
Sherry Pinkstaff ◽  
Mary Ann Peberdy ◽  
Michael C. Kontos ◽  
Sheryl Finucane ◽  
Carl J. Lavie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Stress Testing ◽  
Referral Source ◽  
Cardiac Stress ◽  
Cardiac Stress Testing

scholarly journals A Method for Predicting the Main Indicators of Cardiopulmonary Stress Testing for Patients with Chronic Heart Failure

2020 ◽  
Vol 23 (1) ◽  
pp. 96-104
Author(s):  
A. S. Krasichkov ◽  
E. Mbazumutima ◽  
F. Shikama ◽  
E. M. Nifontov
Keyword(s):  
Heart Failure ◽  
Oxygen Consumption ◽  
Chronic Heart Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Significant Risk ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Peak Oxygen Consumption ◽  
Prognostic Information

Introduction. Cardiopulmonary stress test provides significant diagnostic and prognostic information of the condition of patients with cardiovascular and pulmonary diseases. There is a serious problem, that final phase of stress testing is a physically difficult exercise for a person. There is a significant risk of occurrence and development of pathological conditions of the patient's cardiovascular system. One of the solutions is the development of methods for assessing the biological parameters of the patients at the end of a load protocol based on data from the initial stages of the test.Aim. Development of a method for finding an estimate of the maximum heart rate (HR) and of the peak oxygen consumption (OC) for the patients with chronic heart failure at the end of a cardiorespiratory exercise stress test, based on the results of the study obtained at the first initial stages of the test.Materials and methods. For the study, 149 anonymized records of rhythmograms and data of changes in the oxygen consumption of the patients with chronic heart failure were used. The patients underwent a cardiopulmonary stress test by a bicycle ergometer using step-by-step load protocol (the load power increase at each stage was 10 W, the duration of the load stage was 1 min)Results. Based on the analysis of the data obtained, a method for assessing the peak values of HR and of PC of the patients with chronic heart failure was developed.Conclusion. The relative error of the proposed estimate of the HR peak in most cases was no more than 10 %, which allows it to be used for practical purposes. It was established that when performing 70 % of the stress protocol, the error of the proposed estimate of the OC peak in most cases did not exceed 20 %. More research is needed to improve the accuracy of the assessment for using in medical applications aimed to the modernization of methods and equipment for stress testing of the patients.

scholarly journals Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 435-440 ◽  
Author(s):  
Doug Richards ◽  
Nazanin Meshkat ◽  
Jaqueline Chu ◽  
Kevin Eva ◽  
Andrew Worster
Keyword(s):  
Chest Pain ◽  
Stress Testing ◽  
Stress Test ◽  
Intervention Group ◽  
Exercise Stress Test ◽  
Low Risk ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Control Group

ABSTRACTIntroduction:Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP).Methods:Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations.Results:Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (χ2= 6.69,p&lt; 0.001) with a relative risk of 1.29 (95% confidence interval 1.18–1.40), and the results remained significant after a “worst case” sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary.Conclusion:When ED staff order an outpatient exercise stress test following investigation for potential ACS, patients are more likely to complete the test if it is booked for them before ED discharge. After discharge, many low-risk chest pain patients feel they are not at risk and do not return to their FP for further testing in a timely manner as advised. Changing to a strategy of ED booking of exercise stress testing may help earlier identification of patients with coronary heart disease.

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