Safety Of Stress Testing Research Articles

The Safety of Stress Testing in Patients With Aortic Aneurysm

The Safety of Stress Testing in Patients With Aortic Aneurysm

Safety of Stress Testing With Cocaine Use

Safety of Stress Testing With Cocaine Use

The Safety of Stress Testing in Patients With Seizure Disorder

The Safety of Stress Testing in Patients With Seizure Disorder

Complications of exercise and pharmacologic stress echocardiography.

Stress echocardiography is a diagnostic cardiovascular exam that is commonly utilized for multiple indications, including but not limited to the assessment of obstructive coronary artery disease, valvular disease, obstructive hypertrophic cardiomyopathy, and diastolic function. Stress echocardiography can be performed via both exercise and pharmacologic modalities. Exercise stress is performed with either treadmill or bicycle-based exercise. Pharmacologic stress is performed via either dobutamine or vasodilator-mediated (i.e., dipyridamole, adenosine) stress testing. Each of these modalities is associated with a low overall prevalence of major, life-threatening adverse outcomes, though adverse events are most common with dobutamine stress echocardiography. In light of the recent COVID-19 pandemic, the risk of infectious complications to both the patient and stress personnel cannot be negated; however, when certain precautions are taken, the risk of infectious complications appears minimal. In this article, we review each of the stress echocardiographic modalities, examine major potential adverse outcomes and contraindications, assess the risks of stress testing in the setting of a global pandemic, and examine the utilization and safety of stress testing in special patient populations (i.e., language barriers, pediatric patients, pregnancy).

Safety of Stress Testing by Paramedical Professionals

Safety of Stress Testing by Paramedical Professionals

Safety And Feasibility Of Stress Testing In Patients With Implantable Cardioverter Defibrillators

Stress testing is integral to evaluate patients with heart disease. However, few data are available regarding safety of stress testing in patients with implantable cardioverter defibrillators (ICDs). Some exercise laboratories consider maximal exercise stress testing and pharmacologic stress testing with dobutamine contraindications in patients with ICDs and some laboratories inactivate ICDs prior to stress testing. PURPOSE The aim of this retrospective study was to assess the safety and feasibility of exercise and pharmacologic stress testing (PST) in patients with ICDs. METHODS Patients with ICD implantation and subsequent stress testing were included in this analysis. Chart review was performed. Primary end-points were occurrence of malignant ventricular arrhythmias (MVAs), onset of burst pacing or ICD firing, cardiopulmonary resuscitation (CPR) or death during stress testing. Secondary end-points were need for urgent coronary revascularization based on stress testing results and hospital readmissions for MVAs. RESULTS From January 1999 to December 2003, 1734 patients underwent ICD implantation or generator replacement. A total of 84 patients subsequently underwent 107 stress tests at William Beaumont Hospital, Royal Oak. Mean age was 67±12 years and 76% were men. Indications for ICD implantation were dilated cardiomyopathy (51%), sustained ventricular tachycardia (39%), sudden cardiac death (8%) and long QT syndrome (1%). 41% underwent exercise stress testing and 59% underwent PST utilizing dobutamine (21%) or dipyridamole (38%). Left ventricular ejection fraction was 32±20. 71% had fixed defects and 22% had reversible perfusion defects as determined by myocardial perfusion imaging. None of the ICDs were inactivated prior to stress testing. Heart rate at peak stress averaged 92±27 beats per minute. 83% were on beta-receptor antagonists. Although 4% of patients had self-terminating, non-sustained ventricular tachycardia at peak stress, none had sustained ventricular tachycardia precipitating burst pacing, ICD shock, CPR or death. One patient underwent urgent coronary angiography, but was found to have non-critical coronary disease. There were no hospital readmissions for MVAs. CONCLUSIONS These preliminary findings suggest that stress testing can be performed safely in patients with ICDs. MVAs requiring emergent treatment are rare occurrences during stress testing. Knowledge of programmed ventricular tachycardia and ventricular fibrillation zones may help predetermine maximal heart rates on stress testing and preclude routine inactivation of ICDs prior to testing.

Safety of stress testing during the evolution of unstable angina pectoris or non–ST-elevation myocardial infarction

Patients (n = 1,106) were chosen from the conservative arm of the Treat Angina with aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction (TACTICS-TIMI) 18 trial. Only 1 patient had a myocardial infarction and another died on the day of stress testing (mortality 0.12%). In patients with unstable angina pectoris or non-ST-elevation myocardial infarction treated with aspirin, heparin, and tirofiban, performance of an exercise or a pharmacologic stress test in selected patients within 48 to 72 hours after admission appears to be associated with a low risk of complications.

Safety of stress testing in patients with hypertrophic cardiomyopathy

<h2>Abstract</h2> Two hundred sixty-three consecutive patients with hypertrophic cardiomyopathy underwent stress testing. Major complications occurred in 0.04% of patients and minor events occurred in 23%.

Safety of stress testing in patients with hypertrophic cardiomyopathy

Two hundred sixty-three consecutive patients with hypertrophic cardiomyopathy underwent stress testing. Major complications occurred in 0.04% of patients and minor events occurred in 23%.

1097-97 Safety of stress testing following an acute coronary syndrome

1097-97 Safety of stress testing following an acute coronary syndrome

Feasibility of Maximal Cardiopulmonary Exercise Testing in Patients With End-Stage Arthritis of the Hip and Knee Prior to Total Joint Arthroplasty

Although no studies exist, to our knowledge, that examine the feasibility and safety of stress testing in a consecutive series of patients with severe arthritis, musculoskeletal conditions are often listed as relative contraindications to graded exercise testing. The current study was designed to examine the feasibility of maximal exercise testing in patients with end-stage arthritis prior to total joint arthroplasty. An observational and descriptive study in a consecutive series of patients with severe arthritis. This study was conducted in the outpatient clinics and cardiopulmonary exercise physiology laboratory of a rural teaching hospital. Sixty-one patients with severe osteoarthritis and rheumatoid arthritis were recruited from the orthopedic surgical service immediately before total joint arthroplasty of the hip, knee, or both. A reference group of 23 nonarthritic control patients were recruited from the general medical population of the same hospital and subjected to measures of arthritis severity. The severity of arthritis was graded by assessment of variables reflective of subjective symptoms, lifestyle impact, joint deformity, and radiographic abnormality. Arthritic subjects underwent a single graded, maximal, symptom-limited, cardiopulmonary exercise test using an electronically braked ergometer and a metabolic cart. Subjects were first asked to pedal with their legs; those apparently incapable performed the same task using their arms. Ninety-five percent of subjects who presented for an exercise test were capable of symptom-limited exercise. Of 29 patients evaluated before hip replacement, 66% completed leg tests, 31% completed arm tests, and 3% were incapable of symptom-limited exercise. Of 30 patients evaluated before knee replacement, 57% completed leg tests and 37% completed arm tests, while 7% were incapable of symptom-limited exercise. Two patients were evaluated before hip and knee surgery; one completed a leg study and one completed an arm study. Among the 37 subjects completing leg tests, a mean percentage of age-predicted maximum heart rate (APMHR) of 92 +/- 11% and a mean respiratory exchange ratio (RER) of 1.15 +/- 0.13 were noted. Among the 21 completing arm tests, a mean percentage of APMHR of 87 +/- 11% and a mean RER of 1.10 +/- 0.10 were observed. High rates of achievement of physiologic values indicative of maximal exercise (80% or more of APMHR and RER > or = 1.0) were noted in individuals in both exercise groups. Similar findings were noted regardless of the patient's subjective symptomatic limitation to exercise and the presence or absence of documented or suspected coronary heart disease. Most patients with severe arthritis are capable of maximal, symptom-limited exercise using ergometry methods. Ergometry stress testing may be a viable, low-cost alternative to dipyramidole-thallium testing or cardiac catheterization in some patients with arthritis warranting objective assessment of known or suspected cardiac disease.

Complications of ergometer exercise in children

To determine the frequency of significant complications of exercise testing in children, we reviewed 1,730 studies performed over a 9-year period, 1973 to 1982. The protocol used a graded, continuous test to maximal effort on a cycle ergometer. The overall incidence of complications was 1.79%, similar to the 1.7% previously reported by Freed [4]. No deaths occurred. Complications were classified into 4 groups with their frequency of occurrence as follows: chest pain (0.69%), dizziness or syncope (0.29%), decreased blood pressure (0.35%), hazardous arrhythmias (0.46%). These data confirm that exercise testing in children has low morbidity and mortality. We believe that the safety of stress testing should encourage physicians to expand its use in the assessment of functional ability.