Treadmill exercise stress testing in the assessment of severity and management of ischaemic heart disease - abstract

ABSTRACT

Patients with definite ischaemic heart disease were subjected to treadmill exercise stress testing to assess the severity of their disease. Twelve lead electrocardiographic recordings were done and Standard Bruce Protocol used. Critical disease was diagnosed with profound ST segment depression beginning within three minutes, at low heart rates, with angina, and attenuated or hypotensive blood pressure response. Disease was considered severe with marked ST depression beginning within 6 minutes and persisting the full duration was regarded as moderate positivity. Mild disease showed mild definite significant ST depression persisting for longer than 4 minutes with or without angina. Thirty six patients (32 M, 4 F) were studied over a six month period, Thirteen (36 percent) showed critical disease by the above criteria and urgent coronary angiography (C.A.) with a view to aorto-coronary bypass surgery (A.C.B.S.) was recommended. So far six had C.A. (ages 44-68); all showed critical left main equivalent disease. Five necessitated urgent A.C.B.S., a total of 16 gragts being used. There were six severly positive tests and C.A. has also been recommended for this group. One had myocaridal infarction 3 months after assessment. Medical therapy was regarded as optimal therapy for eight with moderate, and nine with mild disease. One had thallium stress test which did not show significant myocardium in jeopardy. Treadmill exercise stress testing is a useful non-invasive tool in selecting patients who will benefit from C.A. and A.C.B.S. as opposed to continuing medical therapy (AU)