Clinical Case Database / Category: Patient Management
Supervising an exercise treadmill test
James SG Signy, Stephen F Copeland, Janet A Scott, Mark Signy
Foundation Years Journal, volume 3, issue 2, p.20 (123Doc Education, London, March 2009)
The exercise treadmill test, usually performed to a graduated routine known as the Bruce protocol, has been a standard test for investigating chest pain and ischaemic heart disease (IHD) for many years and is still very widely used. As a Foundation Year colleague you may be asked as part of your programme in cardiology or acute medicine to assist with the supervision of these tests. When used properly they are easy to do, informative and a very useful contribution to the diagnosis and subsequent treatment of patients with ischaemic heart disease. In this short paper, we have tried to summarise the indications for treadmill testing, the pretest contraindications to look out for, the test itself, what constitutes a positive or negative test and the possible complications. It is by necessity a brief run-through and further reading is recommended below. The section about the test itself has been written by a senior cardiac physiologist and a consultant nurse. When supervising a test, you should always be accompanied by a well-qualified cardiac physiologist or nurse and do not feel any qualms about asking them for help and advice. Many of them have supervised literally thousands of tests.
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James SG Signy
Peninsula Medical School
Stephen F Copeland
Senior Chief Cardiac Physiologist and Cardiac manager
Janet A Scott
Worthing Hospital and Royal Sussex County Hospital
1. Sekhri N, Feder GS, Junghans C, Eldridge S, Umaipalan A, Madhu R, Hemingway H, Timmis AD. Incremental prognostic value of the exercise electrocardiogram in the initial assessment of patients with suspected angina: cohort study. BMJ, November 2008, 13(337):A2240.
2. Hill J, Timmis A. Exercise tolerance testing (review). BMJ, 4 May 2002, 324(7345):1084â€“1087.
3. Mark DB, Hlatky MAS, Harrell FE, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med, 1987, 106:793â€“800.
4. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines. J Am Coll Cardiol, 16 October 2002, 40(8):1531â€“1540 (full guideline on ACC website).
5. Clinical guidance by consensus: recommendations for clinical exercise tolerance testing. Society for Cardiological Science and Technology/British Cardiovascular Society 2008. (Guideline document.)
6. Abramson B. Electrocardiography in suspected angina. BMJ, November 2008, 13(337):A2340. 7. Gershlick AH, de Belder M, Chambers J, Hackett D, Keal R, Kelion A, Neubauer S, Pennell DJ, Rothman M, Signy M, Wilde P. Role of non-invasive imaging in the management of coronary artery disease: an assessment of likely change over the next 10 years. A report from the British Cardiovascular Society Working Group (review). Heart, April 2007, 93(4):423â€“431.
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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