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Exercise stress testing   Dr Shivanand Patil
General Applications   ,[object Object],[object Object],[object Object],[object Object]
METABOLIC EQUIVALENT ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
ELECTROCARDIOGRAPHIC MEASUREMENTS
Mason –Likar modification ,[object Object],[object Object],[object Object]
Mason –Likar modification ,[object Object],[object Object],[object Object],[object Object],[object Object]
Mason –Likar modification
Baseline Abnormalities - Obscure ECG changes during exercise ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types of ST Segment Displacement   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Normal
Types of ST Segment Displacement ,[object Object],[object Object],[object Object]
Abnormal
False-positive
Types of ST Segment Displacement ,[object Object],[object Object],[object Object],[object Object],[object Object]
Different ECG patterns
MEASUREMENT OF ST SEGMENT DISPLACEMENT   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ischemic exercise-induced ECG
MEASUREMENT OF ST SEGMENT DISPLACEMENT ,[object Object],[object Object],[object Object]
MEASUREMENT OF ST SEGMENT DISPLACEMENT ,[object Object],[object Object],[object Object]
MEASUREMENT OF ST SEGMENT DISPLACEMENT ,[object Object],[object Object],[object Object]
UPSLOPING ST SEGMENTS   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ST SEGMENT ELEVATION   ,[object Object],[object Object],[object Object],[object Object],[object Object]
ST SEGMENT ELEVATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ST SEGMENT ELEVATION ,[object Object],[object Object],[object Object],[object Object]
ST SEGMENT ELEVATION
T WAVE CHANGES   ,[object Object],[object Object],[object Object],[object Object]
Pseudonormalization of T waves
OTHER ECG MARKERS   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NONELECTROCARDIOGRAPHIC OBSERVATIONS
Blood Pressure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exertional Hypotension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Work Capacity ,[object Object],[object Object],[object Object]
Sub-Maximal Exercise ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Heart Rate Response ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Heart Rate Response ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rate-Pressure Product ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chest discomfort ,[object Object],[object Object],[object Object]
Diagnostic use of Exercise testing
Sensitivity and Specificity ,[object Object],[object Object],[object Object],[object Object]
Sensitivity and Specificity 66% 53% 81% 86% Multivessel CAD Left main or TVD --- 25-71% LAD>RCA>LCx SVD 77% 68% In CAD (General) Specificity Sensitivity Patients
Limitations ,[object Object],[object Object],[object Object]
Noncoronary causes of ST segment depression ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Noncoronary causes of ST segment depression ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adverse prognosis and multivessel CAD ,[object Object],[object Object],[object Object]
Adverse prognosis and multivessel CAD ,[object Object],[object Object],[object Object]
Exercise testing in determining prognosis
Symptomatic Patients ,[object Object],[object Object]
After Myocardial infarction ,[object Object],[object Object],[object Object],[object Object]
Cardiac Arrhythmias and conduction disturbances
Ventricular Premature Contraction ,[object Object],[object Object]
 
 
[object Object],[object Object]
Supraventricular Arrhythmias ,[object Object]
Pre-Excitation Syndrome ,[object Object],[object Object],[object Object]
Special Clinical Applications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Special Clinical Applications ,[object Object],[object Object],[object Object],[object Object]
Special Clinical Applications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Special Clinical Applications ,[object Object],[object Object],[object Object],[object Object]
Special Clinical Applications ,[object Object],[object Object],[object Object],[object Object]
Indications for terminating exercise testing
Indications for terminating exercise testing
CONTRAINDICATIONS ,[object Object],[object Object]
CONTRAINDICATIONS TO EXERCISE TESTING (ACC/AHA) ,[object Object],[object Object],[object Object],[object Object],[object Object]
CONTRAINDICATIONS TO EXERCISE TESTING (ACC/AHA )… ,[object Object],[object Object],[object Object],[object Object],[object Object]
CONTRAINDICATIONS TO EXERCISE TESTING (ACC/AHA ) ,[object Object],[object Object],[object Object],[object Object],[object Object]
CONTRAINDICATIONS TO EXERCISE TESTING (ACC/AHA )… ,[object Object],[object Object],[object Object],[object Object],[object Object]
TMT Report ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank You
Work Capacity in METS-Women
Work Capacity in METS-Men
Terms-Evalution of test results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Terms-Evalution of test results ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pretest probability  of CAD Low Very low Intermediate Very low Intermediate Low High  Intermediate 40-49 Men Women Very low Very low Low  Very low Intermediate Very low Intermediate Intermediate 30-39 Men Women Asymptomatic Nonanginal Chest pain Atypical or Probable angina Typical or Definite angina Age/ Sex
Pretest probability  of CAD Low Low Intermediate Intermediate Intermediate Intermediate High High 60-69 Men Women Low  Very low Intermediate Low Intermediate Intermediate High Intermediate 50-59 Men Women Asymptomatic Nonanginal Chest pain Atypical or Probable angina Typical or Definite angina Age/ Sex
Duke treadmill score
Duke Treadmill Score ,[object Object],[object Object],[object Object],[object Object],[object Object]
PROGNOSTIC SCORES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VETERENS AFFAIRS (VA) SCORE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
METABOLIC EQUIVALENT… 1 IV 2-3 III 4-6 II 6-10 I METS NYHA
Special applications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Asymptomatic Population ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventricular Premature Contraction ,[object Object],[object Object],[object Object],[object Object],[object Object]

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