Exercise
INDICATIONS:

1-Detection of CAD           .Intermediate pretest probability
                                       .High risk factors (DM, PAD, CVA...)
2-Risk stratification of post-MI patients
                                   
Prior to DC = Submaximal test at 4-6 days
                                   Early           = symptom-limited at 14-21 days
                                   Late            = symptom limited at 3-6 weeks
3-Risk stratification of chronic stable CAD into low risk category (managed medically) or high risk category
(revbascularization)
4-Risk stratification of low risk ACS 6-12 hours after presentation without active ischemia or heart failure
within
5-Risk stratification of intermediate risk ACS 1-3 days after presentation
6-Risk stratification before noncardiac surgery in patients with known CAD or those with high risk
factors for CAD
7-To evaluate the efficacy of therapeutic interventions
(anti-ischemic drug therapy or coronary
revascularization) and in
tracking subsequent risk based on serial changes in myocardial perfusion in known
CAD patients

ABSOLUTE CONTRAINDICATIONS:

1-High risk unstable angina
2-Decompensated or inadequately controlled CHF
3-Uncontrolled HTN (BP>200/110 mmHg)
4-Uncontrolled arrhythmia
5-Severe symptomatic aortic stenosis
6-Acute PE
7-Acute myocarditis or pericarditis
8-Acute aortic dissection
9-Severe pulmonary HTN
10-Acute MI (<4 days)
11-Acute illness

RELATIVE CONTRAINDICATIONS:

1-Known LM CAD
2-Moderate Aortic Stenosis
3-HOCM or outflow obstruction
4-Tachy/Brady arrhythmias
5-High degree AV Block
6-Electrolyte abnormalities
7-Mental / physical impairment

PHARMACOLOGIC INDICATIONS:
(combined with imaging - vasodilator not dobutamine)

1-LBBB
2-WPW
3-PPM

ENDING:

1-HR < 100 bpm and / or exercise induced ST changes resolved
2-At least 5 minutes into recovery
3-The radiotracer should be injected as close to peak exercise as possible, encourage 1 minute walking
afterwards
4-Blood pressure medications with antianginal properties (BB, CCB and nitrates) may lower the
diagnostic accuracy of the test

ALL EXERCISE TESTS SHOULD BE
SYMPTOM-LIMITED. Achievement of 85% of MAAPHR is not an
indication to stop.
(>2 mm) or St elevation (> 1mm) in leads without diagnostic Q waves except V1 or aVR
> 10 mmHg from baseline