Exercise Stress Testing in Clinical Cardiology: A Practical Guide to Performance and Interpretation

Figures

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  Figure 1. Representation of lead placement for noise reduction during ECG-EST. LA, left arm; LL, left leg; RA, right arm; RL, right leg.

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  Figure 2. Schematic representation of a clinical exercise testing laboratory. (a) Patient intake and preparation, resting ECG acquisition. (b) Supervised exercise testing. (c) Post-test recovery with vital signs assessment and report generation.

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  Figure 3. Definition of ST-segment depression changes during exercise. On the left column, example of how to correctly measure ST-segment depression. On the right column, abnormal ST-segment responses to EST: horizontal (a) and downsloping (b) ST-segment depression ≥ 1 mV and slowly upsloping (0.5–1.0 mV/s) ST-segment of >0.15 mV (c). Define the isoelectric line (1); define the j-point (2); measure the ST-segment depression after 80 msec from the j-point (3), or 60 msec (4) according to the heart rhythm (HR).

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  Figure 4. Clinical Box. (a) Resting ECG. (b) Intermittent ventricular pre-excitation (blue line) and normal atrioventricular conduction (red line). (c) Shows 1:1 antidromic conduction via accessory pathway (blue line) and secondary ST-segment depression (light blue area).

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  Figure 5. Premature ventricular beats morphology and probable site of origin. Schematic representation of the main sites of origin of PVBs and their ECG features. RV = right ventricle. LVOT = left ventricle outflow tract; NCC = non-coronary aortic cusp.

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  Figure 6. Clinical Box. In blue the fascicular premature ventricular beats realizing the R-on-T phenomenon, and organized in a triplet.

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  Figure 7. Clinical Box. (a) Atrial-sensed ventricular paced rhythm at rest. (b) Normal atrial tracking at 100 W workload. (c) T-wave oversensing (red arrow) resulting in loss of atrial tracking (2:1 behavior). P-waves are highlighted by blue circles; ventricular paced beats are indicated by red lines.