- In treadmill stress testing, the patient walks a treadmill or rides a stationary bicycle until reaching a target heart rate; typically 70% to 80% of the maximum predicted heart rate. Treadmill stress testing has 70% sensitivity and specificity among the general population.
- Indications for stress testing have been adapted from the American Heart Association (AHA) and the American College of Cardiology (ACC)
- Reasons for terminating a stress test include:
- ST-segment elevations of 2 mm or more.
- 20 mm Hg drop in systolic blood pressure.
- Drop in heart rate or the development of heart block.
- Progressively increasing angina.
- ST-segment depression of 2 mm or greater.
- Three or more premature ventricular contractions (PVCs).
- Supraventricular arrhythmias.
- Severe hypertension.
- ST-segment depression at baseline that progresses during the test.
- Claudication.
- Fatigue, dyspnea, or feelings of light-headedness.
- Equipment malfunction.
-
- Complications of stress testing include supraventricular tachyarrhythmias, bradycardias, heart failure, hypotension, ventricular ectopy (due to ventricular tachycardia), ventricular fibrillation, stroke, MI, and death.
- Contraindications for performing a stress test include:
- AMI.
- Unstable coronary syndrome.
- Wolff-Parkinson-White syndrome.
- Uncontrolled arrhythmias.
- High-degree atrioventricular (AV) blocks.
- Acute myocarditis.
- Acute pericarditis.
- Severe aortic stenosis.
- Uncontrolled hypertension.
-
Nursing and Patient Care Considerations
- Explain to patient how the procedure will be done and screen for contraindications.
- Advise patient to abstain from eating, smoking, and consuming caffeine for 2 hours before the test.
- Inform patient that monitoring will occur throughout the test for signs of complications.
- Advise patient to inform you of how he is feeling during the test.
- Monitor patient throughout testing for color, respirations, ECG changes, and blood pressure.
