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Exercise Treadmill Testing Part I ,[object Object],[object Object],[object Object]
ETT  Workshop Format ,[object Object],[object Object],[object Object],[object Object],[object Object]
OBJECTIVES ,[object Object],[object Object],[object Object],[object Object]
ETT by Family Physicians ? ,[object Object],Goeschel DP et al, J Fam Pract 1994; 38:132
ETT by Family Physicians ? ,[object Object],Jurica,JW et al. Graded Exercise Stress Testing in Family Practice and Internal Medicine Residencies . J Fam Pract 1989; 29: 537-41
Why ETT? ,[object Object],[object Object]
Why ETT? ,[object Object]
Why ETT by Family Physicians? ,[object Object],[object Object],[object Object],[object Object]
Reasons cited by FPs not  performing ETT: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Fam Pract 1994 ; 38 (2) : 135
Conclusion ,[object Object],Goeschel, DP et al. Geographic Variation in Exercise Testing by Family Physicians. J Fam Pract 1994; 38 (2):132-137
Feasibility ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Competence in ETT: ACP / ACC / AHA Task Force, 1990 ,[object Object]
Maintenance of Competence: ACP / ACC / AHA Task Force, 1990 ,[object Object]
ACC / AHA Task Force, 1997 ,[object Object]
Treadmill Systems Evaluated Spacelabs / Burdick Quest Stress System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treadmill Systems ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ETT System Layout Treadmill BP Cuff Recorder Monitor Controller Crash Cart
Treadmill System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient Selection Criteria ,[object Object]
Chest Pain... ,[object Object],[object Object],[object Object]
Risk Factors: Coronary Artery Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Indications for ETT... ,[object Object],[object Object],[object Object]
Patient Selection Criteria Indications for Office-Based Graded Exercise Testing: Screening for ischemic heart disease in asymptomatic individuals (especially those with multiple cardiac risk factors) Evaluation of  (atypical) chest pain  Determining exercise capacity;  and giving an exercise prescription.
Patient Selection Criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient Selection Criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Before the ETT... ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Informed Consent ,[object Object],[object Object],[object Object],[object Object]
Complications of ETT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Five Year Experience: ETT in a FP Residency, Scottsdale Arizona ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Fam Med 1994; 26:290-292
How long? How fast? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Which ETT Protocol ? ,[object Object],[object Object],[object Object],[object Object],[object Object]
ETT Tracing... ,[object Object],[object Object],[object Object]
Patterns indicative of ischemia...
Exercise induced ST Depression ... ,[object Object],[object Object]
Patterns  not   indicative of ischemia...
Sign/Symptom Testing Endpoints ,[object Object],[object Object],[object Object],[object Object],[object Object]
Relative Indications for terminating the ETT... ,[object Object],[object Object],[object Object],[object Object],[object Object]
Absolutely terminate the test when... ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Possible causes of False Positive ETT for CAD: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Options for evaluating ischemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Echocardiography ,[object Object],[object Object],[object Object],[object Object]
Testing options... ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When is a Thallium ETT needed? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sensitivity / Specificity ,[object Object],[object Object],[object Object],[object Object]
Sensitivity  /  Specificity (  $ 250)  ($ 1300 +)  ($ 3000+)
Clinical Case 1 ,[object Object],[object Object],[object Object]
Clinical Case 2 ,[object Object],[object Object],[object Object]
Clinical Case 3 ,[object Object],[object Object],[object Object]
Clinical Case 4 ,[object Object],[object Object]
Clinical Case 5 ,[object Object],[object Object]
Caveats on ETT... ,[object Object],[object Object],[object Object],[object Object]
Referral from clinical sites ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Exercise Treadmill Testing

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  • 17. ETT System Layout Treadmill BP Cuff Recorder Monitor Controller Crash Cart
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  • 23. Patient Selection Criteria Indications for Office-Based Graded Exercise Testing: Screening for ischemic heart disease in asymptomatic individuals (especially those with multiple cardiac risk factors) Evaluation of (atypical) chest pain Determining exercise capacity; and giving an exercise prescription.
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  • 45. Sensitivity / Specificity ( $ 250) ($ 1300 +) ($ 3000+)
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