Pocket Guide to Stress Testing, 2nd Edition

The go-to handbook for those performing and analysing cardiac stress tests The stress test is key to the clinical evaluation and management of patients with known or potential cardiovascular disease. By measuring the heart's ability to respond to external stress, it can provide vital insights into the general physical condition of patients, highlighting abnormalities in blood flow, risk of coronary artery disease, and more. The Pocket Guide to Stress Testing gives cardiology professionals a complete breakdown of this everyday procedure that they can carry with them and consult on the go. This second edition has been fully revised to reflect the most up-to-date information available on the best approaches to conducting and interpreting various forms of stress test. With chapters spanning topics such as testing guidelines, nuclear imaging techniques, and emergency and aftercare protocols, the clear and practical contents cover all aspects of the subject. This essential new text includes: A complete overview of exercise stress testing, covering indications, protocols, preparation, and interpretation Guidelines for the standard treadmill test, as well as for the various pharmacological stress tests for patients unable to complete an exercise ECG test An extensive list of references and reading suggestions to help trainees to expand their knowledge End-of-chapter summaries and new tables and illustrations As the field of cardiology continues to change and develop apace, this new edition of The Pocket Guide to Stress Testing provides physicians, trainee cardiologists, and cardiac nurses with a reliable, up-to-date resource for use in everyday practice.

·  1 Introduction

·  Introduction

·  Pathophysiologic Considerations

·  Preparations and Precautions

·  Methodology

·  Endpoints to Terminate Exercise ECG Stress Tests

·  Indications Versus Contraindications (see Chapters 3 and 4)

·  Interpretations of the ECG Stress Test

·  Clinical Values of the Exercise ECG Test

·  Cardiac Arrhythmias and the Exercise ECG Test (Chapter 12)

·  Hemodynamic Responses to Exercise

·  Complications and Potential Risks (Chapters 12 and 21)

·  References

·  2 Preparations and Precautions

·  Introduction

·  Preparations and Precautions

·  History Taking and Physical Examination

·  12‐Lead Electrocardiogram

·  Blood Pressure (BP) Monitoring

·  Premature Test Termination

·  References

·  3 Indications

·  Introduction

·  Indications

·  References

·  4 Contraindications to Stress Testing

·  Introduction

·  Absolute Contraindications

·  Relative Contraindications

·  References

·  5 Exercise Stress ECG Test Protocols

·  Introduction

·  General Testing Procedures

·  Exercise ECG Testing Protocols

·  References

·  6 Stress ECG Testing with Nuclear Myocardial Perfusion Imaging Techniques

·  Introduction

·  Nuclear Perfusion Agents

·  Stress Test and Radiotracer Protocols

·  Image Interpretation

·  Clinical Application of Nuclear Myocardial Imaging

·  References

·  7 Stress Echocardiography

·  Introduction

·  Exercise Stress Echocardiography

·  Dobutamine Stress Echocardiography

·  Other Methods of Stress Echocardiography

·  References

·  8 Pharmacological Stress Testing

·  Introduction

·  Vasodilator Agents

·  Beta‐Adrenergic Agonist

·  References

·  9 Cardiopulmonary Exercise Testing

·  Introduction

·  Physiology

·  Procedural Aspects of CPX Testing

·  Measurements

·  Applications in Clinical Practice

·  Reporting

·  References

·  10 Stress Testing After Acute Coronary Syndromes

·  Introduction

·  Guidelines for Stress Testing After ACS

·  Exercise ECG Protocols After ACS

·  Myocardial Imaging

·  References

·  11 Proper Selection of the Mode of Stress Testing

·  Introduction

·  General Comments

·  Selection of Mode Stress Testing (see Figure 11.2)

·  References

·  12 Exercise‐induced Cardiac Arrhythmias

·  Introduction

·  Equipment

·  Electrophysiologic Effects of Exercise

·  Value of Exercise Stress Testing in Diagnosing and Managing Arrhythmias

·  Cardiac Arrhythmias and Termination of Exercise Testing

·  Classification, Diagnosis, and Clinical Significance of Exercise‐Induced Arrhythmias

·  References

·  13 Complications

·  Introduction

·  Cardiac Complications

·  Noncardiac Complications

·  Ill‐Defined and Miscellaneous Complications

·  References

·  14 Interpretation

·  Introduction

·  Physiologic Responses to Exercise

·  Abnormal Responses to Exercise

·  Electrocardiographic Changes

·  Hemodynamic Changes

·  Symptoms and Signs

·  Clinical Implications

·  Reporting

·  References

·  15 False‐Positive and False‐Negative Exercise ECG Test Results

·  Introduction

·  False‐Positive Exercise ECG Responses

·  False‐Negative Exercise ECG Responses

·  References

·  16 Pediatric Exercise Testing

·  Introduction

·  Indications for Exercise Testing of Children

·  Children’s Responses to Exercise

·  Performing Exercise Testing in Children

·  References

·  17 Follow‐up Care and Management

·  Introduction

·  General Principles and Goals of Exercise Stress Testing

·  Large Scale Studies Assessing Predictive Implications of Exercise ECG Stress Testing

·  Exercise ECG Parameters Associated with Prognosis

·  Prognostic Value of Myocardial Imaging

·  References

·  18 Value of Exercise (Stress) ECG Testing Before Engaging in Exercise Programs or Competitive Sports

·  Introduction

·  Proper Interpretation

·  Asymptomatic Patients

·  Prior to Vigorous Exercise or Competitive Sports

·  References

·  19 Exercise Prescriptions for Healthy Individuals and Cardiac Patients

·  Introduction

·  Physiology of Exercise

·  Exercise Prescription for Healthy Subjects

·  Exercise Prescription for the Cardiac Patient

·  References

·  20 Computer Technology in the Field of Exercise ECG Stress Testing

·  Introduction

·  Computer‐Driven Automated Performance of the Exercise ECG Test

·  Data Processing

·  Computerized Analysis of ST‐Segment Response to Stress

·  Computer Applications to Estimate Post‐Test Probability of CAD

·  References

·  21 Medicolegal Aspects of Stress ECG Testing

·  Introduction

·  The Stress Laboratory

·  Medical Personnel

·  Test Preparation (see Chapters 2 and 3)

·  Test Performance

·  Proper Emergency Equipment and Drugs

·  Medico‐legal Aspects as they Pertain to Stress ECG Testing

·  References

·  22 Educational Guide for Patients and Families

·  Introduction

·  Exercise ECG (Treadmill) Stress Test

·  Exercise‐Myocardial Perfusion Imaging (“Nuclear”) Scan

·  Vasodilator (Adenosine, Dipyridamole, or Regadenoson) Cardiac Perfusion Test

·  Dobutamine Myocardial Perfusion Imaging (“Nuclear”) Stress Test

·  Exercise Treadmill Test or Dobutamine Test with Echocardiography (“Stress Echocardiography”)

·  Important for All Tests