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post-MI exercise testing; rehabilitation treadmill testing; predischarge exercise testing
Post-MI exercise testing limited exercise testing on selected patients with myocardial infarction may be done 8-10 days post-MI, &/or pre-hospital discharge.
Indications:
1) prognosis/mortality risk assessment
2) to select patients for earlier discharge & more rapid rehabilitation
3) to detect patients with conduction instability
4) to determine adequacy of medical management
5) to facilitate planning a safe home activity program
6) to achieve a favorable psychologic impact
Selection of patients:
1) patient physically able to walk on treadmill
2) electrically stable - controlled ventricular ectopy
3) hemodynamically stable
a) no symptoms congestive heart failure
1] no pulmonary edema
2] no persistent venous stasis
b) no persistent hypotension as a complication of myocardial infarction
c) special consideration given to patients with
1] resting pulse > 95/min
2] diastolic BP > 95
3] systolic BP < 95
4] > 10 mm Hg postural drop in BP
5] 2nd or 3rd degree heart block
6] active myocarditis
7] recently implanted pacemaker
Procedure:
Naughton protocol is generally used.
Termination of test
1) 70% of maximum predicted heart rate (MPHR)
2) heart rate of 130/min
3) 4 mets of activity
4) ischemia
5) excessive fatigue, dyspnea or dizziness
6) progressive decrease in heart rate of systolic BP
7) increased AV block
8) significant new or increasing ventricular ectopy
9) excessive vasoconstriction (cool & clammy)
10) musculoskeletal symptoms or difficulty with balance
11) supervening atrial fibrillation or flutter
Interpretation:
- indications for cardiac catherization [1]
a) unable to exercise
b) exercise-induced ST-segment depression
c) failure to acheive 5 METS
d) failure to increase systolic blood pressure by 10-30 mm Hg
Related
maximum predicted heart rate MPHR
Naughton protocol
General
exercise stress testing
References
- Medical Knowledge Self Assessment Program (MKSAP) 14,
American College of Physicians, Philadelphia 2006