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Family history
z Family history z
(m> 55, f> 65)
z Cigarette smoking
z Cigarette smoking
z Hypertension (<6 mo)
z Dyslipidemia
z Hypertension
z Impaired fasting glucose (>140/90)
z Obesity z Dyslipidemia
z Sedentary Lifestyle (TC >200 mg/dL, LDL > 130 mg/dL, HDL < 40
mg/dL, or on lipid lowering meds)
1
Risk Factors, cont. Is Stress Testing Safe?
2
ACSM Absolute Contra-
Conflicting Guidelines? Indications for testing pg 50
3
Stable vs. Non-Stable
Angina
Angina
z Characteristics z Silent angina
Substernal Pain ST depression but no symptoms
Precipitated by exertion z Stable angina
Promptly relieved by rest or nitroglycerin
occurs predictably with progressive
z Typical angina (patients with all exercise at approximately the same rate-
three characters) pressure product
z Atypical angina (patients with 2) z Unstable angina
z Nonanginal (patients with 1) abrupt increase in frequency or
(Roberts 97, pg 144) occurrence at rest
4
Relative Indications,
Case Studies
cont.
4. Fatigue, shortness of breathe, z Lessons learned
wheezing, leg cramps, claudication
dont test a person with unstable
5. BBB or intraventricular conduction angina (most important contra-
delay that cannot be distinguished indication)
from ventricular tachycardia
dont test a person with known,
6. Increasing chest pain severe, left coronary artery
disease
7. SBP > 250 mm Hg and/or DBP > 115
mm Hg dont continue a test if bp falls
with increase in work load
Conclusions
z Is stress testing
safe?
When yes
When no
z What can you do to
make stress testing
as safe as possible?
When not to test?
When to stop?