Criteria for Exercise Stress Tests and COPD Management

What is the target heart rate (THR) for an exercise stress test?

Typically calculated as 85% of age-predicted max HR (220 − age).

What indicates a positive exercise stress test?

Symptoms indicating heart conditions (eg. myocardial ischaemia, CAD). Symptoms include: ≥1 mm horizontal or downsloping ST segment depression, angina symptoms, abnormal blood pressure or heart rate response, or ventricular arrhythmias.

What defines a negative exercise stress test?

No signs/symptoms of heart conditions, adequate heart rate achieved, and normal ECG response.

Who should receive an Implantable Cardioverter Defibrillator (ICD)?

Had a dangerous heart rhythm that was not caused by something fixable

Have weak heart pumping (low ejection fraction), especially with heart failure symptoms

Have blocked heart arteries and irregular heartbeats during tests

A weak heart

Have a genetic heart condition like long QT, or a thick heart muscle

What is the left ventricular ejection fraction (LVEF) threshold for ICD consideration in heart failure?

LVEF ≤ 35% with NYHA class II or III heart failure.

What are the thresholds for peripheral arterial obstructive disease (PAOD) assessments in hospital?

Peripheral ischaemic threshold < angina threshold ≤ STOP intensity.

What are the thresholds for PAOD assessments out of hospital?

Peripheral ischaemic threshold ≤ STOP intensity ≤ angina threshold.

What are pharmacological stress tests used for?

Used when patients can't perform physical exercise, utilizing drugs like dobutamine or adenosine to mimic exercise stress on the heart.

What does mean arterial pressure indicate?

Average pressure in arteries during one cardiac cycle, indicating perfusion pressure to organs.

How is mean arterial pressure calculated?

Calculated as: (2xDiastolic + Systolic) ÷ 3.

What is the normal range for mean arterial pressure?

70-100 mmHg; below 60 mmHg may indicate inadequate perfusion.

What is the role of exercise in managing COPD?

Improves physical function, reduces symptoms, and enhances quality of life.

What are the key benefits of exercise for COPD patients?

Reduces breathlessness and fatigue, improves muscle strength, increases exercise tolerance, and enhances quality of life.

What should be reviewed before starting an exercise program for COPD?

Current treatments, co-morbidities, and a cardiopulmonary exercise test.

What components should an exercise plan for COPD include?

Lower and upper limb endurance and strength training, interval training, flexibility work, inspiratory muscle training, and balance training.

What monitoring should be done during exercise for COPD patients?

Use RPE (Rate of Perceived Exertion), monitor dyspnoea, oxygen saturation, heart rate, and blood pressure.

What is the significance of a cardiopulmonary exercise test before starting an exercise program?

To assess safety, identify limitations (e.g., ischemia, hypoxia), and guide exercise prescription.

What is the recommended action before starting an exercise program for COPD patients?

Medical clearance is advised.

What is the purpose of inspiratory muscle training in COPD exercise plans?

To improve respiratory muscle strength and function.

What is the importance of balance training in COPD exercise programs?

To reduce the risk of falls.

What are the signs of myocardial ischemia during an exercise stress test?

ST segment depression, angina symptoms, abnormal heart rate or blood pressure responses.

What is the significance of ventricular arrhythmias in an exercise stress test?

They indicate a positive test suggesting myocardial ischemia.