Stress Electrocardiography in Exercise Based Cardiac Rehabilitation

Exercise-based cardiac rehabilitation is an important treatment strategy for heart failure patients to promote their physical, psychological, and social recovery. Before starting cardiac rehabilitation, it is necessary to evaluate whether symptoms and signs of heart failure were controlled, underlying causes were corrected, left ventricular systolic function was improved, and essential medications with appropriate dosages were administered. Cardiac rehabilitation team should know contraindications and criteria for prompt termination of exercise program. During exercise-based cardiac rehabilitation, various cardiac complications including myocardial ischemia, arrhythmias, and vasovagal reactions can be induced during or after completion of exercise program. Inappropriate shock therapy may be delivered for sinus tachycardia if the patient has an implantable defibrillator. Most of the cardiac complications can be detected early if electrocardiographic changes are monitored and appropriately interpreted. However, incidence of fatal cardiac complications during exercise-based cardiac rehabilitation is very low. Exercise program should not be canceled or delayed due to immoderate concerns about potential cardiac complications. To prevent or respond to the cardiac complications, close communications are required between the cardiology and cardiac rehabilitation staffs.