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G. PROCEDURE :
1. Patient is properly identified via hospital policy for patient identification.
2. Informed consent should be signed and dated, with time for signing indicated.
3. The patient is brought into the stress testing laboratory. The test is explained, questions are answered, and
informed consent for the test is signed.
4. After skin preparation, ten electrodes are placed on specific areas of the chest (RA, RL, LA, LL, V1-V6).
Electrodes should be placed on patient while he/she is standing in order to standardize procedure.
5. Resting heart rate, blood pressure, and electrocardiogram are obtained, both supine and standing.
6. All data obtained during the test will be entered in the stress testing computer system.
7. An assessment is completed by the test supervisor which may include, but is not limited to: reason for
testing, history of present illness, current medications and whether they were taken on the day of the test,
past medical history, allergies to medication, presence of risk factors for cardiovascular disease, cardiac
history, history of asthma or other pulmonary problems, presence of any orthopedic or neurological
problems that may prohibit walking on the treadmill and how the patient is feeling on the day of the test.
8. A focused physical examination may be done which may include, but is not limited to: heart and lungs
auscultation.
9. Appropriate lab data is reviewed on inpatients/ED patients to verify two (2) negative sets of cardiac
enzymes.
10. The order is reviewed for completeness and appropriateness of test.
11. After evaluating the above data, the test supervisor determines whether to proceed with testing. If testing
is determined inappropriate, unsafe, or clinically not indicated, the test supervisor will notify referring
provider. The test supervisor may change an exercise stress test to a pharmacologic stress test per protocol
if the patient is deemed to be mentally or physically unable to exercise or if the patient refuses to exercise.
12. Test supervisor chooses the appropriate protocol. Standard Bruce Protocol is recommended or, if indicated,
modified Bruce protocol or Naughton protocol.
13. Patient exercises on the treadmill with the amount of exertion gradually increasing per protocol. Heart rate
and heart rhythm, as well as subjecting and objective signs of test tolerance, are continuously monitored.
Blood pressure is intermittently monitored.
14. The treadmill is stopped when the patient can no longer exercise, there are concerning symptoms that
appear, or changes that occur in the EKG, heart rate, heart rhythm, or blood pressure (including
hypotension: >20mmHg decrease compared to the previous stage in the setting of clinical evidence of
ischemia).
15. There is a minimal five-minute recovery period where the heart rate and rhythm are continuously
monitored and blood pressure is monitored minimally every two minutes.
16. The test is completed when the blood pressure, heart rate and rhythm are stable and any symptoms, EKG
changes or arrhythmias have resolved.
17. Test supervisor will interpret the stress test, incorporating all clinical variables (workload, EKG changes, HR,
and BP response) and prepare a preliminary report.
18. Critical test results, as defined under separate cover, are communicated to attending cardiologist. Attending
cardiologist will notify ordering physician within one hour of test interpretation and document on final
report.
19. The patient is disconnected from the stress testing equipment; all but three (3) precordial electrodes are
removed.
H. ATTACHMENTS :
None
I. REFERENCES :
ACC/AHA Guidelines for Exercise Testing.