Clinical Applications of Exercise Stress Echocardiography
Firstly, patients are questioned about their symptoms, past cardiovascular medical history and risk factors for coronary artery disease. After an explanation and preparation for the procedure by a cardiopulmonary technician, a 12-lead electrocardiogram is obtained. Bruce protocol is usually performed. In the assessment of non-coronary artery disease, a modified Bruce protocol is applied for easier evaluation of Doppler parameters rather than the classical Bruce protocol, in some clinical scenarios.
Criteria for test interruption are: fatigue, angina with increasing intensity, dizziness, ST-segment depression greater than 3 mm, complex ventricular arrhythmias, systolic blood pressure greater than 240 mmHg or diastolic blood pressure greater than 130 mmHg or a blood pressure drop greater than 20 mmHg. The test is considered to be positive for myocardial ischemia when ST-segment depression occurs, with a horizontal or down sloping displacement greater than 1 mm measured 0.08 seconds after the J point. The ECG exercise treadmill test is considered inconclusive when there are baseline ST-T changes (left bundle branch block, digitalis effect, left ventricular hypertrophy) or when the patient does not reach 85% of the theoretical maximum age-adjusted heart rate. The exam is negative for myocardial ischemia when the patient's heart rate exceeds 85% of the theoretical maximum age-adjusted heart rate without the previously mentioned changes.
Methodology of Exercise Stress Echocardiography
Exercise Test in Treadmill
Firstly, patients are questioned about their symptoms, past cardiovascular medical history and risk factors for coronary artery disease. After an explanation and preparation for the procedure by a cardiopulmonary technician, a 12-lead electrocardiogram is obtained. Bruce protocol is usually performed. In the assessment of non-coronary artery disease, a modified Bruce protocol is applied for easier evaluation of Doppler parameters rather than the classical Bruce protocol, in some clinical scenarios.
Criteria for test interruption are: fatigue, angina with increasing intensity, dizziness, ST-segment depression greater than 3 mm, complex ventricular arrhythmias, systolic blood pressure greater than 240 mmHg or diastolic blood pressure greater than 130 mmHg or a blood pressure drop greater than 20 mmHg. The test is considered to be positive for myocardial ischemia when ST-segment depression occurs, with a horizontal or down sloping displacement greater than 1 mm measured 0.08 seconds after the J point. The ECG exercise treadmill test is considered inconclusive when there are baseline ST-T changes (left bundle branch block, digitalis effect, left ventricular hypertrophy) or when the patient does not reach 85% of the theoretical maximum age-adjusted heart rate. The exam is negative for myocardial ischemia when the patient's heart rate exceeds 85% of the theoretical maximum age-adjusted heart rate without the previously mentioned changes.
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