What is the safety of treadmill stress testing following acute myocardial infarction (MI)?

Answer

Current guidelines for the treatment of patients with acute MI include medical therapy, thrombolytic agents, and coronary revascularization. These interventions have led to a marked improvement in prognosis for post-MI patients, particularly those who have been treated with reperfusion, and mortality has been low among patients who have received thrombolytic agents or direct angioplasty.

Patients who are unable to perform an exercise test have a much higher rate of adverse events than those who are able to perform an exercise test. Symptomatic ischemic ST depression with exercise testing after thrombolytic therapy increases the risk of cardiac mortality 2-fold, but the absolute risk rate remains low (1.7% at 6 months).

Exercise testing after MI is generally safe. Submaximal testing can be performed at 4-7 days, and a symptom-limited test can be performed 3-6 weeks later. Some experts feel that symptom-limited tests can be conducted early after discharge, at approximately 14-21 days.

Exercise testing is useful in activity counseling after discharge from the hospital, and it is also an important tool in exercise training, as part of comprehensive cardiac rehabilitation for assessing the patient’s response to the exercise training program.

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Media Gallery

Normal radionuclide uptake (dipyridamole-Cardiolite).
Normal wall motion with radionuclide uptake.
Inferior-wall myocardial infarct and fixed defect.
Motion abnormalities in inferior wall consistent with inferior-wall myocardial infarction.
Inferobasal fixed defect and lateral wall ischemia.
Wall motion abnormalities in inferobasal region.

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David Akinpelu, MD, FACP Emergency Medicine Attending Physician, Riverside Tappahannock Hospital/Riverside Shore Memorial Hospital, Riverside Medical Group

David Akinpelu, MD, FACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Yasmine S Ali, MD, MSCI, FACC, FACP Assistant Clinical Professor of Medicine, Vanderbilt University School of Medicine; President, LastSky Writing, LLC

Yasmine S Ali, MD, MSCI, FACC, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Medical Writers Association, National Lipid Association, Tennessee Medical Association

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Chief Editor

Eric H Yang, MD Associate Professor of Medicine, Director of Cardiac Catherization Laboratory and Interventional Cardiology, Mayo Clinic ArizonA

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Acknowledgements

Javier M Gonzalez, MD Consulting Staff, Department of Cardiology, Citrus Cardiology Consultants

Javier M Gonzalez, MD is a member of the following medical societies: American College of Cardiology and American Medical Association

Disclosure: Nothing to disclose.

Ronald J Oudiz, MD, FACP, FACC, FCCP Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting

Justin D Pearlman, MD, ME, PhD, FACC, MA Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Director of Cardiology Quality Program KMC, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School

Justin D Pearlman, MD, ME, PhD, FACC, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America

Disclosure: Nothing to disclose.

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