Graded exercise testing (GXT): extension of medical history and physical examination

Size: px
Start display at page:

Download "Graded exercise testing (GXT): extension of medical history and physical examination"

Transcription

1

2 Related Readings Fletcher, G. F., Balady, G. J., Amsterdam, E. A., Chaitman, B., Eckel, R., Fleg, J., et al. (2001). Exercise standards for testing and training: A statement for healthcare professionals from the American Heart Association. Circulation, 104(14), [Free Full Text]

3 Graded exercise testing (GXT): extension of medical history and physical examination GXT been preliminary step in diagnosis of hemodynamically significant coronary artery disease (CAD) Primary diagnostic criteria have been; ST-segment changes on the electrocardiogram (ECG) and their correlation with symptoms (angina pectoris, shortness of breath) consistent with exertional myocardial ischemia

4 The ST level is measured relative to the P-Q junction ST segment depression is the most common manifestation of exercise-induced myocardial ischemia

5 Several reasons for conducting a GXT before assuming risk of conducting an exercise test, one must be certain that indications for the test are adequate Dictate the relative criteria for terminating the test are judged and how the test results are evaluated For example, attitude when conducting GXT on healthy individual at risk for CVD different than a patient who presents clinically

6 Clinically Accepted Reasons for Performing Graded Exercise Testing Extension of the history and physical allows physician to examine patient during symptoms Evaluate exertional discomfort Chest discomfort Dyspnea Leg discomfort Palpitations Cerebral symptoms Evaluate the presence of occult coronary artery disease Risk stratification in patients with known cardiovascular disease Follow-up of therapy Exercise prescription ACC/AHA 2002, Circulation 106:

7 Several things must be considered; indications and contraindications to exercise testing type of ergometer endpoint of exercise test protocol and safety considerations Both absolute and relative contraindications person conducting test should go over informed consent immediately before test even if patient has already signed important to tell patient what likely to feel during the test

8 Absolute Rest Acute MI (within 2 days) High-risk unstable angina Uncontrolled cardiac arrhythmias Active endocarditis Symptomatic severe aortic stenosis Symptomatic heart failure Pulmonary infarction Acute myocarditis or pericarditis Inability to obtain consent Relative* Left main coronary stenosis Stenotic valvular heart disease Electrolyte abnormalities Tachyarrhythmias Bradyarrhythmias Atrial fibrillation Hypertrophic cardiomyopathy High-degree AV block * Relative contraindications can be superseded if benefits outweigh risks of exercise ACC/AHA 2002, Circulation 106:

9 Summary of Studies Using Exercise ECG Testing in Chest Pain Centres Source: ACC/AHA Guideline Update for Exercise Testing: Summary Article. Gibbons et al. 2002, 106: Circulation

10 Perform resting ECG before beginning stress test 1. identify contraindications for testing 2. make sure resting ECG is normal to allow interpretation of changes that might occur during exercise test

11 1. Initial level of exertion should be submaximal 2. Increments between stages should be comparatively small and of consistent size 3. Protocol should allow estimation of exercise capacity 4. Test should be efficient of patient and physician time

12 Protocols suitable for clinical evaluation should include; low-intensity warm-up phase, progressive, continuous exercise, demand (for oxygen) is elevated to a desired level total duration of 8-12 minutes Typically sub-maximal, terminating (unless otherwise indicated) at predetermined % of estimated MHR (~75-80%) Bruce protocol (Bruce et al. 1973) Modified Bruce (Lerman et al. 1976) Astrand protocol (Astrand 1965)

13 Bruce treadmill protocol most widely used clinical setting for asymptomatic or high risk patients meets general principles criteria Protocol begins at 2.7 km/hr /10% grade, increases by 1.3 km/h / 2% grade every 3mins

14 Heyward VH. 2006, Advanced Fitness Assessment and Exercise Prescription, 5/e, Champaign, IL: Human Kinetics.

15 Bruce Treadmill Protocol for VO 2max Test Time Bruce Speed Grade METs min:sec Stage (km/hr) (%) Walk 0:00-3: :00-6: Jog/Run 6:00-9: :00-12: Run 12:00-15: :00-18: :00-21: Recovery (Jog/Walk) 0:00-2: Adapted from ASCM 2005, Health related physical fitness assessment manual. Lippincott, Williams and Wilkins, New York, NY

16 Adapted from ASCM 2005, Health related physical fitness assessment manual. Lippincott, Williams and Wilkins, New York, NY Estimate VO 2max calculated from total exercise duration using the appropriate regression formula: Men: VO 2max = 2.94 Time (min) Young Men: VO 2max = 2.94 Time (min) Women: VO 2max = 2.94 Time (min) Working example: female client exercise duration 7:52 (52/60 = 0.86) VO 2max = 2.94 (7.86) = 26.8 ml kg -1 min -1

17 Advantages 1. Allows the patient to reach high levels of exertion and is especially appropriate for active patients 2. Requires a shorter duration of testing than other protocols because of the rapid increase in workload Disadvantages 1. Patients must adjust to the change in both slope and speed at each stage 2. Most patients need to be running by stage 4 or 5

18 Protocol ideal only for younger individuals normal exercise capacity and a good ability to communicate with the physician conducting the test Less than optimal for older, more debilitated patients relatively high starting aerobic requirements and the large increases between stages encourage extensive handrail support, compromises accurate evaluation of exercise capacity

19 Naughton protocol is often recommended maintains nearly constant treadmill speed ( km/h), and increase workload increments in grade (between 2 and 5%) every 2 min (Naughton et al. 1964) When testing athletes increments in workload should be adapted in accordance with level of fitness treadmill speed and elevation should begin at 5 km/h and 0% grade, increase by 1.6 km/h and 2% every 2 min. running protocol negates accurate ECG and blood pressure recording s, patient s health must be ascertained beforehand

20 Heyward VH. 2006, Advanced Fitness Assessment and Exercise Prescription, 5/e, Champaign, IL: Human Kinetics.

21 Relation of METs to stages in the various testing protocols. Functional class refers to New York Heart Association class; Abbreviations: kpm = kilopond-meters; MPH = miles per hour; %GR = percent grade. Source: AHA 2001, Circulation 104:

22 Test should be continued until the clinical question that prompted GXT has been answered arbitrary termination criteria based on a predetermined workload or percent of the age-predicted HR difficult to justify Considering the importance of ex capacity as prognostic marker, failure to take patient to fatigue or symptom or sign limitation is hard to defend after abnormal findings have been documented, little justification for continuation of test

23 ST-segment elevation (>1.0 mm) in leads without Q waves (other than V1 or avr) Drop in SBP >10 mmhg, despite increase in workload, when accompanied by any other evidence of ischemia Moderate-to-severe angina (grade 3 to 4) CNS symptoms (eg, ataxia, dizziness, or near syncope) Signs of poor perfusion (cyanosis or pallor) Sustained ventricular tachycardia Technical difficulties monitoring ECG or systolic blood pressure Subject s request to stop Source: ACC/AHA Guideline Update for Exercise Testing: Summary Article. Gibbons et al. 2002, 106: Circulation

24 ST or QRS changes such as excessive ST displacement (horizontal or downsloping of >2 mm) or marked axis shift Drop in SPB >10 mmhg despite increase in workload, in the absence of other evidence of ischemia Increasing chest pain Fatigue, shortness of breath, wheezing, leg cramps, Arrhythmias other than sustained ventricular tachycardia Hypertensive response (systolic blood pressure >250 mm Hg and/or diastolic blood pressure >115 mm Hg). Development of bundle-branch block that cannot be distinguished from ventricular tachycardia Source: ACC/AHA Guideline Update for Exercise Testing: Summary Article. Gibbons et al. 2002, 106: Circulation

25 5 factors must be considered during the interpretation 1. Clinical responses 2. ECG responses 3. Exercise capacity 4. Hemodynamic responses 5. Integrated response, as reflected by exercise test scores

26 Clinical response to exercise test must be evaluated in terms of the clinical context reflected by pretest likelihood of ischemic CVD that might have been the indication for the exercise test Fewer symptoms observed during exercise testing than during spontaneous exercise influence of warm-up during exercise testing (Maybaum et al. 1996, Am J Cardiol 78: ) If so, why would this be the case?

27 Normal response to progressive treadmill exercise in healthy subjects Source: AHA 2001, Circulation 104:

28 Normal ECG has three clearly recognisable waves which accompany each cardiac cycle P Wave = atrial depolarisation QRS Complex = ventricular depolarisation T wave = indicates ventricular repolarisation

29

30 Sinus rhythm Tachycardia Bradycardia Arrhythmia

31 ECG changes in ST segment: Benchmark exercise-induced ischemia usually a lead with greatest degree of ST change, surrounded by leads with progressively less ST change ST-segment depression, changes that occur early during ex test, evident in multiple leads, persist into recovery predictive of either severe CAD or multivessel disease

32 ST segment depression common manifestation of exercise-induced myocardial ischemia. ST segment elevation during exercise localises the site of severe transient ischemia resulting from significant proximal disease or spasm. ECG abnormalities at rest, (T wave inversion; ST segment depression) may return to normal during attacks of angina and during exercise in some subjects with ischemic heart disease.

33 Dysrhythmias that increase in frequency or complexity with progressive exercise; 1. associated with ischemia 2. associated with hemodynamic instability thought to be more malignant than isolated dysrhythmias high-grade dysrhythmias occurring during exercise or recovery associated with poor long term prognosis

34 Exercise-induced arrhythmias generated by enhanced sympathetic tone, increased myocardial oxygen demand, or both. The period immediately after exercise is particularly dangerous because of the high catecholamine levels that are associated with generalized vasodilation

35 High VO 2max inferred to predict relatively high Q infers absence of serious limitations left ventricular function Importance of ex capacity relative to prognosis of patients with CVD (Myers et al. 2002, N Engl J Med 346: ) significant issue relative to ex capacity is imprecision of estimating ex capacity from ex performance error in estimating ex capacity from prediction equations is about 1 MET unimportant (<10% error) in young, healthy individuals more significant (15 25% error) in individuals with reduced exercise capacities

36 Ex capacity understood in terms of age- and gender-predicted norms VO 2max below 20 th percentile for age and sex, often indicative of sedentary lifestyle, associated with increased risk of death (Blair et al. 1995, JAMA 273: ) data based on physically active individuals, which probably should be the interpretative norm (Morris et al. 1993, J Am Coll Cardiol 22: ; ACSM 2006 GETP 7/e)

37 Evaluate momentary safety during exercise testing abnormalities in pattern/magnitude of SBP response recognised for prognostic significance patients who cannot achieve adequate ex HR response have unfavorable prognosis beyond accounted for by symptoms or ECG changes Chronotropic incompetence Chronotropic index

38 Chronotropic incompetence: failure to achieve 85% of the age-predicted heart rate in patients with no pharmacologic reason to have limitation in HR response magnitude of prognostic value of poor HR response is as powerful as is an exercise-induced myocardial perfusion deficit Abnormal chronotropic response provides information that is independent of myocardial perfusion combination of perfusion deficit and abnormal chronotropic index provides worse prognosis than either abnormality alone regression analysis: failure to HR by 12bpm during 1 st associated with death during follow-up period min of recovery strongly failure of HR to recover related to inability to reassert vagal control over HR, predisposition to arrhythmias

39 Use of ex test scores combine both favorable and unfavorable ex test results into a single prognostically useful term Duke Index (Mark et al. 1991, N Engl J Med 325: ) balances favorable result (exercise capacity) against two unfavorable results (ST-depression magnitude and presence and severity of angina pectoris) calculated score related to well-defined 5-year survival rate allows categorisation of patient (low-, moderate-, and high-risk subgroups) used in combination with simple hemodynamic findings such as abnormal pattern of HR recovery or combination of abnormal chronotropic index or an abnormal HR recovery

40 Duke Nomogram Duke Nomogram uses five steps to estimate prognosis for a given individual from the parameters of the Duke score 1. Observed amount of ST-depression marked on ST-segment deviation line 2. Observed degree of angina is marked on line for angina, and these two points are connected 3. Point where line intersects the ischemia reading line is noted 4. Observed exercise tolerance is marked on ex capacity line 5. Mark on the ischemia reading line is connected to the mark on the exercise capacity line, and the estimated 5-year survival or average annual mortality rate is read from the point at which this line intersects the prognosis scale

41 Sample nomogram shows testing results of 55 yro male sheetmetal worker with atypical chest pain patient reached 7METsbefore the test was stopped because of exercise-limiting angina. 2mm horizontal ST-segment depression at max exercise. Predicted annual cardiovascular mortality for this patient 4.0%, which is high.

42 Apparently independent information gained from pattern of increase in HR during exercise majority of healthy individuals, rate of increase in HR negatively accelerated at exercise intensities above the second ventilatory threshold 5% healthy individuals and high % of individuals with CVD, HR performance curve positively accelerated increase in the rate of HR is a method of defending Q in individuals who have large decreases in stroke volume at high exercise intensities

43 SBP normally negatively accelerated manner during incremental exercise magnitude of increase ~5 10mmHg per MET, minimal increase of 10mmHg from rest to maximal exercise considered normal Peak SBP > 250 mmhg or > 140 mmhg considered hypertensive response somewhat predictive of future resting hypertension In patients with Q limitations, inappropriately slow increase BP or a SBP decrease midway through Extest

44 SBP decrease below resting value or >10 mmhg after preliminary increase (in presence of other indices of ischemia) grossly abnormal sufficient reason to stop the test immediately DBP difficult to measure with accuracy during GXT increase >10 mmhg considered to be abnormal finding, as is an increase to more than 115mmHg consistent with exertional ischemia Post-exercise SBP normally decreases promptly 3-min post-ex SBP should be < 90% of SBP at peak exercise 3-min post-ex SBP should < SBP measured 1 min post-ex

45 Major advantage of measuring gas exchange is more accurate measurement of functional capacity also allow the determination of ventilatory threshold may be useful in defining prognosis

46 Much information in simple incremental GXT data more important in terms of defining prognosis than making specific diagnosis of obstructive CAD central feature appears to be functional exercise capacity Prognostic impression gained from exercise capacity typically balanced by ECG or symptomatic evidence of exertional myocardial ischemia relationship well expressed in exercise test scores such as the Duke Index Hemodynamic responses shown to be very powerful prognostic markers

47 Key Concept Exercise testing is an extension of the history and physical designed to allow the physician to evaluate the patient in circumstances likely to be provocative of the signs or symptoms consistent with exertional myocardial ischemia or other manifestations of CVD

Chapter 21: Clinical Exercise Testing Procedures

Chapter 21: Clinical Exercise Testing Procedures Publisher link: thepoint http://thepoint.lww.com/book/show/2930 Chapter 21: Clinical Exercise Testing Procedures American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise

More information

Exercise Test: Practice and Interpretation. Jidong Sung Division of Cardiology Samsung Medical Center Sungkyunkwan University School of Medicine

Exercise Test: Practice and Interpretation. Jidong Sung Division of Cardiology Samsung Medical Center Sungkyunkwan University School of Medicine Exercise Test: Practice and Interpretation Jidong Sung Division of Cardiology Samsung Medical Center Sungkyunkwan University School of Medicine 2 Aerobic capacity and survival Circulation 117:614, 2008

More information

My Patient Needs a Stress Test

My Patient Needs a Stress Test My Patient Needs a Stress Test Amy S. Burhanna,, MD, FACC Coastal Cardiology Cape May Court House, New Jersey Absolute and relative contraindications to exercise testing Absolute Acute myocardial infarction

More information

Contra-indications, Risks, and Safety Precautions for Stress Testing. ACSM guidelines, pg 20 7 ACSM RISK FACTORS. Risk Classifications pg 27

Contra-indications, Risks, and Safety Precautions for Stress Testing. ACSM guidelines, pg 20 7 ACSM RISK FACTORS. Risk Classifications pg 27 Contra-indications, Risks, and Safety Precautions for Stress Testing Data to Support Stress Testing How safe is stress testing? Contra-indications Termination Criteria Ellstad Chapt 5 ACSM Chapts 3-6 Seattle

More information

Stress ECG is still Viable in Suleiman M Kharabsheh, MD, FACC Consultant Invasive Cardiologist KFHI KFSHRC-Riyadh

Stress ECG is still Viable in Suleiman M Kharabsheh, MD, FACC Consultant Invasive Cardiologist KFHI KFSHRC-Riyadh Stress ECG is still Viable in 2016 Suleiman M Kharabsheh, MD, FACC Consultant Invasive Cardiologist KFHI KFSHRC-Riyadh Stress ECG Do we still need stress ECG with all the advances we have in the CV field?

More information

Chad Morsch B.S., ACSM CEP

Chad Morsch B.S., ACSM CEP What Is Cardiac Stress Testing? Chad Morsch B.S., ACSM CEP A Cardiac Stress Test is a test used to measure the heart's ability to respond to external stress in a controlled clinical environment. Cardiac

More information

Risk Stratification for CAD for the Primary Care Provider

Risk Stratification for CAD for the Primary Care Provider Risk Stratification for CAD for the Primary Care Provider Shimoli Shah MD Assistant Professor of Medicine Directory, Ambulatory Cardiology Clinic Knight Cardiovascular Institute Oregon Health & Sciences

More information

CHRONIC CAD DIAGNOSIS

CHRONIC CAD DIAGNOSIS CHRONIC CAD DIAGNOSIS Chest Pain Evaluation 1. Approach to diagnosis of CAD 2. Classification of chest pain 3. Pre-test likelihood CAD 4. Algorithm for chest pain evaluation in women 5. Indications for

More information

Treadmill Exercise ECG Test. Pai-Feng Kao MD Taipei Medical University-Wan Fang Hospital Date:

Treadmill Exercise ECG Test. Pai-Feng Kao MD Taipei Medical University-Wan Fang Hospital Date: Treadmill Exercise ECG Test Pai-Feng Kao MD Taipei Medical University-Wan Fang Hospital Date: 97-09-23 Foam Cells Atherosclerosis Timeline Fatty Streak Intermediate Lesion Atheroma Fibrous Plaque Complicated

More information

Subject: Assessment of Functional Capacity Melanie Elliott-Eller RN MSN Lee Lipsenthal MD February 2011

Subject: Assessment of Functional Capacity Melanie Elliott-Eller RN MSN Lee Lipsenthal MD February 2011 Subject: Assessment of Functional Capacity Melanie Elliott-Eller RN MSN Lee Lipsenthal MD February 2011 The Dr. Dean Ornish Program for Reversing Heart Disease has historically required a maximal exercise

More information

HEART CONDITIONS IN SPORT

HEART CONDITIONS IN SPORT HEART CONDITIONS IN SPORT Dr. Anita Green CHD Risk Factors Smoking Hyperlipidaemia Hypertension Obesity Physical Inactivity Diabetes Risks are cumulative (multiplicative) Lifestyles predispose to RF One

More information

Aerobic Exercise Screening Stratification Tool

Aerobic Exercise Screening Stratification Tool Aerobic Screening Stratification Tool Disclaimer: The Aerobics Screening Stratification Tool is a working document currently used within the Stroke Rehabilitation Service of St. Joseph s Care Group- Thunder

More information

Clinical Considerations of High Intensity Interval Training (HIIT)

Clinical Considerations of High Intensity Interval Training (HIIT) Clinical Considerations of High Intensity Interval Training (HIIT) Jenna Taylor Exercise Physiologist & Dietitian The Wesley Hospital PhD Candidate The University of Queensland What is High Intensity Interval

More information

Basics of Cardiopulmonary Exercise Test Interpretation. Robert Kempainen, MD Hennepin County Medical Center

Basics of Cardiopulmonary Exercise Test Interpretation. Robert Kempainen, MD Hennepin County Medical Center Basics of Cardiopulmonary Exercise Test Interpretation Robert Kempainen, MD Hennepin County Medical Center None Conflicts of Interest Objectives Explain what normally limits exercise Summarize basic protocol

More information

The importance of follow-up after a cardiac event: CARDIAC REHABILITATION. Dr. Guy Letcher

The importance of follow-up after a cardiac event: CARDIAC REHABILITATION. Dr. Guy Letcher The importance of follow-up after a cardiac event: CARDIAC REHABILITATION Dr. Guy Letcher The National Medicare Experience Mortality After Angioplasty 225,915 patients Mortality After Bypass Surgery 357,885

More information

10 Graded Exercise Testing

10 Graded Exercise Testing 10 Graded Exercise Testing Clinton A. Brawner, MS, RCEP CONTENTS Background 111 Timing of the GXT 113 Repeating the GXT 114 Pre-Test Considerations 114 Protocol Selection 114 Preparing for the GXT 116

More information

Severe Hypertension. Pre-referral considerations: 1. BP of arm and Leg 2. Ambulatory BP 3. Renal causes

Severe Hypertension. Pre-referral considerations: 1. BP of arm and Leg 2. Ambulatory BP 3. Renal causes Severe Hypertension *Prior to making a referral, call office or Doc Halo, to speak with a Cardiologist or APP to discuss patient and possible treatment options. Please only contact the patient's cardiologist.

More information

Aerobic Exercise Screening Stratification Tool

Aerobic Exercise Screening Stratification Tool Aerobic Screening Stratification Tool Disclaimer: The Aerobics Screening Stratification Tool is a working document currently used within the Stroke Rehabilitation Service of Toronto Rehabilitation Institute

More information

Practice Exam Case Study

Practice Exam Case Study Practice Exam 2017 Case Study A 58-year old professor presents himself to your clinic. He is apparently healthy, but his older brother had a heart attack at age 60, as did his father (age 62). He is clinically

More information

CURRENT STATUS OF STRESS TESTING JOHN HAMATY D.O.

CURRENT STATUS OF STRESS TESTING JOHN HAMATY D.O. CURRENT STATUS OF STRESS TESTING JOHN HAMATY D.O. INTRODUCTION Form of imprisonment in 1818 Edward Smith s observations TECHNIQUE Heart rate Blood pressure ECG parameters Physical appearance INDICATIONS

More information

Using and Interpreting Exercise Stress Testing in Clinical Practice

Using and Interpreting Exercise Stress Testing in Clinical Practice Using and Interpreting Exercise Stress Testing in Clinical Practice Exercise stress testing may be useful to elicit the presence of cardiovascular disease and in later evaluation of such disease. Anthony

More information

DECLARATION OF CONFLICT OF INTEREST

DECLARATION OF CONFLICT OF INTEREST DECLARATION OF CONFLICT OF INTEREST F. Baborski 1, I. Scuric 1, D. Cerovec 1, M. Novoselec 1, V. Slivnjak 1, K. Fuckar 1, N. Lakusic 1, Z. Vajdic 2, R. Bernat 3, K. Kapov-Svilicic 3 (1) Special Hospital

More information

Chapter 08. Health Screening and Risk Classification

Chapter 08. Health Screening and Risk Classification Chapter 08 Health Screening and Risk Classification Preliminary Health Screening and Risk Classification Protocol: 1) Conduct a Preliminary Health Evaluation 2) Determine Health /Disease Risks 3) Determine

More information

Cardiopulmonary Physical Therapy. Haneul Lee, DSc, PT

Cardiopulmonary Physical Therapy. Haneul Lee, DSc, PT Cardiopulmonary Physical Therapy Haneul Lee, DSc, PT Clinical Laboratory Studies Other Noninvasive Diagnostic Tests Other Imaging Modalities Exercise Testing Pharmacologic Stress Testing Cardiac Catheterization

More information

Mobilization and Exercise Prescription

Mobilization and Exercise Prescription 1 Clinicians can use this job aid as a tool to guide them through mobilization and exercise prescription with patients who have cardiopulmonary conditions. Mobilization and Exercise Prescription Therapy

More information

PROPEL: PRomoting Optimal Physical Exercise for Life* Submaximal Graded Exercise Assessment Guidelines

PROPEL: PRomoting Optimal Physical Exercise for Life* Submaximal Graded Exercise Assessment Guidelines PROPEL: PRomoting Optimal Physical Exercise for Life* Submaximal Graded Exercise Assessment Guidelines PROPEL: PRomoting Optimal Physical Exercise for Life* Submaximal Graded Exercise Assessment I. Foreword

More information

EXERCISE STRESS TESTING

EXERCISE STRESS TESTING EXERCISE STRESS TESTING Șuș Ioana, Gliga Mihai I. THEORETICAL BACKGROUND 1. Strength, power and endurance of muscles The parameters that characterize muscles performance are strength, power and endurance.

More information

The 2001 version of the exercise standards statement 1 has

The 2001 version of the exercise standards statement 1 has AHA Scientific Statement Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association Gerald F. Fletcher, MD, FAHA, Chair; Philip A. Ades, MD, Co-Chair; Paul Kligfield,

More information

Chapter 26: Exercise Assessment in Special Populations

Chapter 26: Exercise Assessment in Special Populations Chapter 26: Exercise Assessment in Special Populations American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise testing and prescription (6th ed.). New York: Lippincott,

More information

Disclosure. 3. ST depression indicative of ischemia is most commonly observed in leads: 1. V1-V2. 2. I and avl 3. V

Disclosure. 3. ST depression indicative of ischemia is most commonly observed in leads: 1. V1-V2. 2. I and avl 3. V Interpreting Stress Induced Ischemia by ECG, Bundle Branch Block & Arrhythmias Disclosure Gregory S Thomas MD, MPH Medical Director, MemorialCare Heart & Vascular Institute, Long Beach Memorial Astellas

More information

Effect of intravenous atropine on treadmill stress test results in patients with poor exercise capacity or chronotropic incompetence ABSTRACT

Effect of intravenous atropine on treadmill stress test results in patients with poor exercise capacity or chronotropic incompetence ABSTRACT Effect of intravenous atropine on treadmill stress test results in patients with poor exercise capacity or chronotropic incompetence Samad Ghaffari, MD, Bahram Sohrabi, MD. ABSTRACT Objective: Exercise

More information

DEPARTMENT NAME PRE-PARTICIPATION SCREENING THE SPORTS PHYSICAL

DEPARTMENT NAME PRE-PARTICIPATION SCREENING THE SPORTS PHYSICAL PRE-PARTICIPATION SCREENING THE SPORTS PHYSICAL Michele Krenek, MSN, RN, FNP-C TCHAPP Conference, Houston, TX April 4, 2019 PRE-PARTICIPATION SPORTS SCREENING According to the AHA the definition of the

More information

Comparison of the Ejection Time-Heart Rate Relationships in Normal and Ischemic Subjects

Comparison of the Ejection Time-Heart Rate Relationships in Normal and Ischemic Subjects Comparison of the Ejection Time-Heart Rate Relationships in Normal and Ischemic Subjects Clarence M. AGRESS, M.D., Stanley WEGNER, Shigeo NAKAKURA, M. D., Eugene H. LEHMAN, Jr., Ph. D., and Leonardo CHAIT,

More information

Choosing the Appropriate Stress Test: Brett C. Stoll, MD, FACC February 24, 2018

Choosing the Appropriate Stress Test: Brett C. Stoll, MD, FACC February 24, 2018 Choosing the Appropriate Stress Test: Brett C. Stoll, MD, FACC February 24, 2018 Choosing the Appropriate Stress Test: Does it Really Matter? Brett C. Stoll, MD, FACC February 24, 2018 Conflicts of Interest

More information

Family Practice. Stress tests: How to make a calculated choice. For personal use only. Copyright Dowden Health Media

Family Practice. Stress tests: How to make a calculated choice. For personal use only. Copyright Dowden Health Media For mass reproduction, content licensing and permissions contact Dowden Health Media. Family Practice the journal of Stress tests: How to make a calculated choice Spare your patients unnecessary stress

More information

GEORGE MASON UNIVERSITY School of Recreation, Health, and Tourism. KINE 350-C01: Exercise Prescription and Programming (3) Summer 2015

GEORGE MASON UNIVERSITY School of Recreation, Health, and Tourism. KINE 350-C01: Exercise Prescription and Programming (3) Summer 2015 GEORGE MASON UNIVERSITY School of Recreation, Health, and Tourism KINE 350-C01: Exercise Prescription and Programming (3) Summer 2015 DAY/TIME: M-Th 12:30-2:45 pm LOCATION: Bull Run Hall 246 PROFESSOR:

More information

C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders

C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders GENERAL ISSUES REGARDING MEDICAL FITNESS-FOR-DUTY 1. These medical standards apply to Union Pacific Railroad (UPRR) employees

More information

Study methodology for screening candidates to athletes risk

Study methodology for screening candidates to athletes risk 1. Periodical Evaluations: each 2 years. Study methodology for screening candidates to athletes risk 2. Personal history: Personal history of murmur in childhood; dizziness, syncope, palpitations, intolerance

More information

Listing Form: Heart or Cardiovascular Impairments. Medical Provider:

Listing Form: Heart or Cardiovascular Impairments. Medical Provider: Listing Form: Heart or Cardiovascular Impairments Medical Provider: Printed Name Signature Patient Name: Patient DOB: Patient SS#: Date: Dear Provider: Please indicate whether your patient s condition

More information

Stress echo workshop STRESSORS

Stress echo workshop STRESSORS Stress echo workshop STRESSORS Adham Ahmed, MD Lecturer of Cardiology, Ain Shams Indications of Stress Echo CAD Diagnosis Prognosticat ion 1 Physiologic Basis 1930s: Tennant and Wiggers Relationship between

More information

P F = R. Disorder of the Breast. Approach to the Patient with Chest Pain. Typical Characteristics of Angina Pectoris. Myocardial Ischemia

P F = R. Disorder of the Breast. Approach to the Patient with Chest Pain. Typical Characteristics of Angina Pectoris. Myocardial Ischemia Disorder of the Breast Approach to the Patient with Chest Pain Anthony J. Minisi, MD Department of Internal Medicine, Division of Cardiology Virginia Commonwealth University School of Medicine William

More information

The purpose of this report is to provide revised standards

The purpose of this report is to provide revised standards AHA Scientific Statement Exercise Standards for Testing and Training A Statement for Healthcare Professionals From the American Heart Association Gerald F. Fletcher, MD, Chair; Gary J. Balady, MD, Vice

More information

MYOCARDIALINFARCTION. By: Kendra Fischer

MYOCARDIALINFARCTION. By: Kendra Fischer MYOCARDIALINFARCTION By: Kendra Fischer Outline Definition Epidemiology Clinical Aspects Treatment Effects of Exercise Exercise Testing Exercise Rx Summary and Conclusions References Break it down MYOCARDIAL

More information

Heart Disorders. Cardiovascular Disorders (Part B-1) Module 5 -Chapter 8. Overview Heart Disorders Vascular Disorders

Heart Disorders. Cardiovascular Disorders (Part B-1) Module 5 -Chapter 8. Overview Heart Disorders Vascular Disorders Cardiovascular Disorders (Part B-1) Module 5 -Chapter 8 Overview Heart Disorders Vascular Disorders Susie Turner, MD 1/7/13 Heart Disorders Coronary Artery Disease Cardiac Arrhythmias Congestive Heart

More information

Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc.

Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc. Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc. The Miracle of Living February 21, 2018 Matthew Ostrom MD,FACC,FHRS Division of

More information

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac

More information

Scope

Scope Scope Global burden of heart disease Physical activity trends Overview of CR A happy problem Principles of CR in athletes Classification of sport Existing guidelines Exercise testing & prescription HIIT

More information

Choosing the Right Cardiac Test. Outline

Choosing the Right Cardiac Test. Outline Choosing the Right Cardiac Test Atif Qasim, M.D., M.S.C.E. University of California, San Francisco Disclosures: None 2013 Outline Focus on choosing the optimal tests for coronary disease evaluation Overview

More information

Common Codes for ICD-10

Common Codes for ICD-10 Common Codes for ICD-10 Specialty: Cardiology *Always utilize more specific codes first. ABNORMALITIES OF HEART RHYTHM ICD-9-CM Codes: 427.81, 427.89, 785.0, 785.1, 785.3 R00.0 Tachycardia, unspecified

More information

Case Question. Evaluation of Chest pain in the Office and Cardiac Stress Testing

Case Question. Evaluation of Chest pain in the Office and Cardiac Stress Testing Evaluation of Chest pain in the Office and Cardiac Stress Testing Chad Link, DO FACC Sparrow Hospital Thoracic and Cardiovascular Institute Chairman- TCI Cardiology Section Disclosures Speakers Bureau

More information

EKG Competency for Agency

EKG Competency for Agency EKG Competency for Agency Name: Date: Agency: 1. The upper chambers of the heart are known as the: a. Atria b. Ventricles c. Mitral Valve d. Aortic Valve 2. The lower chambers of the heart are known as

More information

Cardiac arrhythmias. Janusz Witowski. Department of Pathophysiology Poznan University of Medical Sciences. J. Witowski

Cardiac arrhythmias. Janusz Witowski. Department of Pathophysiology Poznan University of Medical Sciences. J. Witowski Cardiac arrhythmias Janusz Witowski Department of Pathophysiology Poznan University of Medical Sciences A 68-year old man presents to the emergency department late one evening complaining of increasing

More information

Subject: Outpatient Phase Ii Cardiac Rehab Individualized Treatment Plan And Exercise Prescription

Subject: Outpatient Phase Ii Cardiac Rehab Individualized Treatment Plan And Exercise Prescription CARDIAC REHAB POLICY & PROCEDURES Policy #: CR 208 Subject: Outpatient Phase Ii Cardiac Rehab Individualized Treatment Plan And Exercise Prescription Purpose: To establish guidelines for developing and

More information

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning based ECG practice E-book REtrive REpeat RElearn Design by S I T T I N U N T H A N G J U I P E E R I Y A W A

More information

Skin supplied by T1-4 (medial upper arm and neck) T5-9- epigastrium Visceral afferents from skin and heart are the same dorsal root ganglio

Skin supplied by T1-4 (medial upper arm and neck) T5-9- epigastrium Visceral afferents from skin and heart are the same dorsal root ganglio Cardio 2 ECG... 3 Cardiac Remodelling... 11 Valvular Diseases... 13 Hypertension... 18 Aortic Coarctation... 24 Erythropoiesis... 27 Haemostasis... 30 Anaemia... 36 Atherosclerosis... 44 Angina... 48 Myocardial

More information

UNDERSTANDING YOUR ECG: A REVIEW

UNDERSTANDING YOUR ECG: A REVIEW UNDERSTANDING YOUR ECG: A REVIEW Health professionals use the electrocardiograph (ECG) rhythm strip to systematically analyse the cardiac rhythm. Before the systematic process of ECG analysis is described

More information

ECG Interpretation Cat Williams, DVM DACVIM (Cardiology)

ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) Providing the best quality care and service for the patient, the client, and the referring veterinarian. GOAL: Reduce Anxiety about ECGs Back to

More information

McHenry Western Lake County EMS System Optional CE for EMT-B, Paramedics and PHRN s Bradycardia and Treatments Optional #7 2018

McHenry Western Lake County EMS System Optional CE for EMT-B, Paramedics and PHRN s Bradycardia and Treatments Optional #7 2018 McHenry Western Lake County EMS System Optional CE for EMT-B, Paramedics and PHRN s Bradycardia and Treatments Optional #7 2018 This month we will be looking at a specific ECG Rhythm and its treatments

More information

Recommended Evaluation Data Excerpt from NVIC 04-08

Recommended Evaluation Data Excerpt from NVIC 04-08 Recommended Evaluation Data Excerpt from NVIC 04-08 Purpose: This document is an excerpt from the Medical and Physical Evaluations Guidelines for Merchant Mariner Credentials, contained in enclosure 3

More information

The assessment of functional capacity reflects the ability

The assessment of functional capacity reflects the ability AHA Scientific Statement Assessment of Functional Capacity in Clinical and Research Settings A Scientific Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention

More information

CHEST PAIN CDU INCLUSION CRITERIA

CHEST PAIN CDU INCLUSION CRITERIA CHEST PAIN CDU INCLUSION CRITERIA No clinical criteria for ACS Stable vital signs Initial ECG and cardiac biomarkers not consistent with ACS Low to intermediate ACS risk (HEART score 0-6) [Ref 1, 2] Plan

More information

Cardiovascular Disorders Lecture 3 Coronar Artery Diseases

Cardiovascular Disorders Lecture 3 Coronar Artery Diseases Cardiovascular Disorders Lecture 3 Coronar Artery Diseases By Prof. El Sayed Abdel Fattah Eid Lecturer of Internal Medicine Delta University Coronary Heart Diseases It is the leading cause of death in

More information

The standard exercise treadmill test is widely used

The standard exercise treadmill test is widely used The Prognostic Value of Exercise Testing in Elderly Men Joshua M. Spin, MD, PhD, Manish Prakash, MD, Victor F. Froelicher, MD, Sara Partington, Rachel Marcus, MD, Dat Do, MD, Jonathan Myers, PhD PURPOSE:

More information

PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE. Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology

PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE. Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology Medical University of Łódź The heart is made up of four chambers Left Atrium Right Atrium Left Ventricle

More information

ECG Cases and Questions. Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology

ECG Cases and Questions. Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology ECG Cases and Questions Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology 32 yo female Life Insurance Physical 56 yo male with chest pain Terminology Injury ST elevation Ischemia T wave inversion

More information

12-Lead ECG Interpretation. Kathy Kuznar, RN, ANP

12-Lead ECG Interpretation. Kathy Kuznar, RN, ANP 12-Lead ECG Interpretation Kathy Kuznar, RN, ANP The 12-Lead ECG Objectives Identify the normal morphology and features of the 12- lead ECG. Perform systematic analysis of the 12-lead ECG. Recognize abnormalities

More information

Electrocardiography Abnormalities (Arrhythmias) 7. Faisal I. Mohammed, MD, PhD

Electrocardiography Abnormalities (Arrhythmias) 7. Faisal I. Mohammed, MD, PhD Electrocardiography Abnormalities (Arrhythmias) 7 Faisal I. Mohammed, MD, PhD 1 Causes of Cardiac Arrythmias Abnormal rhythmicity of the pacemaker Shift of pacemaker from sinus node Blocks at different

More information

Hanna K. Al-Makhamreh, M.D., FACC Interventional Cardiologist

Hanna K. Al-Makhamreh, M.D., FACC Interventional Cardiologist Hanna K. Al-Makhamreh, M.D., FACC Interventional Cardiologist Introduction. Basic Life Support (BLS). Advanced Cardiac Life Support (ACLS). Cardiovascular diseases (CVDs) are the number one cause of death

More information

National Coverage Determination (NCD) for Cardiac Pacemakers (20.8)

National Coverage Determination (NCD) for Cardiac Pacemakers (20.8) Page 1 of 12 Centers for Medicare & Medicaid Services National Coverage Determination (NCD) for Cardiac Pacemakers (20.8) Tracking Information Publication Number 100-3 Manual Section Number 20.8 Manual

More information

Chapter 10 Measurement of Common Anaerobic Abilities and Cardiorespiratory Responses Related to Exercise

Chapter 10 Measurement of Common Anaerobic Abilities and Cardiorespiratory Responses Related to Exercise Chapter 10 Measurement of Common Anaerobic Abilities and Cardiorespiratory Responses Related to Exercise Slide Show developed by: Richard C. Krejci, Ph.D. Professor of Public Health Columbia College 3.26.13

More information

12 Lead ECG Interpretation

12 Lead ECG Interpretation 12 Lead ECG Interpretation Julie Zimmerman, MSN, RN, CNS, CCRN Significant increase in mortality for every 15 minutes of delay! N Engl J Med 2007;357:1631-1638 Who should get a 12-lead ECG? Also include

More information

By the end of this lecture, you will be able to: Understand the 12 lead ECG in relation to the coronary circulation and myocardium Perform an ECG

By the end of this lecture, you will be able to: Understand the 12 lead ECG in relation to the coronary circulation and myocardium Perform an ECG By the end of this lecture, you will be able to: Understand the 12 lead ECG in relation to the coronary circulation and myocardium Perform an ECG recording Identify the ECG changes that occur in the presence

More information

A Morbidly Obese Woman

A Morbidly Obese Woman CASE LIBRARY SERIES NO. 04 PREOPERATIVE EVALUATION WITH MPI IN A Morbidly Obese Woman CASE DISCUSSION PROVIDED BY JAMES A. ARRIGHI, MD ASSOCIATE PROFESSOR OF MEDICINE ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY

More information

Cardiac Output MCQ. Professor of Cardiovascular Physiology. Cairo University 2007

Cardiac Output MCQ. Professor of Cardiovascular Physiology. Cairo University 2007 Cardiac Output MCQ Abdel Moniem Ibrahim Ahmed, MD Professor of Cardiovascular Physiology Cairo University 2007 90- Guided by Ohm's law when : a- Cardiac output = 5.6 L/min. b- Systolic and diastolic BP

More information

Home exercise program

Home exercise program Home exercise program Medical evaluation General medical evaluation Risk stratification Functional evaluation Behaviour modification Stress reduction Counselling Support group Risk modification DM, HT,

More information

E-LEARNING IN SPORTS MEDICINE

E-LEARNING IN SPORTS MEDICINE E-LEARNING IN SPORTS MEDICINE V. Zeman, L. Bolek, P. Míka Faculty of Medicine, Charles University, Plzen Electronic lecture presentations in sports medicine education have been used in our faculty for

More information

BUSINESS. Articles? Grades Midterm Review session

BUSINESS. Articles? Grades Midterm Review session BUSINESS Articles? Grades Midterm Review session REVIEW Cardiac cells Myogenic cells Properties of contractile cells CONDUCTION SYSTEM OF THE HEART Conduction pathway SA node (pacemaker) atrial depolarization

More information

Adult Pre Participation Screening and Exercise Prescription Practicum

Adult Pre Participation Screening and Exercise Prescription Practicum Adult Pre Participation Screening and Exercise Prescription Practicum Objectives of this exercise: To administer pre participation screening and risk stratification for clients To write an appropriate

More information

ECG Workshop. Nezar Amir

ECG Workshop. Nezar Amir ECG Workshop Nezar Amir Myocardial Ischemia ECG Infarct ECG in STEMI is dynamic & evolving Common causes of ST shift Infarct Localisation Left main artery occlusion: o diffuse ST-depression with ST elevation

More information

Electrocardiography for Healthcare Professionals

Electrocardiography for Healthcare Professionals Electrocardiography for Healthcare Professionals Kathryn A. Booth Thomas O Brien Chapter 5: Rhythm Strip Interpretation and Sinus Rhythms Learning Outcomes 5.1 Explain the process of evaluating ECG tracings

More information

Diploma in Electrocardiography

Diploma in Electrocardiography The Society for Cardiological Science and Technology Diploma in Electrocardiography The Society makes this award to candidates who can demonstrate the ability to accurately record a resting 12-lead electrocardiogram

More information

Dos and Don t in Cardiac Arrhythmia. Case 1 -ECG. Case 1. Management. Emergency Admissions. Reduction of TE risk -CHADS 2 score. Hospital Admissions

Dos and Don t in Cardiac Arrhythmia. Case 1 -ECG. Case 1. Management. Emergency Admissions. Reduction of TE risk -CHADS 2 score. Hospital Admissions Emergency Admissions Dos and Don t in Cardiac Arrhythmia Tom Wong, MD, FESC Consultant Cardiologist, Honorary Senior Lecturer Royal Brompton & Harefield Hospitals National Heart and Lung Institute, Imperial

More information

Screening for Asymptomatic Coronary Artery Disease: When, How, and Why?

Screening for Asymptomatic Coronary Artery Disease: When, How, and Why? Screening for Asymptomatic Coronary Artery Disease: When, How, and Why? Joseph S. Terlato, MD FACC Clinical Assistant Professor, Brown Medical School Coastal Medical Definition The presence of objective

More information

DYSRHYTHMIAS. D. Assess whether or not it is the arrhythmia that is making the patient unstable or symptomatic

DYSRHYTHMIAS. D. Assess whether or not it is the arrhythmia that is making the patient unstable or symptomatic DYSRHYTHMIAS GENERAL CONSIDERATIONS A. The 2015 American Heart Association Guidelines were referred to for this protocol development. Evidence-based science was implemented in those areas where the AHA

More information

12 Lead EKG Chapter 4 Worksheet

12 Lead EKG Chapter 4 Worksheet Match the following using the word bank. 1. A form of arteriosclerosis in which the thickening and hardening of the vessels walls are caused by an accumulation of fatty deposits in the innermost lining

More information

Steven J. Lester MD, FRCP(C), FACC, FASE Relevant Financial Relationship(s) None Off Label Usage None

Steven J. Lester MD, FRCP(C), FACC, FASE Relevant Financial Relationship(s) None Off Label Usage None Steven J. Lester MD, FRCP(C), FACC, FASE Relevant Financial Relationship(s) None Off Label Usage None 1 2,000 Noninvasive Procedures 1,600 Units of Service/ 1,000 Beneficiaries 1,200 800 Evaluation and

More information

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Cardiac Anatomy

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Cardiac Anatomy Mosby,, an affiliate of Elsevier Normal Cardiac Anatomy Impaired cardiac pumping Results in vasoconstriction & fluid retention Characterized by ventricular dysfunction, reduced exercise tolerance, diminished

More information

EXS 145 Guidelines for Exercise Testing & Prescription

EXS 145 Guidelines for Exercise Testing & Prescription EXS 145 Guidelines for Exercise Testing & Prescription 11-3-11 Andrew Weiler M.Ed MCCD Adjunct Faculty CGCC Employee Wellness Coordinator SRPMIC Employee Wellness Coordinator Pot & Window LLC Today How

More information

ECG interpretation basics

ECG interpretation basics ECG interpretation basics Michał Walczewski, MD Krzysztof Ozierański, MD 21.03.18 Electrical conduction system of the heart Limb leads Precordial leads 21.03.18 Precordial leads Precordial leads 21.03.18

More information

Cardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology

Cardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Cardiac evaluation for the noncardiac patient Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Objectives! Review ACC / AHA guidelines as updated for 2009! Discuss new recommendations

More information

Masqueraders of STEMI

Masqueraders of STEMI Masqueraders of STEMI Steven M. Costa, M.D. Assistant Professor Department of Medicine Division of Cardiology Scott & White Memorial Hospital and Clinic Texas A&M University Health Science Center Disclosures

More information

ECG ABNORMALITIES D R. T AM A R A AL Q U D AH

ECG ABNORMALITIES D R. T AM A R A AL Q U D AH ECG ABNORMALITIES D R. T AM A R A AL Q U D AH When we interpret an ECG we compare it instantaneously with the normal ECG and normal variants stored in our memory; these memories are stored visually in

More information

THE FRAMINGHAM STUDY Protocol for data set vr_soe_2009_m_0522 CRITERIA FOR EVENTS. 1. Cardiovascular Disease

THE FRAMINGHAM STUDY Protocol for data set vr_soe_2009_m_0522 CRITERIA FOR EVENTS. 1. Cardiovascular Disease THE FRAMINGHAM STUDY Protocol for data set vr_soe_2009_m_0522 CRITERIA FOR EVENTS 1. Cardiovascular Disease Cardiovascular disease is considered to have developed if there was a definite manifestation

More information

Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014

Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications for cardiac catheterization Before a decision to perform an invasive procedure such

More information

Stress tests: How to make a calculated choice Spare your patients unnecessary stress testing by determining their pretest probability for CAD

Stress tests: How to make a calculated choice Spare your patients unnecessary stress testing by determining their pretest probability for CAD PRACTICA MEDICALÅ19 REFERATE GENERALE Stress tests: How to make a calculated choice Spare your patients unnecessary stress testing by determining their pretest probability for CAD DENNIS P. BREEN, MD University

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure (review

More information

Endurance Exercise and Cardiovascular Health

Endurance Exercise and Cardiovascular Health Endurance Exercise and Cardiovascular Health Professor Sanjay Sharma St George s University of London St George s Hospital NHS Trust sasharma@sgul.ac.uk @SSharmacardio Conflicts/Disclosures: None Objectives

More information

Signal Processing of Stress Test ECG Using MATLAB

Signal Processing of Stress Test ECG Using MATLAB Signal Processing of Stress Test ECG Using MATLAB Omer Mukhtar Wani M. Tech ECE Geeta Engineering College, Panipat Abstract -Electrocardiography is used to record the electrical activity of the heart over

More information