Absolute Contraindications to Exercise Testing - ANSWER • A recent significant change in
the resting ECG suggesting significant ischemia, recent MI (within 2 d), or other acute cardiac
event
• Unstable angina
• Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Suspected or known dissecting aneurysm
• Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
Relative Contraindications to Exercise Testing - ANSWER • Left main coronary stenosis
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities (hypokalemia or hypomagnesemia)
• Severe arterial hypertension (SBP>200 mmHg and/or DBP >110 mmHg) at rest
• Tachydysrhythmia or bradydysrhythmia
• Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
• Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
• High-degree AV block
• Ventricular aneurysm
• Uncontrolled metabolic disease (diabetes, thyrotoxicosis, or myxedema)
• Chronic infectious disease (e.g. HIV)
• Mental or physical impairment leading to inability to exercise adequately
1
,General Indications for Stopping an Exercise Test - ANSWER • Onset of angina or angina-
like symptoms
• Drop in SBP of ≥10 mmHg with an increase in work rate or if SBP decreases below the
value obtained in the same position prior to testing
• Excessive rise in BP: SBP>250 mmHg and/or DBP>115 mmHg
• Shortness of breath, wheezing, leg cramps, or claudication
• Signs of poor perfusion: light-headedness, confusion, ataxia (loss of full control of bodily
movements), (pallor) unhealthy pale appearance, cyanosis (bluish skin color), nausea, or
cold and clammy skin
• Failure of HR to increase with increased exercise intensity
• Noticeable change in heart rhythm by palpation or auscultation
• Subject requests to stop
• Physical or verbal manifestations of severe fatigue
• Failure of the testing equipment
Absolute Indications for stopping an exercise test - ANSWER • Drop in SBP ≥10 mmHg
with an increase in work rate, or if SBP decreases below the value obtained in the same
position prior to testing when accompanied by other evidence of ischemia
• Moderately severe angina (defined as 3 on standard scale)
• Increasing nervous system symptoms (e.g. ataxia, dizziness, or near syncope)
• Signs of poor perfusion (cyanosis or pallor)
• Technical difficulties monitoring the ECG or SBP
• Subject's desire to stop
• Sustained ventricular tachycardia
• ST elevation (+1.0 mm) in leads without diagnostic Q waves (other than V1 or aVR)
Relative Indications for stopping an exercise test - ANSWER • Drop in SBP ≥10 mmHg with
an increase in work rate, or if SBP below the value obtained in the same position prior to
testing
2
, • ST or QRS changes such as excessive ST depression (>2 mm horizontal or down sloping ST-
segment depression) or marked axis shift
• Arrhythmias other than sustained V Tach, including multifocal PVCs, triplets of PVCs, SVT,
heart block, or bradyarrhythmias
• Fatigue, shortness of breath, wheezing, leg cramps, or claudication
• Development of bundle-branch block or intraventricular conduction delay that cannot be
distinguished from V Tach
• Increasing chest pain
• Hypertensive response (SBP>250 mmHg and/or DBP>115 mmHg)
ST segment depression - ANSWER ≥1 mm of horizontal or down sloping ST↓ 60-80 ms
beyond the J point suggesting myocardial ischemia
Chronotropic incompetence - ANSWER 1. Peak exercise HR about 20 BPM below the age
predicted HRmax or an inability to achieve > 85% of the age predicted HRmax for subjects
limited by volitional fatigue.
2. Chronotropic index <.8
Heart Rate Recovery - ANSWER less than or equal to 12 BPM at 1 minute for walking, or
less than or equal to 22 BPM at 2 mins for supine position
Sensitivity - ANSWER % of pts. tested with known CVD who demonstrate significant ST
segment changes.
Exercise EKG sensitivity usually requires greater than or equal to 70% stenosis
True Positive - ANSWER Horizontal or down sloping ST segment depression of ≥1.0 mm
and correctly identifies a patient with CVD
False Negative - ANSWER test shows no or non-diagnostic ECG changes and fails to
identify patients with underlying CVD
3
the resting ECG suggesting significant ischemia, recent MI (within 2 d), or other acute cardiac
event
• Unstable angina
• Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Suspected or known dissecting aneurysm
• Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
Relative Contraindications to Exercise Testing - ANSWER • Left main coronary stenosis
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities (hypokalemia or hypomagnesemia)
• Severe arterial hypertension (SBP>200 mmHg and/or DBP >110 mmHg) at rest
• Tachydysrhythmia or bradydysrhythmia
• Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
• Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
• High-degree AV block
• Ventricular aneurysm
• Uncontrolled metabolic disease (diabetes, thyrotoxicosis, or myxedema)
• Chronic infectious disease (e.g. HIV)
• Mental or physical impairment leading to inability to exercise adequately
1
,General Indications for Stopping an Exercise Test - ANSWER • Onset of angina or angina-
like symptoms
• Drop in SBP of ≥10 mmHg with an increase in work rate or if SBP decreases below the
value obtained in the same position prior to testing
• Excessive rise in BP: SBP>250 mmHg and/or DBP>115 mmHg
• Shortness of breath, wheezing, leg cramps, or claudication
• Signs of poor perfusion: light-headedness, confusion, ataxia (loss of full control of bodily
movements), (pallor) unhealthy pale appearance, cyanosis (bluish skin color), nausea, or
cold and clammy skin
• Failure of HR to increase with increased exercise intensity
• Noticeable change in heart rhythm by palpation or auscultation
• Subject requests to stop
• Physical or verbal manifestations of severe fatigue
• Failure of the testing equipment
Absolute Indications for stopping an exercise test - ANSWER • Drop in SBP ≥10 mmHg
with an increase in work rate, or if SBP decreases below the value obtained in the same
position prior to testing when accompanied by other evidence of ischemia
• Moderately severe angina (defined as 3 on standard scale)
• Increasing nervous system symptoms (e.g. ataxia, dizziness, or near syncope)
• Signs of poor perfusion (cyanosis or pallor)
• Technical difficulties monitoring the ECG or SBP
• Subject's desire to stop
• Sustained ventricular tachycardia
• ST elevation (+1.0 mm) in leads without diagnostic Q waves (other than V1 or aVR)
Relative Indications for stopping an exercise test - ANSWER • Drop in SBP ≥10 mmHg with
an increase in work rate, or if SBP below the value obtained in the same position prior to
testing
2
, • ST or QRS changes such as excessive ST depression (>2 mm horizontal or down sloping ST-
segment depression) or marked axis shift
• Arrhythmias other than sustained V Tach, including multifocal PVCs, triplets of PVCs, SVT,
heart block, or bradyarrhythmias
• Fatigue, shortness of breath, wheezing, leg cramps, or claudication
• Development of bundle-branch block or intraventricular conduction delay that cannot be
distinguished from V Tach
• Increasing chest pain
• Hypertensive response (SBP>250 mmHg and/or DBP>115 mmHg)
ST segment depression - ANSWER ≥1 mm of horizontal or down sloping ST↓ 60-80 ms
beyond the J point suggesting myocardial ischemia
Chronotropic incompetence - ANSWER 1. Peak exercise HR about 20 BPM below the age
predicted HRmax or an inability to achieve > 85% of the age predicted HRmax for subjects
limited by volitional fatigue.
2. Chronotropic index <.8
Heart Rate Recovery - ANSWER less than or equal to 12 BPM at 1 minute for walking, or
less than or equal to 22 BPM at 2 mins for supine position
Sensitivity - ANSWER % of pts. tested with known CVD who demonstrate significant ST
segment changes.
Exercise EKG sensitivity usually requires greater than or equal to 70% stenosis
True Positive - ANSWER Horizontal or down sloping ST segment depression of ≥1.0 mm
and correctly identifies a patient with CVD
False Negative - ANSWER test shows no or non-diagnostic ECG changes and fails to
identify patients with underlying CVD
3
