心电图教程6.pptVIP

HLT0073Class 5Cardiac DiagnosticsInstrumentation  Instructor: Joanne Lambley, MSc (Kin) Agenda Exercise Electrocardiography What is it? Who should be tested? Modalities Protocols Measurements Supervision Components of Test Exercise Electrocardiography What is Exercise Electrocardiography? Used in the clinical setting Assesses patient’s ability to tolerate increasing intensities of exercise Monitors ECG, BP, Symptoms For indications of exertion-related abnormalities (not present at rest) myocardial ischemia arrhythmias Who should be tested? Evaluation of disease severity among patients with known or suspected coronary artery disease (CAD) After MI, before hospital discharge Determine functional capacity Activity counseling Exercise prescription Return to work evaluation Estimate prognosis Exercise Test Modalities Most common: Treadmill Cycle ergometer Alternative method: Arm ergometry Treadmill More common form of exercise (walking) Patients more likely to obtain higher peak HR Should have handrails for patients to steady themselves, BUT…. Holding handrails should be discouraged as it: reduces the work done by the patient can interfere with quality of ECG recording Risk of fall – emergency stop button should be close by (for staff only) Cycle Ergometer Less expensive Require less space, portable Quieter Alternative for patients unable to perform weight-bearing exercise Less upper body movement Better quality ECG and BP measurements Unfamiliar exercise for many patients Highly dependent on patient motivation Must be able to adjust work rates in increments Electronically braked Mechanically braked Arm Ergometer Alternative for patients who cannot perform leg exercise Replaced by nonexercise pharmacologic stress testing (ie persantine) Sensitivity for detection of CAD less than treadmill testing Can be used for exercise prescription for disabled Exercise Protocols Test should last 8 – 12 min Bruce protocol most common Stage 1: 1.7 mph and 10% grade Stage 2: