title: Symptom-limited vs heart-rate-limited exercise testing soon after myocardial infarction.
abstract: To develop guidelines for exercise testing soon after uncomplicated myocardial infarction, 93 men completed a heart-rate-limited (HRL) protocol and 107 completed a symptom-limited (SXL) protocol 3 weeks after the acute event. In the HRL protocol, effort terminated at a heart rate of 130 beats/min in the absence of a limiting symptom, exertional hypotension or ventricular tachycardia. Peak heart rate was not an end point in the SXL protocol. Despite a higher peak heart rate and work load in patients who completed the SXL protocol, the prevalence of exercise-induced ischemic ST-segment depression and ventricular ectopic activity was similar in the two groups. No complications occurred with either protocol. Twelve patients (6%) had cardiac events within the next 2 months. Regardless of the test protocol used, early events were more common in patients with ischemic ST-segment responses (15%) than in patients without ischemic responses (3%) (p less than 0.01). In contrast, exercise-induced ventricular arrhythmias were not predictive of early events. Eleven weeks after infarction, when all tests were SXL, the prevalence of exercise-induced ischemic ST-segment depression and premature ventricular complexes was similar to that at 3 weeks. We conclude that SXL and HRL exercise test protocols reveal a similar prevalence of ischemic ST-segment depression and ventricular ectopic activity soon after uncomplicated myocardial infarction.
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis; D001145:Arrhythmias, Cardiac / Q000175:diagnosis; D003289:Convalescence; D003327:Coronary Disease / Q000175:diagnosis; D004562:Electrocardiography; D005080:Exercise Test; D006339:Heart Rate; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*