Skip to main content
SpringerLink
Log in

Interpreting the Exercise Test

  • Chapter
Book cover Exercise Stress Testing for Primary Care and Sports Medicine

  • 1432 Accesses

This chapter focuses on the interpretation of the exercise test. The first half discusses the important parameters of the test to be evaluated. The second half discusses how the information from the test can be used to estimate the probability of coronary disease and likelihood of future cardiac events. This important area of risk stratification allows the physician to place the patient in low-, moderate-, or high-risk groups and to identify which patients benefit from referral to cardiology for consideration of revascularization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Londeree BR, Moeschberger ML. Influence of age and other factors on maximal heart rate. J Cardiopulm Rehabil 1984;4: 44–49.

    Google Scholar 

  2. Froelicher VF, Myers J. Exercise and the Heart, 5th ed. Elsevier, 2006, 110.

    Google Scholar 

  3. Froelicher VF, Brammel H. Davis G, et al. A comparison of three maximal treadmill exercise protocols. J Appl Physiol 1974; 36: 720–725.

    Google Scholar 

  4. Sheffield LT, Malouf JA, Sawyer JA, et al. Maximal heart rate and treadmill performance of healthy women in relation to age. Circulation 1979; 57:79–84.

    Google Scholar 

  5. Cooper KH, Purdy JG, White SR et al. Age-fitness adjusted maximal heart rates. Med Sport 1977;10:78–88.

    Google Scholar 

  6. Bruce RA, Gey GO Jr., Cooper MN, et al. Seattle Heart Watch: Initial clinical, circulatory and electrocardiographic responses to maximal exercise. Am J Cardiol 1974; 33:459–469.

    Article  PubMed  CAS  Google Scholar 

  7. Azarbal B, Hayes SW, Lewin HC, Hachamovitch R, Cohen I, Berman DS. The incremental prognostic value of percentage of Heart Rate Reserve achieved over myocardial perfusion single-photon emission computed tomography in the prediction of cardiac death and all-cause mortality. JACC 2004;44:425–430.

    Google Scholar 

  8. Sandvik L, Eriksson J, Ellestad MH, Eriksson G, Thaulow E, Mundal R, Rodahl K. Heart rate increase and maximal heart rate during exercise as predictors of cardiovascular mortality: A 16 year follow-up study of 1960 healthy men. Coronary Artery Disease 1995;6: 667–679.

    Article  PubMed  CAS  Google Scholar 

  9. Ellestad MH. tress Testing: Principles and Practice, 4th ed. hiladelphia, A Davis, 996, 46.

    Google Scholar 

  10. McNeer JF, Margolis JR, Le KL, et al. The role of the exercise test in the evaluation of patients for ischemic heart disease. Circulation 1978; 57:64–70.

    PubMed  CAS  Google Scholar 

  11. Lauer MS, Okin PM, Larson MG Evans JC, Levy D. Impaired heart rate response to graded exercise: Prognostic implications of chronotropic incompetence in the Framingham Heart Study. Circulation 1996;93: 1520–1526.

    PubMed  CAS  Google Scholar 

  12. Ellestad MH, Wan MKC. Predictive implications of stress testing follow-up of 2700 subjects after maximum treadmill stress testing. irculation 1975;1:63.

    Google Scholar 

  13. Falcone C, Buzzi MP, Klersy C, Schwartz PJ. Rapid heart rate increase at onset of exercise predicts adverse cardiac events in patients with coronary artery disease. Circulation 2005; 112:1959–1964.

    Article  PubMed  Google Scholar 

  14. Leeper NJ, Dewey FE, Ashley EA, et al. Prognostic value of heart rate increase at onset of exercise testing. Circulation 2007; 115:468–474.

    Article  PubMed  Google Scholar 

  15. Cole CR, Blackstone EH, Pashkow FJ, et al. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 1999; 341:1351–1357.

    Article  PubMed  CAS  Google Scholar 

  16. Shetler K, Marcus R, Froelicher VF, et al. eart rate recovery: Validation and methodologic issues. Am Coll Cardiol 2001; 8;980–1987.

    Google Scholar 

  17. Ellestad MH. Stress Testing; Principles and Practice, 5th ed. Oxford University Press, 2003, 335.

    Google Scholar 

  18. Froelicher VF, Myers J. Exercise and the Heart, 5th ed. Elsevier, 2006, 120.

    Google Scholar 

  19. Taylor AJ, Beller GA. Postexercise systolic blood pressure response: Clinical Application to the assessment of ischemic heart disease. Amer Fam Physician 58; 1126–1130, 1998.

    Google Scholar 

  20. Ellestad MH. Stress Testing; Principles and Practice, 5th ed. Oxford University Press, 2003, 344–345.

    Google Scholar 

  21. Dubach P, Froelicher VF, Klein J et al. Exercise-induced hypotension in a male population-Criteria, causes, and prognosis. Circulation 1988;78: 1380–1387.

    PubMed  CAS  Google Scholar 

  22. Gibbons RJ, Balady GJ, Bricker JT et al. ACC/AHA 2002 Guideline update for exercise testing: a report of the ACC/AHA Task Force on Practice Guidelines 2002. Am Coll Cardiol Web Site.

    Google Scholar 

  23. Bodegard J, Erikssen G, Bjornholt JV, et al. Reasons for terminating an exercise test provide independent prognostic information. 2014 apparently healthy men followed for 26 years. Eur Heart J doi: 10.1093/eurheartj/ehi278.

    Google Scholar 

  24. Ellestad MH. Stress Testing; Principles and Practice, 5th ed. Oxford University Press, 2003, 296–297.

    Google Scholar 

  25. Udall JA, Ellestad MH. Predictive implications of ventricular premature contractions associated with treadmill stress testing. Circulation 1977;56:985–989.

    PubMed  CAS  Google Scholar 

  26. Jouven X, Zurick M, Desnos M, et al. Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations. N Eng J Med 2000;343: 826–833.

    Article  CAS  Google Scholar 

  27. ACSM’s resource manual for Guidelines for exercise testing and prescription. American College of Sports Medicine; 5th ed. Lippincott Williams and Wilkins, Baltimore, 2006, 122–126.

    Google Scholar 

  28. Myers J, Kaykha A, George S et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med 2004;117:912–918.

    Article  PubMed  Google Scholar 

  29. Evans CH, Harris G, Menold V, Ellestad MH. A Basic Approach to the interpretation of the exercise test. Primary Care 2001;28: 80–81.

    Google Scholar 

  30. Ellestad MH. Stress Testing; Principles and Practice, 5th ed. Oxford University Press, 2003, 43–75.

    Google Scholar 

  31. Stuart R, Ellestad MH. psloping ST-segments in exercise testing. m J Cardiol 1976;7:9.

    Article  Google Scholar 

  32. oldschlager N, Selzer A, Cohn K. Treadmill stress test as indicators of presence and severity of coronary artery disease. Ann Intern Med 1976; 85:277–286.

    Google Scholar 

  33. Taylor AJ, Beller GA. Patients with greater than 2 mm of ST depression do not have a greater ischemic burden by thallium-201 scintigraphy. Circulation 86(suppl II):138, 1992.

    Google Scholar 

  34. Dunn RF, et al. xercise-induced ST elevation. irculation 1980;1:89.

    Google Scholar 

  35. Ellestad MH. Stress Testing; Principles and Practice, 5th ed. Oxford University Press, 2003, 216–218.

    Google Scholar 

  36. Lee JH, Crump R, Ellestad MH. Significance of precordial T-wave increase during treadmill stress testing. Am J Cardiol 1995;76:1297–1299.

    Article  PubMed  CAS  Google Scholar 

  37. Rasouli ML, Ellestad MH. Usefulness of ST depression in ventricular premature complexes to predict myocardial ischemia. Am J Cardiol 2001;87: 891–894.

    Article  PubMed  CAS  Google Scholar 

  38. Selvester RH, Gillespie TL. imulated ECG surface map’s sensitivity to local segments of myocardium. In epeschkin E, Rush S. Eds. roceeding, Vermont Conference Body Surface Mapping of Cardiac Fields. Advances in Cardiology. Vol. 10. Basel, witzerland: S. Karger, Basel, 1974:120.

    Google Scholar 

  39. Ellstad MH, Crump R, Surber M. The significance of lead strength on ST changes during treadmill stress tests. J Electrocardiol 1993;25 (supp): 31.

    Google Scholar 

  40. Heller IH, Cates C, Popma J et al. Intracoronary Doppler assessment of moderate Coronary Artery Disease; Comparison with 201 TI imaging and coronary angiography. Circulation 1997; 96:484–490.

    PubMed  CAS  Google Scholar 

  41. Wilson RF, Marcus ML, Christensen BV, et al. Accuracy of exercise electrocardiography in detecting physiologically significant coronary arterial lesions. Circulation 1991;83: 412–420.

    PubMed  CAS  Google Scholar 

  42. Ellestad MH. The time has come to reexamine the gold standard when evaluating noninvasive testing. Am J Cardiol 2001;87: 100–101.

    Article  PubMed  CAS  Google Scholar 

  43. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 1979;300: 1350–1358.

    PubMed  CAS  Google Scholar 

  44. Epstein, SE: Implications of probability analysis on the strategy used for non-invasive detection of coronary artery disease. Am J Cardiol 46:491–499, 1980.

    Article  PubMed  CAS  Google Scholar 

  45. Mark DB, Hlathy MA, Harrell FE Jr., et al. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med 1987;106: 793–800.

    PubMed  CAS  Google Scholar 

  46. Mark DB, Shaw L, Harrell FE, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med 1991; 325:849–853.

    PubMed  CAS  Google Scholar 

  47. Morrow K, Morris CK, Froelicher VF, Hideg A. Prediction of cardiovascular death in men undergoing noninvasive evaluation for CAD. Ann Intern Med 1993;118: 689–695.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. St. Anthony’s Hospital, St. Petersburg, FL

    Corey H. Evans

  2. Private Practice Family Physician, Florida Institute of Family Medicine, St. Petersburg, FL, USA

    Corey H. Evans

  3. Exercise Laboratory, Memorial Heart Institute; Department of Cardiology, University of California, Irvine School of Medicine, Long Beach, CA, USA

    Myrvin H. Ellestad

Authors
  1. Corey H. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Myrvin H. Ellestad
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Private Practice Family Physician Florida Institute of Family Medicine, Director of Medical Education St. Anthony’s Hospital, St. Petersburg, FL, USA

    Corey H. Evans MD, MPH

  2. Director, Sports Medicine Fellowship Department of Community and Family Medicine, University of Missouri—Kansas City Truman Medical Center Lakewood, Kansas City, MO, USA

    Russell D. White MD (Professor of Medicine) (Professor of Medicine)

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Evans, C.H., Ellestad, M.H. (2009). Interpreting the Exercise Test. In: Evans, C.H., White, R.D. (eds) Exercise Stress Testing for Primary Care and Sports Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-76597-6_5

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-76597-6_5

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-76596-9

  • Online ISBN: 978-0-387-76597-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation