This extensive list of contraindications shows that a good clinical history is required prior to performing the test.
- Acute myocardial infarction (within 2 days)
- Unstable angina (rest pain in previous 48 hours)
- Uncontrolled cardiac arrhythmias
- Symptomatic severe aortic stenosis
- Uncontrolled heart failure
- Acute pulmonary embolus or pulmonary infarction
- Acute myocarditis or pericarditis
- Acute aortic dissection
- Severe pulmonary hypertension
- Left main coronary stenosis
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- Moderate stenotic valvular heart disease
- Electrolyte abnormalities
- Severe hypertension (systolic >200mmHg, diastolic >110mmHg)
- Tachyarrhythmias
- Bradyarrythmias
- Severe hypertrophic obstructive cardiomyopathy (HOCM) or other outflow tract obstruction
- High degree atrioventricular (AV) block
- Mental or physical impairment leading to inability to exercise adequately
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Click on the Indications for terminating a stress test tab above to continue.
The reasons for stopping a stress test fall into two main categories: ECG criteria and physical symptoms or signs.
ECG criteria
- Severe ST depression (>3mm)
- ST segment elevation >1mm in non-Q wave lead
- Frequent ventricular extrasystoles
- Sustained ventricular tachycardia
- New atrial fibrillation or suprventricular tachycardia
- Development of new bundle branch block (BBB)
- New second or third degree heart block
- Cardiac arrest
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Physical symptoms and signs
- Patient asks to stop due to fatigue (commonest reason)
- Moderate to severe angina
- Decrease in systolic blood pressure (BP) >10mmHg from baseline, despite an increase in workload, with evidence of ischaemia
- Hypertensive response (systolic >250mmHg, diastolic >115 mmHg)
- Increasing central nervous system (CNS) symptoms e.g. ataxia, dizziness, near syncope
- Fatigue, leg cramp claudication
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