post-MI exercise testing; rehabilitation treadmill testing; predischarge exercise testing
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Introduction
Post-MI exercise testing limited exercise testing on selected patients with myocardial infarction may be done 8-10 days post-MI, &/or pre-hospital discharge.
Indications
- prognosis/mortality risk assessment
- to select patients for earlier discharge & more rapid rehabilitation
- to detect patients with conduction instability
- to determine adequacy of medical management
- to facilitate planning a safe home activity program
- to achieve a favorable psychologic impact
Selection of patients:
- patient physically able to walk on treadmill
- electrically stable - controlled ventricular ectopy
- hemodynamically stable
- no symptoms congestive heart failure
- no pulmonary edema
- no persistent venous stasis
- no persistent hypotension as a complication of myocardial infarction
- special consideration given to patients with
- resting pulse > 95/min
- diastolic BP > 95
- systolic BP < 95
- > 10 mm Hg postural drop in BP
- 2nd or 3rd degree heart block
- active myocarditis
- recently implanted pacemaker
- no symptoms congestive heart failure
Procedure
Naughton protocol is generally used.
Termination of test
- 70% of maximum predicted heart rate (MPHR)
- heart rate of 130/min
- 4 mets of activity
- ischemia
- excessive fatigue, dyspnea or dizziness
- progressive decrease in heart rate of systolic BP
- increased AV block
- significant new or increasing ventricular ectopy
- excessive vasoconstriction (cool & clammy)
- musculoskeletal symptoms or difficulty with balance
- supervening atrial fibrillation or flutter
Interpretation
- indications for cardiac catherization[1]
- unable to exercise
- exercise-induced ST-segment depression
- failure to acheive 5 METS
- failure to increase systolic blood pressure by 10-30 mm Hg