Guidelines for results of open access exercise test

NEGATIVE
NEGATIVE SUBMAXIMAL
EQUIVOCAL
POSITIVE
 
ADVERSE POSITIVE
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Max sensitivity of test is 70% - beware false negatives! Coronary ischaemia reasonably excluded Highly unrelaiable for exclusion of ischaemia Unreliable result
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Specificity of test approx 90% so +ve test usually denotes definite coronary ischaemia
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Aspirin 150mg daily
REVERSE RISK FACTORS
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Reconsider symptoms and overall likelihood of CAD
Refer cardiologist if indicated
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      Increment medication:
Sublingual GTN or spray
+ Beta blocker
+/- Regular nitrate
+/- Calcium antagonist
+/- Nicorandil 		  Maximise medication:
Sublingual GTN or spray
+ Beta blocker
+ Regular nitrate
+ Calcium antagonist
+ Nicorandil
     
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      Good anginal relief by <= 2 agents? All need assessment for angiography
     
| Yes
| No
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      GP review Refer to cardiologist

 

Some notes on exercise tests and reporting of results

Maximum HR with exercise:
 
Best reliability
Less reliable
Unreliable
Target is 220 minus age in years
 
Peak HR = 100% of max
Peak HR = 85-100% of max
Peak HR = <85% of max
Exercise time of standard Bruce: if <6mins = adverse feature
Limiting symptoms: did pt develop symptom in question (angina)?
Positive test if: planar or downsloping ST depression >= 1mm
Lead groups: II,III,aVF = inferior
I, aVL = high lateral
V1,V2,V3 = anteroseptal
V4,V5,V6 = anterolateral