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Routine exercise ECG three weeks after acute myocardial infarction
Insights
Exercise testing in the third week after myocardial infarction is safe and provides an objective measure of physical capacity. This assessment aids in guiding patients back to normal activities and offers significant psychological benefits.
Area of Science:
- Cardiology
- Exercise Physiology
- Rehabilitation Medicine
Background:
- Acute myocardial infarction (AMI) necessitates careful assessment of physical work capacity before patient discharge.
- Early post-MI exercise testing can inform rehabilitation strategies and return-to-activity guidelines.
Purpose of the Study:
- To evaluate the safety and utility of symptom-limited exercise testing in patients during the third week after AMI.
- To assess physical work capacity and physiological responses to exercise in post-MI patients.
Main Methods:
- 209 patients underwent maximal symptom-limited bicycle ergometer exercise tests 18 days post-AMI.
- Continuous electrocardiogram (ECG) and heart rate (HR) monitoring, with minute-by-minute blood pressure (BP) measurements.
- Exercise was progressively increased, aiming for maximal symptom-limited performance.
Main Results:
- The test was safely tolerated by all patients, with fatigue being the most common reason for cessation (58%).
- Significant increases in average heart rate (80 to 129 bpm) and systolic blood pressure (126 to 170 mmHg) were observed.
- Myocardial ischemia (ST-T changes) occurred in 70% of patients, and ventricular ectopic beats in 42%, with all disturbances resolving spontaneously.
Conclusions:
- Exercise testing is a safe and objective method for assessing physical work capacity in patients in the third week post-AMI.
- The test provides crucial data for guiding patients on returning to normal life and offers psychological reassurance.
Abstract:
In the third week after acute myocardial infarction, mean 18 days, exercise tests have been performed in 209 patients prior to discharge from the Coronary Care Unit. The exercise was done on a bicycle ergometer with electrically controlled braking, starting at the load 300 kpm/min (equal to 50 W), increasing with 300 kpm/min every 6th min, aiming at a maximal symptom-limited performance. ECG, in 3 extremity leads and 3 precordial leads, and heart rate (HR) were continuously recorded, and blood pressure (BP) was measured every minute. The most common cause for discontinuing exercise was fatigue (in 58%). Anginal pain or dyspnoea was the cause in 23.8%. Only in 9.1% was the exercise interrupted by the investigator because of rhythm disturbances or pronounced ST-T changes. Maximal work varied from 1 min exercise at 300 kpm/min to 6 min at 900 kpm/min (150 W); 18% of all patients were able to work for 6 min at 600 kpm/min (100 W). HR increased on an average from 80 beats/min at rest to 129 beats/min at maximal work load. Systolic blood pressure (SBP) increased on an average from 126 to 170 mmHg. The maximal values reached during exercise were HR 170/min, and SBP 270 mmHg. The product HR X SPB increased a little more than two-fold on an average. ST-T changes indicating myocardial ischaemia during exercise were observed in 70%. During exercise ventricular ectopic beats occurred in 42%. All rhythm disturbances provoked by exercise disappeared spontaneously shortly after work. Persistent ECG changes, reinfarction or other serious complications were not observed in connection with the exercise test. It is concluded that an exercise test under controlled circumstances is safe in patients of all ages in the third week after myocardial infarction. It is an objective measure of physical work capacity and described the reaction to physical activity. It gives a basis for advising return to normal life and is of great psychological importance to the patient.