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EXERCISE TESTING AFTER MYOCARDIAL INFARCTION.

The conventional predischarge post-myocardial- infarction exercise test is stopped after a specified period even if the patient does not have restricting symptoms. These investigators compared the usual low-level exercise test with a full symptom-limited exercise test in 200 patients about one week after uncomplicated acute MI. Each patient underwent the two types of testing on consecutive days before discharge.

The symptom-limited tests lasted longer (554 vs. 389 seconds) and led to greater work loads (5.7 vs. 4.2 metabolic equivalents) and higher heart rates (121 vs. 108 beats per minute). Only 56 patients developed ST depression during the low-level test, as compared with 89 during the symptom-limited test. The number of patients with angina or ST depression increased from 66 on the low-level test to 105 on the symptom-limited test. One patient had a cardiac rupture during the symptom-limited test and died during the recovery period.

These data demonstrate that a low-level exercise test does not provide as much information as a symptom-limited test. However, the one fatal complication provides a sobering reminder that the increased workload of a symptom-limited test adds danger along with information.

— THL

Published in Journal Watch General Medicine October 20, 1992

Citation(s):

Juneau M et al. Symptom-limited versus low level exercise testing before hospital discharge after myocardial infarction. J Am Coll Cardiol 1992 Oct 20 927-933.

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