![]() ![]() Treatment is indicated to achieve the following goals: BP <140/90 mm Hg, and hemoglobin A1c <7%. Intensive lifestyle modification is appropriate for all patients (smoking cessation, regular physical activity, "heart healthy" diet). History of surviving sudden cardiac death High pretest probability of left main or three-vessel CAD (a Duke treadmill score ≤−11) uncertain diagnosis after noninvasive testing Select coronary angiography for patients with high pretest probability of disease or: Stress tests should be terminated when the patient has exerted maximal effort and achieved at least 85% PMHR, the patient requests to stop or experiences significant anginal or other physical symptoms, or when other adverse markers develop, such as exertional hypotension, significant hypertension, ST-segment elevation or significant ST-segment depression, or ventricular or supraventricular arrhythmias. 1) Ideally, patients should exercise for 6 to 12 minutes to provide adequate time for development of maximal metabolic demand.Ģ) Although achieving 85% of the age-predicted maximal heart rate (PMHR) is considered adequate for diagnosis of ischemia, as heart rate and blood pressure are the major determinants of myocardial oxygen demand, patients should continue to exercise until limited by symptoms.ģ) Achieving a rate pressure product (heart rate × systolic blood pressure) of at least 25,000 is also considered an adequate workload, as this measure reflects left ventricular myocardial performance.Ī standard Bruce protocol increases the speed and grade of the treadmill every 3 minutes, and patients who have poor functional capacity and cannot achieve at least the first stage of the Bruce protocol (5 metabolic equivalents ) have significantly higher all-cause mortality. ![]()
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