4. It is of 2 types they are
1) Submaximal est
2) Maximal est
5. Principles & Purpose
Patient Preparation
Understanding the report
When NOT to do it – Contraindications
When to do it - Indications
6. To identify the cardio vascular endurance
the likelihood and extent of coronary artery
disease (CAD)
7. 1. Tread mill
2. Bicycle ergometer
3. Arm ergometer
4. Pharmacological stress testing
5. 6MWT / 12MWT
6. Holter monitoring (A Holter monitor is a battery-operated portable
device that measures and records your heart's activity (ECG) continuously for
24 to 48 hours or longer depending on the type of monitoring used)
9. To find out presence of ischemia
To determine the functional aerobic capacity of an
individual
10. +ve test when myocardium is having in
adequative O2 demand
-ve test when there is a balance
myocardium demand
11. 1. Stable Angina pt with chest pain
2. Evaluation of the effectiveness of medical and
surgical therapy
3. Screening for latest CAD (not congenital they
are acquired)
4. Early detection of labile hypertension
12. 5) Evaluation of CHF & arrhythmias
6) Evaluation of functional capacity & exercise
prescription (evaluated by MET’s
14. • Acute myocarditis or pericarditis
• Acute aortic dissection
• Electrolyte abnormalities
• Tachy or Brady arrhythmias
• Mental or physical impairment
• Hypertension (>200/100 at rest)
• Neuromuscular and musculoskeletal disorder exacerbated by
exercise
15. EST might be prematurely stopped for any of the following:
• Moderate to severe angina
Reaching THR
THR= 220 – Age
Eg : 220 – 45 = 175
• Increasing chest pain
• Increasing nervous system symptoms (ataxia, dizziness)
• Signs of poor perfusion (cyanosis or pallor)
• Sustained ventricular tachycardia
16. • ST elevation (≥1.0 mm)
• ST depression (>2 mm)
• Drop in SBP of (≥10 mmHg) BP without ischemia
• Heart block or brady
• Technical difficulties in monitoring ECG or SBP
• Fatigue, shortness of breath, wheezing, leg
cramps
17. Patients should refrain from ingesting food, alcohol, or caffeine or
using tobacco products within 3 hours of testing.
• Patients should be rested for the assessment, avoiding significant
exertion or exercise on the day of the assessment.
• Patients should wear clothing that allows freedom of movement,
including walking or running shoes, and a loose-fitting shirt with
short sleeves that buttons down the front. They should not wear
restrictive undergarments during the test.
18. 1. Patient should be relaxed
2. The room should be humidified
3. Patient is connected to ECG monitor in treadmill
4. before est Check Baseline BP & 12 lead ECG
5. Before est demo is taught to the patient
6. Start treadmill
7. Monitor patient for symptoms
8. Check BP every 3 minutes
9. Treadmill ECG machine records 12 lead ECG periodically
19. Once patient finished est even resting ecg is not
detached upto minimum of 6minutes & is
supposed to monitored. even after completion of
est as some changes can be noticed.
Basics needs like O2 therapy, emergency drugs &
defibrillator should be kept nearer to the patient for
the usage in emergency conditions.
20. TREADMILL
◦ A Treadmill Stress Test (TMT) is a form of stress test
◦ 12lead ecg monitor will be connected to the patient it has few
protocols like
Bruce protocol
Modified bruce protocol
Naughton protocol
Balke & wave protocol
Ramp & Northridge protocol
21.
22. Robert Arthur Bruce was an American cardiologist and a
professor at the University of Washington. He was known as the
"father of exercise cardiology" for his research and development of
the Bruce Protocol.
Before the development of the Bruce Protocol there was no safe,
standardized protocol that could be used to monitor cardiac function
in exercising patients.
Bruce and Dr. Paul Yu began work on developing a treadmill
exercise test.
23. It has 7 stages .
Each stage has 3 minutes
Total duration is 21 minutes
At the end of 2nd minute in every stage we are supposed to measure BP
At the minimum of 5th stage patient reaches THR . So elevation will be
maximum of 20%
The total duration of session is 21 minutes
Before monitoring we should note patient name, age, gender, ocupation,
IP/OP number. These details are helpful for identification
24. Stage Speed
MPH
Elevation % Duration
Time (min)
I 1.7 10 3
II 2.5 12 6
III 3.4 14 9
IV 4.2 16 12
V 5.0 18 15
VI 5.5 20 18
VII 6.0 22 21
25. It has 7 stages
Total duration is 21 minutes
Elevation is 10% only upto III stage
26. Stage Speed
MPH
Elevation (%) Duration
Min
I 1.7 10 3
II 1.7 10 6
III 1.7 10 9
IV 2.5 12 12
V 3.4 14 15
VI 4.2 16 18
VII 5.0 18 21
27. Post CABG (or) post operative conditions of either
pulmonary / cardiac
Older age people
Who are not able to do bruce protocol
28. Bicycle ergometer requires less space, affordable
, less noise
12 lead ecg monitor connected to the patient
Patient requires minimum amount of energy only
patient is supposed to use lower limb muscle
power for cycling
No specific protocol is used
No need of giving intimation for the patient
29. Patient with hemiperesis ( lower limb should have
muscle power minimum grade III)
Any upper limb amputation/ any artificial limb
Patient who are not able to perform the treadmill
Any uppe rlimb weakness
30. 12 lead ecg monitor will be connected to the patient
Patient is supported to used upper limb muscle power
Arm ergometer also requires less space
Less noise & affordable
No need of giving intimation for the patient
31. Patient with hemiperesis ( lower limb muscle should
have muscle power minimum grade III)
Any lower limb amputation/ any artificial limb
Patient who are unable to perform the treadmill &
bicycle ergometer
32.
33. A pharmacological nuclear stress test is a
diagnostic test used to evaluate blood flow to the
heart.
During the test, a small amount of radioactive
tracer is injected into a vein.
A special camera, called a gamma camera,
detects the radiation released by the tracer to
produce computer images of the heart.
34. The results of an EST are usually reported as either
negative, positive or inconclusive.
Negative
A negative test result indicates a normal test which
significantly decreases the likelihood of coronary artery
disease.
Positive
A positive test result occurs where a diagnosis of coronary
artery disease (IHD, angina) is definite.
35. 1) St wave changes
St elevation shows myocardial ischemia
St depression shows myocardial infarction
2) Tall T wave
3) Changes in chest leads
V1 – V3 :RBBB
V2 – V5 :LBBB
36. Interpretation of EST: if patient reaches THR at athe end of
3rd stage, he complaints of leg discomfort at end of 3rd stage.
Corelate with patient clinical findings
37. Inconclusive
An inconclusive test result is usually due to non-
diagnostic ECG changes, or when the test is
terminated early due to exhaustion,
beforemaximum heart rate or workload is reached.
