Stress Testing in Children

2018 ◽  
pp. 517-532
Author(s):  
Brandy Hattendorf
Keyword(s):  
Exercise Testing ◽  
Congenital Heart ◽  
Stress Testing ◽  
Cardiovascular Response ◽  
Maximal Oxygen Consumption ◽  
Signs And Symptoms ◽  
Disease Etiology ◽  
Lung Capacity ◽  
Exercise Induced ◽  
Surgical Treatments

The chapter Stress Testing in Children reviews the opportunity to evaluate children with congenital and acquired cardiovascular disease. Clinical pediatric exercise testing differs from adult testing in both disease etiology as well as the characteristics of cardiovascular response. Unlike exercise testing in adults, the indications for testing in pediatrics generally are not to evaluate for ischemia. Commonly, pediatric exercise testing is used to evaluate specific signs and symptoms induced or aggravated by exercise, including identification of exercise induced arrhythmias, whereas metabolic testing can provide further patient information regarding cardiac output, maximal oxygen consumption, and lung capacity. Exercise testing can also assess the efficacy of medical or surgical treatments for individual congenital heart disease patients. Functional capacity can be used to determine patient safety for recreational, athletic, and vocational activities. Exercise modification and restrictions are necessary for some patients based on the data provided by exercise testing.

Exercise Testing in Patients with Arrhythmias

1990 ◽  
Vol 2 (3) ◽  
pp. 230-248
Author(s):  
Steven R. Neish ◽  
Richard A. Friedman ◽  
J. Timothy Bricker
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Exercise Testing ◽  
Cardiac Rhythm ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Antiarrhythmic Therapy ◽  
Important Method ◽  
Evaluation Exercise ◽  
Exercise Induced

Exercise testing has become an important method for evaluation of pediatric patients with known or suspected arrhythmias. It has proven useful in patients with exercise-induced symptoms, patients with congenital heart disease, and patients with pacemakers. Exercise has predictable effects on the normal electrocardiogram. Exercise can also bring out abnormalities in cardiac rhythm that may not be present at rest. The results of exercise testing can provide information that directs further therapy or evaluation. Exercise testing also helps to evaluate the efficacy of antiarrhythmic therapy in some patients.

Protocols of exercise testing in athletes and cardiopulmonary testing: assessment of fitness

2019 ◽  
pp. 87-97
Author(s):  
Marco Guazzi ◽  
Paolo Emilio Adami
Keyword(s):  
Exercise Testing ◽  
Cardiovascular Response ◽  
Cardiopulmonary Exercise Testing ◽  
Gas Analysis ◽  
Fundamental Information ◽  
Expired Gas Analysis ◽  
Expired Gas ◽  
Exercise Induced ◽  
Response To Exercise ◽  
Cardiopulmonary Testing

Exercise and cardiopulmonary exercise testing are essential in the evaluation of the cardiovascular response to exercise. They are clinically used to evaluate the subject’s capacity to tolerate increasing work loads. Throughout the tests electrocardiographic, haemodynamic, and symptomatic responses are monitored to assess ischaemic, hypertensive, and arrhythmic manifestations of disease. Ventilatory expired gas analysis may also be performed, as it provides fundamental information, particularly in patients with congestive heart failure or other exercise-induced limitations.

Ellestad's Stress Testing

2018 ◽  
Keyword(s):  
Exercise Testing ◽  
Stress Testing ◽  
Exercise Physiology ◽  
Obstructive Coronary Artery Disease ◽  
Diagnostic Testing ◽  
Case Examples ◽  
St Segment ◽  
The Face ◽  
Artery Disease ◽  
Exercise Induced

The 6th edition of the textbook Ellestad’s Stress Testing: Principles and Practice was written for the new and veteran clinician alike performing stress testing. Thoroughly updated, referenced and interspersed with case examples, the book reviews how to get the most out exercise testing, without and with ancillary imaging. In addition to evaluation of ST segment depression, other powerful tools to detect ischemia and forecast the future are reviewed to increase the diagnostic accuracy and prognostic ability of exercise testing. The recognition and significance of exercise induced arrhythmias and conduction defects are examined. When to convert to pharmacologic stress or add ancillary imaging, including myocardial perfusion imaging, echocardiography, coronary calcium scoring, and magnetic reference imaging are reviewed. The use of stress testing in the management of obstructive and non-obstructive coronary artery disease (CAD), heart failure, cardiac rehabilitation, peripheral vascular disease, congenital heart and other cardiovascular diseases (CVD) is examined. Options to optimize the diagnostic capabilities of exercise and other diagnostic testing for women are highlighted. Strategic use of exercise testing in the face of a decreasing burden of CAD in the developed world, as well as the opportunity to rely on exercise testing as the first test to evaluate CVD in the developing world, are reviewed. The fundamentals of exercise physiology and myocardial ischemia that serve as the foundation for exercise testing in health and disease are explained.

Stress Testing Protocols

2018 ◽  
pp. 135-148
Author(s):  
Gregory S. Thomas ◽  
Myrvin H. Ellestad
Keyword(s):  
Oxygen Consumption ◽  
Exercise Testing ◽  
Mental Stress ◽  
Stress Testing ◽  
Intermittent Exercise ◽  
Maximal Oxygen Consumption ◽  
Peak Exercise ◽  
Bicycle Ergometry ◽  
Submaximal Effort ◽  
Testing Protocols

The chapter Exercise Testing Protocols compares the types of protocols available. Historically, exercise testing began with protocols eliciting a submaximal effort. With time, other protocols were developed including intermittent exercise with rest between exercise stages, a ramp protocol with gradually increasing stages, bicycle ergometry, isometric testing and mental stress testing. Given their ability to measure or estimate maximal oxygen consumption (V̇02max) and assess myocardial ischemia during and a peak exercise, maximal treadmill exercise protocols became the most popular. Most commonly used have been those of Bruce, Ellestad, Balke and Ware, Astrand, and Cornell. All successfully achieve maximal workload in a predictable manner.

Exercise in congenital heart disease

1991 ◽  
Vol 1 (2) ◽  
pp. 129-135 ◽  
Author(s):  
Seamus Cullen ◽  
David S. Celermajer ◽  
John E. Deanfield
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Cardiovascular Response ◽  
Heart Defects ◽  
Cardiovascular Fitness ◽  
Subaortic Stenosis ◽  
Exercise Induced ◽  
The Individual ◽  
Response To Exercise

SummaryExercise is of both physical and psychological benefit in children with congenital heart disease, leading to improved cardiovascular fitness and better quality of life. In such children, however, capacity for exercise is often impaired, and there is a risk of exercise-induced mortality or morbidity. We have reviewed the abnormal cardiovascular response to exercise in children with congenital heart defects and postoperative residua, and the role of exercise testing and training in their diagnosis and treatment. Some patients should be excluded absolutely from all but mild regular exercise because of known high risk; for example, those with severe aortic or subaortic stenosis. Other patients should be encouraged to participate in sports without any limitation; for example, those with small left-to-right shunts or mild valvar regurgitation. In many patients strict recommendations cannot be made, and one must consider the individual, the lesion and its hemodynamic implications, and the type and level of exercise contemplated. Children with congenital heart disease should be encouraged to participate in exercise and recreational sport within the limits provided by their cardiovascular defect. Understanding the pathophysiology of these defects, and knowledge of the risk of exercise in certain conditions, will allow the physician to make sensible recommendations for participation in exercise by individual patients.

scholarly journals Cardiopulmonary Exercise Testing—A Valuable Tool, Not Gatekeeper When Referring Patients With Adult Congenital Heart Disease for Transplant Evaluation

2019 ◽  
Vol 10 (3) ◽  
pp. 286-291 ◽  
Author(s):  
Jonathan N. Menachem ◽  
Nosheen Reza ◽  
Jeremy A. Mazurek ◽  
Danielle Burstein ◽  
Edo Y. Birati ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Exercise Testing ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Consumption ◽  
Cardiopulmonary Exercise ◽  
Advanced Therapies ◽  
Adult Congenital

Introduction: Treatment of patients with adult congenital heart disease (ACHD) with advanced therapies including heart transplant (HT) is often delayed due to paucity of objective prognostic markers for the severity of heart failure (HF). While the utility of Cardiopulmonary Exercise Testing (CPET) in non-ACHD patients has been well-defined as it relates to prognosis, CPET for this purpose in ACHD is still under investigation. Methods: We performed a retrospective cohort study of 20 consecutive patients with ACHD who underwent HT between March 2010 and February 2016. Only 12 of 20 patients underwent CPET prior to transplantation. Demographics, standard measures of CPET interpretation, and 30-day and 1-year post transplantation outcomes were collected. Results: Patient Characteristics. Twenty patients with ACHD were transplanted at a median of 40 years of age (range: 23-57 years). Of the 12 patients who underwent CPET, 4 had undergone Fontan procedures, 4 had tetralogy of Fallot, 3 had d-transposition of the great arteries, and 1 had Ebstein anomaly. Thirty-day and one-year survival was 100%. All tests included in the analysis had a peak respiratory quotient _1.0. The median peak oxygen consumption per unit time (_VO2) for all diagnoses was 18.2 mL/kg/min (46% predicted), ranging from 12.2 to 22.6. Conclusion: There is a paucity of data to support best practices for patients with ACHD requiring transplantation. While it cannot be proven based on available data, it could be inferred that outcomes would have been worse or perhaps life sustaining options unavailable if providers delayed referral because of the lack of attainment of CPET-specific thresholds.

A comparison of the diagnostic performance of the ST/HR hysteresis with cardiopulmonary stress testing parameters in detecting exercise-induced myocardial ischemia

2013 ◽  
Vol 168 (2) ◽  
pp. 1274-1279 ◽  
Author(s):  
Marco Zimarino ◽  
Luca Barnabei ◽  
Rosalinda Madonna ◽  
Giuseppe Palmieri ◽  
Francesco Radico ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Diagnostic Performance ◽  
Stress Testing ◽  
Exercise Induced

scholarly journals Is Bisphosphonate-Related Osteonecrosis of the Jaw an Infection? A Histological and Microbiological Ten-Year Summary

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
A. M. Hinson ◽  
C. W. Smith ◽  
E. R. Siegel ◽  
B. C. Stack
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
Large Scale ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Osteonecrosis Of The Jaw ◽  
Multifactorial Disease ◽  
Clinical Signs And Symptoms ◽  
Surgical Treatments

The role of infection in the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is poorly understood. Large-scale epidemiological descriptions of the histology and microbiology of BRONJ are not found in the literature. Herein, we present a systematic review of BRONJ histology and microbiology (including demographics, immunocompromised associations, clinical signs and symptoms, disease severity, antibiotic and surgical treatments, and recovery status) validating that infection should still be considered a prime component in the multifactorial disease.

Exercise-Induced Scalenus Syndrome

2008 ◽  
Vol 36 (2) ◽  
pp. 369-374 ◽  
Author(s):  
Panagiotis Baltopoulos ◽  
Charalampos Tsintzos ◽  
George Prionas ◽  
Maria Tsironi
Keyword(s):  
Quality Of Life ◽  
Thoracic Outlet Syndrome ◽  
Surgical Intervention ◽  
Case Series ◽  
Signs And Symptoms ◽  
Underlying Mechanism ◽  
Level Of Evidence ◽  
Full Activity ◽  
Exercise Induced

Background Thoracic outlet syndrome is described as a group of distinct disorders producing signs and symptoms attributed to compression of nerves and blood vessels in the thoracic outlet region. Purpose To describe the exercise-induced scalenus anticus syndrome attributed to the anterior scalenus hypertrophy as a thoracic outlet syndrome underlying mechanism and to give recommendations for a safe and effective surgical treatment. Study Design Case series; Level of evidence, 4. Methods Twelve young professional athletes admitted for thoracic outlet syndrome (8 cases of neurologic thoracic outlet syndrome, 4 cases of mixed neurologic and vascular thoracic outlet syndrome) who reported numbness, tingling, early fatigue, muscle weakness, and pain were enrolled in the study. Scalenus hypertrophy was suspected to be the causative factor. Scalenectomy was performed in all cases. Results All patients had moderate to severe hypertrophy of the anterior scalenus muscle. Scalenectomy was performed, and there were no intraoperative or postoperative complications. Full activity was quickly achieved, and no recurrence of symptoms was documented. Conclusion Surgical intervention for scalenus anticus syndrome can allow an athlete to return to full activity and improve quality of life. Surgical intervention seems to be the treatment of choice in terms of restoring quality of life and physical activity.

scholarly journals Effect of Beta-Blocker Therapy, Maximal Heart Rate, and Exercise Capacity During Stress Testing on Long-Term Survival (from The Henry Ford Exercise Testing Project)

2016 ◽  
Vol 118 (11) ◽  
pp. 1751-1757 ◽  
Author(s):  
Rupert K. Hung ◽  
Mouaz H. Al-Mallah ◽  
Seamus P. Whelton ◽  
Erin D. Michos ◽  
Roger S. Blumenthal ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Capacity ◽  
Exercise Testing ◽  
Beta Blocker ◽  
Stress Testing ◽  
Maximal Heart Rate ◽  
Term Survival ◽  
Blocker Therapy ◽  
Henry Ford
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