Q. Can you define termination of the stress Test?

Test should be terminated when:

1) PVCS develop in pairs or with increasing frequency or when ventricular tachycardia develops (runs of four or more PVCS).

2) Atrial tachycardia or atrial fibrillation supervenes.

3) There is onset of heart block - either 2nd or 3rd degree A-V block.

4) Angina pain is progressive (grade 3 pain, if grade 4 is the most severe in the patients experience).

5) ST-segment depression has become severe, i.e. 3 to 4mm or more in vigorous asymptomatic subjects. If the patient is known to have severe CAD or angina at low workloads of if the patient is known to have severe CAD or angina at low work loads or if the patient has ST- segment depression at rest, exercise should be terminated with only minor increases in ST- segment depression over the baseline tracing. One should also terminate exercise when ST- segment depression exceeds 2mm if the onset of ischaemia is at low work loads.

6) The heart rate or systolic blood pressure drops progressively with continuing exercise.

7) The patient is unable to continue because of dyspnoea, fatigue or feelings of faintness.

8) Musculoskeletal pain becomes severe, such as might occur with arthritis or claudication.

9) The patient looks vasoconstricted, i.e. pale and clammy.

10) Extreme elevations in systolic and diastolic blood pressures.

11) The patient has reached or exceeded that predicted maximum pulse rate.

12) The physician is in doubt. It takes experience to determine how far to push a sick patients.