Exercise Testing

Checking in to see if others have been performing exercise testing on post spontaneous coronary artery disease patients? I have been using similar guidelines as those post MI from CAD, but wondered if anyone is using different guidelines???

Mark: I performed an exercise test on a patient with SCAD (sudden coronary artery dissection) last week. This was my first. While there is a nice statement from the AHA on SCAD, there is little information on the conduct of an exercise test. We performed the test in order to provide an exercise prescription. In addition to traditional indications to terminate a test, we aimed to end the test when the patient reached anaerobic threshold (gas exchange was measured) or SBP>140 mmHg. The upper limit of the exercise prescription was set at a heart rate that was 10% below the heart rate at AT.

We've done quite a few of these over the past few years. In general, we perform CPET and follow symptom limitations and standard guidelines for exercise testing for patients with heart disease. As long as you're following the guidelines and monitoring (esp. drop in O2P/ BP and symptoms) you should not have any issues with adverse events. As with all higher risk patients, depending on the indication for CPET, we occasionally lower our termination threshold from RER 1.1 to 1.0 or 2nd ventilatory threshold, as @clintonabrawner suggested.

I don't recall having ever performed a TMST on a pt with history of sudden death. Most all of those pt's have an implanted ICD and we do not perform tests on ICD pt's for obvious reasons. We have performed TMST to see if the QT interval lengthens during exercise to see if they are at risk for a spontaneous event.

Marie- I'm assuming TMST= treadmill stress test. If correct, performing a maximal exercise stress test on patients with history of cardiac arrest and/or an implantable cardioverter defibrillator (ICD) is common for clinical indications and research. Risk for inappropriate shock is very low. If your lab primarily sees patients being evaluated for ischemic heart disease and not patients with known disease, this might be the reason you are not seeing patients with ICDs. -CB

Hey Mark: Check out table 3 in this recent JCRP article (it is free for a limited time), there are some great citations for this topic that you might find helpful.

https://journals.lww.com/jcrjournal/Fulltext/2021/11000/Rethinking_Rehabilitation__A_REVIEW_OF_PATIENT.4.aspx?context=FeaturedArticles&collectionId=4