心脏康复评定演示文稿

心脏康复评定演示文稿本文档共91页；当前第1页；编辑于星期日\14点26分优选心脏康复评定本文档共91页；当前第2页；编辑于星期日\14点26分APATIENTCASEEXAMPLE本文档共91页；当前第3页；编辑于星期日\14点26分1.Whyareyouheretoday?2.Haveyoubeendiagnosedwithacardiacdisorderinthepast?3.Haveyouhadanyspecialteststoexamineyourheartlikeanelectrocardiogram,stresstest,echocardiogram,orcardiaccatheterization?本文档共91页；当前第4页；编辑于星期日\14点26分4.Doyouexperienceanginaorshortnessofbreathatrest,onlywithactivity/exercise,orbothatrestandwithactivity/exercise?本文档共91页；当前第5页；编辑于星期日\14点26分5.Ifyouexperienceanginaorbecomeshortofbreathduringactivityorexercisecouldyoupleasedescribethetypeofactivityorexercisewhichproducesyouranginaorshortnessofbreath?本文档共91页；当前第6页；编辑于星期日\14点26分6.Canyoudescribeyouranginaorshortnessofbreath?Canyouhelpmeunderstandyouranginaorshortnessofbreathbypointingtothenumbers1through4todescribethelevelofanginayouexperienceatrestandexerciseorbypointingtoyourlevelofshortnessofbreathusingthis10-pointscaleorbymarkingthisvisualanalogscale?本文档共91页；当前第7页；编辑于星期日\14点26分7.CouldIfeelyourpulsetodetermineyourheartrateandthestrengthofyourpulse?8.CouldIplacethisfingerprobeonyourindexfingertoobtainanoxygensaturationmeasurement?本文档共91页；当前第8页；编辑于星期日\14点26分9.CouldIplacetheseelectrodesonyourchesttoobtainasimplesingle-leadelectrocardiogram(ECG)?本文档共91页；当前第9页；编辑于星期日\14点26分10.CouldItakeyourbloodpressurewhileyouareseatedandthencompareittothebloodpressurewhileyouarelyingdownandthenstanding?Iwouldalsoliketoobserveyourpulse,oxygensaturation,ECG,andsymptomswhenyouarelyingdownandstanding.本文档共91页；当前第10页；编辑于星期日\14点26分11.CouldIlistentoyourheartandlungswithmystethoscope?WhileIdothisIwillconcentrateonwatchingyourECGsothatIcanidentifyyourheartsoundsandanychangesintheECGwhileyouarebreathingdeeplywhenlisteningtoyourlungs.本文档共91页；当前第11页；编辑于星期日\14点26分12.CouldIplace1ofmyhandsonyourstomachand1handonyourupperchesttodeterminehowyoubreathe?13.CouldIplacemyhandsonthelowermostribsoneachsideofyourchesttodeterminehowyoubreathe?14.CouldIplacemyhandsonyourbacktodeterminehowyoubreathe?15.CouldIwrapmytapemeasurearoundyourchestatseveraldifferentsitestodeterminehowyoubreathe?本文档共91页；当前第12页；编辑于星期日\14点26分16.NowthatIunderstandsomeverybasicinformationaboutthemannerinwhichyoubreathecouldyoupleasebreatheinthemannerIinstructyouviasoundsImake,pressurefrommyhands,methodsIshowtoyou,ordifferentbodypositions?IwilloccasionallyplacemyhandsonyourchestandwrapmytapemeasurearoundyourchesttodeterminehowyoubreatheduringthesesimpletestsandIwillaskyoutoidentifyyourlevelofshortnessofbreathusingthe10-pointscaleorvisualanalogscale—Isthisokwithyou?本文档共91页；当前第13页；编辑于星期日\14点26分17.CouldImeasurethestrengthofyourbreathingmusclebyhavingyouplacethismouthpieceinyourmouthandbreatheinandoutasdeeplyandasforcefullyasyouareable?本文档共91页；当前第14页；编辑于星期日\14点26分18.Iwouldlikeyoutonowperformtheactivityorexercisewhichproducesyouranginaorshortnessofbreath.Couldyoupleasedothisnow?本文档共91页；当前第15页；编辑于星期日\14点26分Thankyouforgivingmethechancetoexamineyoutoday.Iwillcallyourphysiciantogetsomemoreinformationaboutyoulikeelectrocardiogram,echocardiogramandpulmonaryfunctionteststhatyousaidwereperformedlastweekaswellasthearterialbloodgasresults,chestX-ray,andexercisetestresults.本文档共91页；当前第16页；编辑于星期日\14点26分PhysicalTherapyExaminationMedicalInformationandRiskFactorAnalysis

listeningtothepatientspasthistoryandprimarycomplaintsiscriticalintheexaminationprocess.

本文档共91页；当前第17页；编辑于星期日\14点26分ExaminationsofPatientAppearancecategorizedbyspecificsignsandsymptoms本文档共91页；当前第18页；编辑于星期日\14点26分Angina-MethodsToEvaluateAnginafromNonanginalPainIfasuspectedanginalpainchanges(increasesordecreases)withbreathing,palpationinthepainfularea,ormovementofajoint(ie,shoulderflexionandabduction)itisverylikelythatthepainisNOTangina.本文档共91页；当前第19页；编辑于星期日\14点26分Angina-MethodsToEvaluateAnginafromNonanginalPainitcanbeworsenedbyphysicalexerciseoractivity.Therefore,ifthesuspectedanginalpainisunchangedwiththepreviouslycitedmaneuversandthepainoccurredwithexertion,itisSUSPECTforangina.Ifthesuspectedanginalpainisunchangedbythesemaneuvers,ifthepainoccurredwithexertion,andifthepaindecreasesorsubsideswithrest,itisverylikelythatthepainISangina.Finally,ifthesuspectedpaindecreasesorsubsideswithnitroglycerin,itisevenmorelikelythatthepainISangina.本文档共91页；当前第20页；编辑于星期日\14点26分本文档共91页；当前第21页；编辑于星期日\14点26分"Other"SymptomsofHeartDiseasedyspneaFatigueDizzinessLightheadednessPalpitationsasenseofimpendingdoom本文档共91页；当前第22页；编辑于星期日\14点26分本文档共91页；当前第23页；编辑于星期日\14点26分ExaminationsofPatientAppearanceskincoloroftheperipheralextremities.Paleorcyanoticskininthelegs,feet,arms,andfingersisassociatedwithpoorcardiovascularfunction.本文档共91页；当前第24页；编辑于星期日\14点26分ExaminationsofPatientAppearanceDiagonalearlobecrease.Thisphenomenonhasbeeninvestigatedformanyyearsandrecentlywasonceagainfoundtobehighlypredictiveofheartdisease本文档共91页；当前第25页；编辑于星期日\14点26分AnthropometricmeasurementsbodyweightfingerpressureonanedematousareaGirthmeasurementsskin-foldcalipermeasurementscalculationofthebodymassindexmeasurethepercentageofbodyfatandleanmusclemass本文档共91页；当前第26页；编辑于星期日\14点26分Jugularvenousdistensionitisoftenduetoright-sidedheartfailure.本文档共91页；当前第27页；编辑于星期日\14点26分本文档共91页；当前第28页；编辑于星期日\14点26分本文档共91页；当前第29页；编辑于星期日\14点26分PalpationoftheRadialPulsePalpationoftheradialpulsecanprovideimportantinformationaboutthestatusofthecardiovascularsystem.MeasurementoftheSystolicBloodPressureandPulseDuringBreathingandSimplePerturbationsoftheBreathingCycle本文档共91页；当前第30页；编辑于星期日\14点26分MeasurementoftheSystolicandDiastolicBloodPressureandPulseinDifferentBodyPositions本文档共91页；当前第31页；编辑于星期日\14点26分

ToDeterminetheStatusoftheCardiovascularSystem

observationofadecreaseinsystolicanddiastolicbloodpressurewithoutasubsequentincreaseinheartratewhenchangingbodypositionfromsupinetostandingisconsideredapositivesignforautonomicnervoussystemdysfunction..本文档共91页；当前第32页；编辑于星期日\14点26分ToDeterminethe

HealthoftheCardiovascularSystemAcardiovascularsystemthatrespondsrapidlytobodypositionchangeislikelyinabetterstateofhealththanacardiovascularsystemthatrespondssluggishly.Bothanunchangedordecreasedheartrateafterstandingfor30seconds(comparedtotheheartrateat15seconds)issuggestiveofautonomicdysfunction.本文档共91页；当前第33页；编辑于星期日\14点26分asluggishorhypoadaptive(lessthannormal)heartrateandbloodpressureresponseduringachangeinbodypositionsupinetostandingshouldbeconsideredabnormalandsuggestiveofanunhealthycardiovascularsystem.本文档共91页；当前第34页；编辑于星期日\14点26分amoreadaptiverapidincreaseinheartrateandbloodpressureaftermovingfromasupinetostandingposition(approximately30seconds)islikelyassociatedwithahealthiercardiovascularsystem本文档共91页；当前第35页；编辑于星期日\14点26分ExaminationofthePulseandArterialBloodPressure

DuringFunctionalTasksandExerciseFrequentmonitoringoftheheartrateandbloodpressuremaybethebestwaytoexaminethesafetyofexerciseandhelptoestablishguidelinesandproceduresforfunctionalorexercisetraining.本文档共91页；当前第36页；编辑于星期日\14点26分anincreaseinthediastolicbloodpressurewhenthediastolicbloodpressureshouldbedecreased(orlow)isastrongindicatorofcardiovasculardysfunction..本文档共91页；当前第37页；编辑于星期日\14点26分PotentialindirectmeasuresofcardiacfunctionSymptomsandfunctionalclassificationCold,pale,andpossiblycyanoticextremitiesJugularvenousdistensionandperipheraledemaHeartsoundsPulseElectrocardiographyBloodpressure本文档共91页；当前第38页；编辑于星期日\14点26分StandardmeasurementofcardiacfunctionCardiaccatheterizationEchocardiographySwan-GanscatheterizationCentralvenouspressureCardiacenzymesANPandBNPRadiologicevidence本文档共91页；当前第39页；编辑于星期日\14点26分ExerciseTesting本文档共91页；当前第40页；编辑于星期日\14点26分IndicationsforExerciseTesting:DiagnosisofCoronaryArteryDiseaseAssessmentofPrognosisinCoronaryArteryDiseaseEvaluationofFunctionalCapacityEvaluationofTherapyforCoronaryDiseaseDeterminationofExercisePrescription本文档共91页；当前第41页；编辑于星期日\14点26分AbsoluteContraindicationstoExerciseTestingAcuteMI(within2days)High-riskunstableanginaUncontrolledcardiacarrhythmiasActiveEndocarditisSevereaorticstenosisDecompensatedheartfailureAcutepulmonaryembolusorinfarction,DVTAcutenoncardiacdisorderaffectingoraggravatedbyexerciseAcutemyocarditis,pericarditisPhysicaldisabilityprecludessafeandadequatetestInabilitytoobtainconsent本文档共91页；当前第42页；编辑于星期日\14点26分RelativeContraindicationstoExerciseTestingLeftmaincoronarystenosisorequivalentModerateaorticvalvularstenosis(?)ElectrolytedisorderTachyarrhythmiasorBradyarrhythmiasAtrialfibrillationwithuncontrolledventricularresponseHypertrophicCardiomyopathy(?gradient)MentalimpairmentleadingtoinabilitytocooperateHigh-degreeAVblock本文档共91页；当前第43页；编辑于星期日\14点26分ECGLeadPlacementfor

ExerciseTesting本文档共91页；当前第44页；编辑于星期日\14点26分ProtocolsforExerciseTesting本文档共91页；当前第45页；编辑于星期日\14点26分BloodPressureResponses:

ExerciseTestingDependencyoncardiacoutputandperipheralresistanceNormalresponses:IncreaseinSBP(>20-30mmHg)NochangeorfallinDBPInadequateriseinSBP:Myocardialischemia,severeLVsystolicdysfunction,aorticorLVOTobstruction,drugtherapy(ß-blockers)Exercise-InducedHypotension(>10mmHgbelowbaseline)Severemyocardialischemia(50%positivepredictivevalueforleftmainor3-vesseldisease),valvularheartdisease,cardiomyopathynoevidenceofclinicallysignificantheartdisease(dehydration,antihypertensivetherapy,prolongedstrenuousexercise)本文档共91页；当前第46页；编辑于星期日\14点26分HeartRateResponsetoExerciseTestingAcceleratedHeartRateResponse:Deconditioning,prolongedbedrest,anemia,metabolicdisorders,conditionsassociatedwithdecreasedbloodvolumeorlowsystemicvascularresistance,autonomicinsufficencyChronotropicincompetence:Inadequateexerciseeffort,drugtherapy(ß-blockers),PrognosticSignificance:(PeakHR-RestingHR)/(220-age-RestingHR)<0.80(Lauer,1999)PeakHR<130bpm(Ellestad)本文档共91页；当前第47页；编辑于星期日\14点26分EvaluationofExerciseEffortduringExerciseTesting:TheBorgPerceivedExertionScale本文档共91页；当前第48页；编辑于星期日\14点26分ExerciseCapacity-ExerciseTestingMETcapacity1MET=3.5ml/kg/minO2consumptionFunctionalAerobicImpairment(FAI) (BruceProtocolspecific)PredictedMETlevel(nomograms)PredictedVO2(ACSMformulae)PracticalAspects:LackofassociationbetweenLVEFandexercisecapacityPrognosticvalueofdecreasedexercisecapacityandactiveCADPredictorofpatient’sdisability本文档共91页；当前第49页；编辑于星期日\14点26分ExerciseTesting-ComplicationsMIordeath:Upto10per10,000tests(1per2,500)Lifethreateningventriculararrhythmias:0-5per100,000Cardiac:Bradyarrhythmias,tachyarrhythmias,acutecoronarysyndromes,heartfailure,hypotension,syncope,deathNoncardiac:Musculoskeletaltrauma,soft-tissueinjuryMiscellaneous:Severefatigue,dizziness,myalgias本文档共91页；当前第50页；编辑于星期日\14点26分AbsoluteIndicationsforTerminationofExerciseTestST-segmentelevation(>1.0mm)inleadswithoutQ-waves(otherthanV1oraVR)Dropinsystolicbloodpressure>10mmHg(persistentlybelowbaseline)despiteanincreaseinworkload,whenaccompaniedbyanyotherevidenceofischemiaModeratetosevereangina(grades3-4)Centralnervoussystemsymptoms(ataxia,dizziness,nearsyncope)Signsofpoorperfusion(cyanosisorpallor)SustainedventriculartachycardiaTechnicaldifficultiesmonitoringtheECGorsystolicBPPatient’srequesttostop本文档共91页；当前第51页；编辑于星期日\14点26分RelativeIndicationsforTerminationofanExerciseTestSTchanges(horizontalordownsloping>2mm)ormarkedaxisshiftDropinsystolicbloodpressure>10mmHg(persistentlybelowbaseline)despiteanincreaseinworkload,intheabsenceofotherevidenceofischemiaandnopresyncopalsymptomsIncreasingchestpainFatigue,shortnessofbreath,wheezing,legcramps,orclaudicationHypertensiveresponse(SBP>250mmHgand/orDBP>115mmHg)Developmentofbundle-branchblock(LBBB)thatcannotbedistinguishedfromventriculartachycardia;?EvidenceofanteriorischemiaArrhythmiasotherthansustainedventriculartachycardia(frequentmultifocalPVC’s,ventriculartriplets,SVT,heartblock,orbradyarrhythmias)GeneralAppearance(diaphoresis,peripheralcyanosis)本文档共91页；当前第52页；编辑于星期日\14点26分CriteriaforReadingST-SegmentChangesontheExerciseECGSTDEPRESSION:Measurementsmadeon3consecutiveECGcomplexes!STlevelismeasuredrelativetotheP-Qjunction3keymeasurements(P-Qjunction,J-point,60-80msecafterJ-point-use60msecforHR>130bpmWhenJ-pointisdepressedrelativetoP-Qjunctionatbaseline:NetdifferencefromtheJjunctiondeterminestheamountofdeviationWhentheJ-pointiselevatedrelativetoP-Qjunctionatbaselineandbecomesdepressedwithexercise:MagnitudeofSTdepressionisdeterminedfromtheP-QjunctionandnottherestingJpoint本文档共91页；当前第53页；编辑于星期日\14点26分CriteriaforReadingST-SegmentChangesontheExerciseECGSTELEVATION:60msecafterJpointin3consecutiveECGcomplexes本文档共91页；当前第54页；编辑于星期日\14点26分CriteriaforAbnormalandBorderlineST-SegmentDepressionontheExerciseECGABNORMAL:1.0mmorgreaterhorizontalordownslopingSTdepressionat60msecafterJpointon3consecutiveECGcomplexesBORDERLINE:0.5to1.0mmhorizontalordownslopingSTdepressionat60msecafterJpointon3consecutiveECGcomplexes2.0mmorgreaterupslopingSTdepressionat60msecafterJpointon3consecutiveECGcomplexes本文档共91页；当前第55页；编辑于星期日\14点26分MorphologyofST-SegmentDeviation

duringExerciseTesting本文档共91页；当前第56页；编辑于星期日\14点26分ValueofRight-SidedECGLeadsduringExerciseTestingfortheDiagnosisofCAD本文档共91页；当前第57页；编辑于星期日\14点26分HorizontalST-segmentDepressionduringExerciseTesting本文档共91页；当前第58页；编辑于星期日\14点26分DownslopingST-SegmentDepressionduringExerciseTesting本文档共91页；当前第59页；编辑于星期日\14点26分ST-SegmentDepressioninEarlyRecoveryPeriodafterExerciseTesting本文档共91页；当前第60页；编辑于星期日\14点26分UpslopingST-SegmentDepressionduringExerciseTesting本文档共91页；当前第61页；编辑于星期日\14点26分MorphologyofST-SegmentDepressionPredictsSeverityofCoronaryArteryDisease

(Goldschlager,1976)本文档共91页；当前第62页；编辑于星期日\14点26分Exercise-InducedST-SegmentElevationwithPriorAnteriorMyocardialInfarction本文档共91页；当前第63页；编辑于星期日\14点26分Exercise-InducedST-SegmentElevationintheSettingofPriorInferolateralMI本文档共91页；当前第64页；编辑于星期日\14点26分Exercise-InducedAnteriorST-SegmentElevationasReflectionofLADIschemia本文档共91页；当前第65页；编辑于星期日\14点26分Indicationsfor

ExerciseTestingintheDiagnosisofObstructiveCoronaryDiseaseCLASSI:Adultpatients(includingthosewithRBBBorlessthan1mmorrestingST-depression)withanintermediatepretestprobabilityofCAD,basedongender,age,andsymptomsCLASSIIa:PatientswithvasospasticanginaCLASSIIb:PatientswithahighpretestprobabilityofCADbyage,symptoms,andgenderPatientswithalowpretestprobabilityofCADbyage,symptoms,andgenderPatientswithlessthan1mmofbaselineSTdepressionandtakingdigoxinPatientswithECGcriteriaofLVHandlessthan1mmSt-depression本文档共91页；当前第66页；编辑于星期日\14点26分Pre-testProbabilityofCAD

byAge,Gender,andSymptomsTypical/DefiniteAnginaPectorisAge30-39 Men Intermediate(10-90%)Women IntermediateAge40-49 Men High(>90%)Women IntermediateAge50-59 Men HighWomen IntermediateAge60-69Men HighWomen High本文档共91页；当前第67页；编辑于星期日\14点26分Pre-testProbabilityofCAD

byAge,Gender,andSymptomsAtypical/PossibleAnginaPectoris:Age30-39Men Intermediate Women VeryLow(<5%)Age40-49 Men Intermediate Women Low(<10%)Age50-50 Men Intermediate Women IntermediateAge60-69 Men Intermediate Women Intermediate本文档共91页；当前第68页；编辑于星期日\14点26分Pre-testProbabilityofCAD

byAge,Gender,andSymptomsNonanginalChestPain:Age30-39 Men Low Women VeryLowAge40-49 Men Intermediate Women VeryLowAge50-59 Men Intermediate Women LowAge60-69 Men Intermediate Women Intermediate

本文档共91页；当前第69页；编辑于星期日\14点26分Pre-testProbabilityofCAD

byAge,Gender,andSymptomsAsymptomatic:Age30-39Men VeryLow Women VeryLowAge40-49Men Low Women VeryLowAge50-59Men Low Women VeryLowAge60-69Men Low Women Low本文档共91页；当前第70页；编辑于星期日\14点26分Indicationsfor

ExerciseTestingintheDiagnosisofObstructiveCoronaryDiseaseClassIII:PatientswiththefollowingECGabnormalities:WPWsyndrome,electronicallypacedventricularrhythm,greaterthan1mmrestingST-depression,completeLBBBPatientswithadocumentedMIorpriorcoronaryangiographydemonstratingsignificantCADhaveanestablisheddiagnosis(?ischemia,prognosis)本文档共91页；当前第71页；编辑于星期日\14点26分ExerciseTesting;SensitivityandSpecificityfortheDiagnosisofCADSensitivity=[Truepositives/truepositives+falsenegatives]x100Specificity=[Truenegatives/falsepositives+truenegatives]x100StandardExerciseTest(mostlymen)*Sensitivity=68% Specificity=77%PredictiveAccuracy=73%*Basedon1.0mmST-segmentdepression本文档共91页；当前第72页；编辑于星期日\14点26分ExerciseTestingintheDiagnosisofCoronaryArteryDiseaseinWomenECGAnalysisalone:Sensitivity: 46-79%Specificity: 48-86%UseofDukePrognosticScore:LowRiskscore:19.1%CAD>75%stenosis, 3.5%3-vesselorleftmaindiseaseIntermediateRiskscore:34.9%CAD>75%stenosis,12.4%3-vesselorleftmaindiseaseHighRiskScore:89.2%CAD>75%stenosis,46%3-vesselorleftmaindisease本文档共91页；当前第73页；编辑于星期日\14点26分RiskAssessmentandPrognosiswithExerciseTestinginPatientswithSymptomsandPriorHistoryofCADClassI:PatientundergoinginitialevaluationwithsuspectedorknownCADincludingthosewithcompleteRBBBandlessthan1mmofrestingECG(exceptions-ClassIIb)PatientswithsuspectedorknowCADpreviouslyevaluated,nowpresentingwithsignificantchangeinclinicalstatusLow-riskacutecoronarysyndromepatients8-12hoursafterpresentationwhohavebeenfreeofactiveischemiaorheartfailuresymptoms(LevelofEvidence=B)Intermediate-riskacutecoronarysyndromepatients2-3daysafterpresentationwhohavebeenfreeofactiveischemiaorheartfailuresymptoms(LevelofEvidence=B)本文档共91页；当前第74页；编辑于星期日\14点26分RiskAssessmentandPrognosiswithExerciseTestinginPatientswithSymptomsandPriorHistoryofCADClassIIa:Intermediate-riskacutecoronarysyndromepatientswhohaveinitialcardiacmarkersthatarenormal,arepeatECGwithoutsignificantchange,andcardiacmarkers6-12hoursaftertheonsetofsymptomsthatarenormalandnootherevidenceofischemiabyobservation(LevelofEvidence=B)ClassIIb:PatientswiththefollowingECGabnormalities:WPWsyndrome,electronicallypacedventricularrhythm,1mmormoreofrestingST-depression,completeLBBBorIVCDwithaQRSduration>120msecPatientswithastableclinicalcoursewhoundergoperiodicmonitoringtoguidetreatment本文档共91页；当前第75页；编辑于星期日\14点26分RiskAssessmentandPrognosiswithExerciseTestinginPatientswithSymptomsandPriorHistoryofCADClassIII:Patientswithsevereco-morbiditylikelytolimitlifeexpectancyand/orcandidacyforrevascularizationHigh-riskacutecoronarysyndromepatients(LevelofEvidence=c)本文档共91页；当前第76页；编辑于星期日\14点26分Short-termRiskAssessmentforDeathorNonfatalMIinPatientswithAcuteCoronarySyndrome

HIGHRISK(atleastoneofthefollowingfeatures):CharacterofPain: Prolongedongoing(>20min)restchestpainClinicalFeatures:Pulmonaryedema,neworworseningMR,S3ornew/worseningrales,hypotension,bradycardia,tachycardia,age>75yrsECGFindings:AnginaatrestwithtransientSTchanges>0.05mV,BBB(neworpresumednew),sustainedventriculartachycardiaBiochemicalMarkers:Elevatedtroponin-I本文档共91页；当前第77页；编辑于星期日\14点26分Short-termRiskAssessmentforDeathorNonfatalMIinPatientswithAcuteCoronarySyndromeINTERMEDIATERISK:Nohigh-riskfeaturebutmusthaveoneofthefollowing:History:PriorMI,peripheralorcerebrovasculardisease,CABGorprolongedaspirinuseCharacterofPain:Prolonged(>20min)restangina,nowresolved,withmoderatetohighlikelihoodofCADRestangina(<20min)orrelievedbysublingualNTGClinicalFindings:age>70yrsECGFindings:T-waveinversionsgreaterthan0.2mV,pathologicalQ-wavesBiochemicalMarkers:Borderlineelevatedtroponin-I本文档共91页；当前第78页；编辑于星期日\14点26分Short-termRiskAssessmentforDeathorNonfatalMIinPatientswithAcuteCoronarySyndromeLOWRISK:Nohighorintermediateriskfeaturesbutanyofthefollowing:CharacterofPain:

New-onsetorprogressiveCCSCIIIorIVanginainpast2weekswithmoderatetohighlikelihoodofCADECGFindings:

NormalorunchangedECGduringanepisodeofchestdiscomfortBiochemicalMarkers:

Normal本文档共91页；当前第79页；编辑于星期日\14点26分PrognosticFactorsfromExerciseTestingElectrocardiographic:MaximumST-depressionMaximumST-elevationST-depressionslope(morphology)NumberofleadsshowingSTchangesDurationofSTdeviationintorecoveryST/HRindexesExercise-inducedventriculararrhythmiasTimetoonsetofSTdeviation本文档共91页；当前第80页；编辑于星期日\14点26分PrognosticFactorsfromExerciseTestingHemodynamic:MaximumexerciseheartrateMaximumexerciseSBPMaximumexercisedoubleproduct(HRxSBP)Totalexerciseduration(functionalcapacity)ExertionalhypotensionChronotropicincompetenceAbnormalheartraterecovery本文档共91页；当前第81页；编辑于星期日\14点26分HeartRateRecoveryAfterExerciseTestingPredictsOutcomeinCAD

本文档共91页；当前第82页；编辑于星期日\14点26分PrognosticFactorsfromExerciseTestingSymptomatic:Exercise-inducedanginaExercise-inducedsymptoms(SOB,dizziness)Timetoonsetofangina本文档共91页；当前第83页；编辑于星期日\14点26分PrognosticScoreinAssessmentofCardiacEventRiskduringExerciseTestingDukePrognosticScore:TreadmillScore=exercisetimex5(amountofST-segmentdeviation)-4xexerciseanginaindex(0=none,1=presentbutnotlimiting,2=reasontostopthetest)HighRisk:<-11 (5%annualmortality)LowRisk:>+5 (0.5%annualmortality)InformationadditivetocoronaryanatomyandLVEF本文档共91页；当前第84页；编辑于星期日\14点26分DukePrognosticScoreNomogram本文档共91页；当前第85页；编辑于星期日\14点26分CombinedPrognosticFactorsIncreasePredictiveValueofExerciseTestingDatainCAD本文档共91页；当前第86页；编辑于星期日\14点26分IndicationsforExerciseTestingafterMyocardialInfarctionClassI:Beforedischargeforprognosticassessment,activityprescription,evaluationofmedicaltherapy(submaximalversusmaximal,submaximal4-6days)Earlyafterdischargeforpr