Clinical value of early exercise testing after myocardial infarction

The clinical utility of predischarge exercise ECGs was assessed prospectively in 47 patients 17 +/- 2 days after myocardial infarction. The graded-interval ergometric exercise protocol was terminated at 450 kilopond-m/min (kpm/min), a heart rate greater than 75% of predicted maximum, or for established clinical indications. Prior to testing, the attending physician and resident indicated their clinical impressions with regard to anticipated (1) angina, (2) exercise capacity, (3) arrhythmias during limited exercise, as well as anticipated discharge medications and activity prescriptions. Ratings were compared to exercise results and consequent alterations in management noted. No complications were noted during the evaluations. Nine patients noted anginal pain during exercise; five were unsuspected by the attending physician or resident. Ten patients demonstrated significant ventricular arrhythmias. Four were receiving antiarrhythmic therapy. Severe limitation of exercise capacity (< 300 kpm/min) was noted in six patients, unanticipated in four. Where not contraindicated, routine use of predischarge exercise ECG testing is recommended.