心臟康復(fù)評定

關(guān)于心臟康復(fù)評定第1頁，講稿共92頁，2023年5月2日，星期三APATIENTCASEEXAMPLE第2頁，講稿共92頁，2023年5月2日，星期三1.Whyareyouheretoday?2.Haveyoubeendiagnosedwithacardiacdisorderinthepast?3.Haveyouhadanyspecialteststoexamineyourheartlikeanelectrocardiogram,stresstest,echocardiogram,orcardiaccatheterization?第3頁，講稿共92頁，2023年5月2日，星期三4.Doyouexperienceanginaorshortnessofbreathatrest,onlywithactivity/exercise,orbothatrestandwithactivity/exercise?第4頁，講稿共92頁，2023年5月2日，星期三5.Ifyouexperienceanginaorbecomeshortofbreathduringactivityorexercisecouldyoupleasedescribethetypeofactivityorexercisewhichproducesyouranginaorshortnessofbreath?第5頁，講稿共92頁，2023年5月2日，星期三6.Canyoudescribeyouranginaorshortnessofbreath?Canyouhelpmeunderstandyouranginaorshortnessofbreathbypointingtothenumbers1through4todescribethelevelofanginayouexperienceatrestandexerciseorbypointingtoyourlevelofshortnessofbreathusingthis10-pointscaleorbymarkingthisvisualanalogscale?第6頁，講稿共92頁，2023年5月2日，星期三7.CouldIfeelyourpulsetodetermineyourheartrateandthestrengthofyourpulse?8.CouldIplacethisfingerprobeonyourindexfingertoobtainanoxygensaturationmeasurement?第7頁，講稿共92頁，2023年5月2日，星期三9.CouldIplacetheseelectrodesonyourchesttoobtainasimplesingle-leadelectrocardiogram(ECG)?第8頁，講稿共92頁，2023年5月2日，星期三10.CouldItakeyourbloodpressurewhileyouareseatedandthencompareittothebloodpressurewhileyouarelyingdownandthenstanding?Iwouldalsoliketoobserveyourpulse,oxygensaturation,ECG,andsymptomswhenyouarelyingdownandstanding.第9頁，講稿共92頁，2023年5月2日，星期三11.CouldIlistentoyourheartandlungswithmystethoscope?WhileIdothisIwillconcentrateonwatchingyourECGsothatIcanidentifyyourheartsoundsandanychangesintheECGwhileyouarebreathingdeeplywhenlisteningtoyourlungs.第10頁，講稿共92頁，2023年5月2日，星期三12.CouldIplace1ofmyhandsonyourstomachand1handonyourupperchesttodeterminehowyoubreathe?13.CouldIplacemyhandsonthelowermostribsoneachsideofyourchesttodeterminehowyoubreathe?14.CouldIplacemyhandsonyourbacktodeterminehowyoubreathe?15.CouldIwrapmytapemeasurearoundyourchestatseveraldifferentsitestodeterminehowyoubreathe?第11頁，講稿共92頁，2023年5月2日，星期三16.NowthatIunderstandsomeverybasicinformationaboutthemannerinwhichyoubreathecouldyoupleasebreatheinthemannerIinstructyouviasoundsImake,pressurefrommyhands,methodsIshowtoyou,ordifferentbodypositions?IwilloccasionallyplacemyhandsonyourchestandwrapmytapemeasurearoundyourchesttodeterminehowyoubreatheduringthesesimpletestsandIwillaskyoutoidentifyyourlevelofshortnessofbreathusingthe10-pointscaleorvisualanalogscale—Isthisokwithyou?第12頁，講稿共92頁，2023年5月2日，星期三17.CouldImeasurethestrengthofyourbreathingmusclebyhavingyouplacethismouthpieceinyourmouthandbreatheinandoutasdeeplyandasforcefullyasyouareable?第13頁，講稿共92頁，2023年5月2日，星期三18.Iwouldlikeyoutonowperformtheactivityorexercisewhichproducesyouranginaorshortnessofbreath.Couldyoupleasedothisnow?第14頁，講稿共92頁，2023年5月2日，星期三Thankyouforgivingmethechancetoexamineyoutoday.Iwillcallyourphysiciantogetsomemoreinformationaboutyoulikeelectrocardiogram,echocardiogramandpulmonaryfunctionteststhatyousaidwereperformedlastweekaswellasthearterialbloodgasresults,chestX-ray,andexercisetestresults.第15頁，講稿共92頁，2023年5月2日，星期三PhysicalTherapyExaminationMedicalInformationandRiskFactorAnalysis

listeningtothepatientspasthistoryandprimarycomplaintsiscriticalintheexaminationprocess.

第16頁，講稿共92頁，2023年5月2日，星期三ExaminationsofPatientAppearancecategorizedbyspecificsignsandsymptoms第17頁，講稿共92頁，2023年5月2日，星期三Angina-MethodsToEvaluateAnginafromNonanginalPainIfasuspectedanginalpainchanges(increasesordecreases)withbreathing,palpationinthepainfularea,ormovementofajoint(ie,shoulderflexionandabduction)itisverylikelythatthepainisNOTangina.第18頁，講稿共92頁，2023年5月2日，星期三Angina-MethodsToEvaluateAnginafromNonanginalPainitcanbeworsenedbyphysicalexerciseoractivity.Therefore,ifthesuspectedanginalpainisunchangedwiththepreviouslycitedmaneuversandthepainoccurredwithexertion,itisSUSPECTforangina.Ifthesuspectedanginalpainisunchangedbythesemaneuvers,ifthepainoccurredwithexertion,andifthepaindecreasesorsubsideswithrest,itisverylikelythatthepainISangina.Finally,ifthesuspectedpaindecreasesorsubsideswithnitroglycerin,itisevenmorelikelythatthepainISangina.第19頁，講稿共92頁，2023年5月2日，星期三第20頁，講稿共92頁，2023年5月2日，星期三"Other"SymptomsofHeartDiseasedyspneaFatigueDizzinessLightheadednessPalpitationsasenseofimpendingdoom第21頁，講稿共92頁，2023年5月2日，星期三第22頁，講稿共92頁，2023年5月2日，星期三ExaminationsofPatientAppearanceskincoloroftheperipheralextremities.Paleorcyanoticskininthelegs,feet,arms,andfingersisassociatedwithpoorcardiovascularfunction.第23頁，講稿共92頁，2023年5月2日，星期三ExaminationsofPatientAppearanceDiagonalearlobecrease.Thisphenomenonhasbeeninvestigatedformanyyearsandrecentlywasonceagainfoundtobehighlypredictiveofheartdisease第24頁，講稿共92頁，2023年5月2日，星期三AnthropometricmeasurementsbodyweightfingerpressureonanedematousareaGirthmeasurementsskin-foldcalipermeasurementscalculationofthebodymassindexmeasurethepercentageofbodyfatandleanmusclemass第25頁，講稿共92頁，2023年5月2日，星期三Jugularvenousdistensionitisoftenduetoright-sidedheartfailure.第26頁，講稿共92頁，2023年5月2日，星期三第27頁，講稿共92頁，2023年5月2日，星期三第28頁，講稿共92頁，2023年5月2日，星期三PalpationoftheRadialPulsePalpationoftheradialpulsecanprovideimportantinformationaboutthestatusofthecardiovascularsystem.MeasurementoftheSystolicBloodPressureandPulseDuringBreathingandSimplePerturbationsoftheBreathingCycle第29頁，講稿共92頁，2023年5月2日，星期三MeasurementoftheSystolicandDiastolicBloodPressureandPulseinDifferentBodyPositions第30頁，講稿共92頁，2023年5月2日，星期三

ToDeterminetheStatusoftheCardiovascularSystem

observationofadecreaseinsystolicanddiastolicbloodpressurewithoutasubsequentincreaseinheartratewhenchangingbodypositionfromsupinetostandingisconsideredapositivesignforautonomicnervoussystemdysfunction..第31頁，講稿共92頁，2023年5月2日，星期三ToDeterminethe

HealthoftheCardiovascularSystemAcardiovascularsystemthatrespondsrapidlytobodypositionchangeislikelyinabetterstateofhealththanacardiovascularsystemthatrespondssluggishly.Bothanunchangedordecreasedheartrateafterstandingfor30seconds(comparedtotheheartrateat15seconds)issuggestiveofautonomicdysfunction.第32頁，講稿共92頁，2023年5月2日，星期三asluggishorhypoadaptive(lessthannormal)heartrateandbloodpressureresponseduringachangeinbodypositionsupinetostandingshouldbeconsideredabnormalandsuggestiveofanunhealthycardiovascularsystem.第33頁，講稿共92頁，2023年5月2日，星期三amoreadaptiverapidincreaseinheartrateandbloodpressureaftermovingfromasupinetostandingposition(approximately30seconds)islikelyassociatedwithahealthiercardiovascularsystem第34頁，講稿共92頁，2023年5月2日，星期三ExaminationofthePulseandArterialBloodPressure

DuringFunctionalTasksandExerciseFrequentmonitoringoftheheartrateandbloodpressuremaybethebestwaytoexaminethesafetyofexerciseandhelptoestablishguidelinesandproceduresforfunctionalorexercisetraining.第35頁，講稿共92頁，2023年5月2日，星期三anincreaseinthediastolicbloodpressurewhenthediastolicbloodpressureshouldbedecreased(orlow)isastrongindicatorofcardiovasculardysfunction..第36頁，講稿共92頁，2023年5月2日，星期三PotentialindirectmeasuresofcardiacfunctionSymptomsandfunctionalclassificationCold,pale,andpossiblycyanoticextremitiesJugularvenousdistensionandperipheraledemaHeartsoundsPulseElectrocardiographyBloodpressure第37頁，講稿共92頁，2023年5月2日，星期三StandardmeasurementofcardiacfunctionCardiaccatheterizationEchocardiographySwan-GanscatheterizationCentralvenouspressureCardiacenzymesANPandBNPRadiologicevidence第38頁，講稿共92頁，2023年5月2日，星期三ExerciseTesting第39頁，講稿共92頁，2023年5月2日，星期三IndicationsforExerciseTesting:DiagnosisofCoronaryArteryDiseaseAssessmentofPrognosisinCoronaryArteryDiseaseEvaluationofFunctionalCapacityEvaluationofTherapyforCoronaryDiseaseDeterminationofExercisePrescription第40頁，講稿共92頁，2023年5月2日，星期三AbsoluteContraindicationstoExerciseTestingAcuteMI(within2days)High-riskunstableanginaUncontrolledcardiacarrhythmiasActiveEndocarditisSevereaorticstenosisDecompensatedheartfailureAcutepulmonaryembolusorinfarction,DVTAcutenoncardiacdisorderaffectingoraggravatedbyexerciseAcutemyocarditis,pericarditisPhysicaldisabilityprecludessafeandadequatetestInabilitytoobtainconsent第41頁，講稿共92頁，2023年5月2日，星期三RelativeContraindicationstoExerciseTestingLeftmaincoronarystenosisorequivalentModerateaorticvalvularstenosis(?)ElectrolytedisorderTachyarrhythmiasorBradyarrhythmiasAtrialfibrillationwithuncontrolledventricularresponseHypertrophicCardiomyopathy(?gradient)MentalimpairmentleadingtoinabilitytocooperateHigh-degreeAVblock第42頁，講稿共92頁，2023年5月2日，星期三ECGLeadPlacementfor

ExerciseTesting第43頁，講稿共92頁，2023年5月2日，星期三ProtocolsforExerciseTesting第44頁，講稿共92頁，2023年5月2日，星期三BloodPressureResponses:

ExerciseTestingDependencyoncardiacoutputandperipheralresistanceNormalresponses:IncreaseinSBP(>20-30mmHg)NochangeorfallinDBPInadequateriseinSBP:Myocardialischemia,severeLVsystolicdysfunction,aorticorLVOTobstruction,drugtherapy(?-blockers)Exercise-InducedHypotension(>10mmHgbelowbaseline)Severemyocardialischemia(50%positivepredictivevalueforleftmainor3-vesseldisease),valvularheartdisease,cardiomyopathynoevidenceofclinicallysignificantheartdisease(dehydration,antihypertensivetherapy,prolongedstrenuousexercise)第45頁，講稿共92頁，2023年5月2日，星期三HeartRateResponsetoExerciseTestingAcceleratedHeartRateResponse:Deconditioning,prolongedbedrest,anemia,metabolicdisorders,conditionsassociatedwithdecreasedbloodvolumeorlowsystemicvascularresistance,autonomicinsufficencyChronotropicincompetence:Inadequateexerciseeffort,drugtherapy(?-blockers),PrognosticSignificance:(PeakHR-RestingHR)/(220-age-RestingHR)<0.80(Lauer,1999)PeakHR<130bpm(Ellestad)第46頁，講稿共92頁，2023年5月2日，星期三EvaluationofExerciseEffortduringExerciseTesting:TheBorgPerceivedExertionScale第47頁，講稿共92頁，2023年5月2日，星期三ExerciseCapacity-ExerciseTestingMETcapacity1MET=3.5ml/kg/minO2consumptionFunctionalAerobicImpairment(FAI) (BruceProtocolspecific)PredictedMETlevel(nomograms)PredictedVO2(ACSMformulae)PracticalAspects:LackofassociationbetweenLVEFandexercisecapacityPrognosticvalueofdecreasedexercisecapacityandactiveCADPredictorofpatient’sdisability第48頁，講稿共92頁，2023年5月2日，星期三ExerciseTesting-ComplicationsMIordeath:Upto10per10,000tests(1per2,500)Lifethreateningventriculararrhythmias:0-5per100,000Cardiac:Bradyarrhythmias,tachyarrhythmias,acutecoronarysyndromes,heartfailure,hypotension,syncope,deathNoncardiac:Musculoskeletaltrauma,soft-tissueinjuryMiscellaneous:Severefatigue,dizziness,myalgias第49頁，講稿共92頁，2023年5月2日，星期三AbsoluteIndicationsforTerminationofExerciseTestST-segmentelevation(>1.0mm)inleadswithoutQ-waves(otherthanV1oraVR)Dropinsystolicbloodpressure>10mmHg(persistentlybelowbaseline)despiteanincreaseinworkload,whenaccompaniedbyanyotherevidenceofischemiaModeratetosevereangina(grades3-4)Centralnervoussystemsymptoms(ataxia,dizziness,nearsyncope)Signsofpoorperfusion(cyanosisorpallor)SustainedventriculartachycardiaTechnicaldifficultiesmonitoringtheECGorsystolicBPPatient’srequesttostop第50頁，講稿共92頁，2023年5月2日，星期三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)第51頁，講稿共92頁，2023年5月2日，星期三CriteriaforReadingST-SegmentChangesontheExerciseECGSTDEPRESSION:Measurementsmadeon3consecutiveECGcomplexes!STlevelismeasuredrelativetotheP-Qjunction3keymeasurements(P-Qjunction,J-point,60-80msecafterJ-point-use60msecforHR>130bpmWhenJ-pointisdepressedrelativetoP-Qjunctionatbaseline:NetdifferencefromtheJjunctiondeterminestheamountofdeviationWhentheJ-pointiselevatedrelativetoP-Qjunctionatbaselineandbecomesdepressedwithexercise:MagnitudeofSTdepressionisdeterminedfromtheP-QjunctionandnottherestingJpoint第52頁，講稿共92頁，2023年5月2日，星期三CriteriaforReadingST-SegmentChangesontheExerciseECGSTELEVATION:60msecafterJpointin3consecutiveECGcomplexes第53頁，講稿共92頁，2023年5月2日，星期三CriteriaforAbnormalandBorderlineST-SegmentDepressionontheExerciseECGABNORMAL:1.0mmorgreaterhorizontalordownslopingSTdepressionat60msecafterJpointon3consecutiveECGcomplexesBORDERLINE:0.5to1.0mmhorizontalordownslopingSTdepressionat60msecafterJpointon3consecutiveECGcomplexes2.0mmorgreaterupslopingSTdepressionat60msecafterJpointon3consecutiveECGcomplexes第54頁，講稿共92頁，2023年5月2日，星期三MorphologyofST-SegmentDeviation

duringExerciseTesting第55頁，講稿共92頁，2023年5月2日，星期三ValueofRight-SidedECGLeadsduringExerciseTestingfortheDiagnosisofCAD第56頁，講稿共92頁，2023年5月2日，星期三HorizontalST-segmentDepressionduringExerciseTesting第57頁，講稿共92頁，2023年5月2日，星期三DownslopingST-SegmentDepressionduringExerciseTesting第58頁，講稿共92頁，2023年5月2日，星期三ST-SegmentDepressioninEarlyRecoveryPeriodafterExerciseTesting第59頁，講稿共92頁，2023年5月2日，星期三UpslopingST-SegmentDepressionduringExerciseTesting第60頁，講稿共92頁，2023年5月2日，星期三MorphologyofST-SegmentDepressionPredictsSeverityofCoronaryArteryDisease

(Goldschlager,1976)第61頁，講稿共92頁，2023年5月2日，星期三Exercise-InducedST-SegmentElevationwithPriorAnteriorMyocardialInfarction第62頁，講稿共92頁，2023年5月2日，星期三Exercise-InducedST-SegmentElevationintheSettingofPriorInferolateralMI第63頁，講稿共92頁，2023年5月2日，星期三Exercise-InducedAnteriorST-SegmentElevationasReflectionofLADIschemia第64頁，講稿共92頁，2023年5月2日，星期三Indicationsfor

ExerciseTestingintheDiagnosisofObstructiveCoronaryDiseaseCLASSI:Adultpatients(includingthosewithRBBBorlessthan1mmorrestingST-depression)withanintermediatepretestprobabilityofCAD,basedongender,age,andsymptomsCLASSIIa:PatientswithvasospasticanginaCLASSIIb:PatientswithahighpretestprobabilityofCADbyage,symptoms,andgenderPatientswithalowpretestprobabilityofCADbyage,symptoms,andgenderPatientswithlessthan1mmofbaselineSTdepressionandtakingdigoxinPatientswithECGcriteriaofLVHandlessthan1mmSt-depression第65頁，講稿共92頁，2023年5月2日，星期三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第66頁，講稿共92頁，2023年5月2日，星期三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第67頁，講稿共92頁，2023年5月2日，星期三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

第68頁，講稿共92頁，2023年5月2日，星期三Pre-testProbabilityofCAD

byAge,Gender,andSymptomsAsymptomatic:Age30-39Men VeryLow Women VeryLowAge40-49Men Low Women VeryLowAge50-59Men Low Women VeryLowAge60-69Men Low Women Low第69頁，講稿共92頁，2023年5月2日，星期三Indicationsfor

ExerciseTestingintheDiagnosisofObstructiveCoronaryDiseaseClassIII:PatientswiththefollowingECGabnormalities:WPWsyndrome,electronicallypacedventricularrhythm,greaterthan1mmrestingST-depression,completeLBBBPatientswithadocumentedMIorpriorcoronaryangiographydemonstratingsignificantCADhaveanestablisheddiagnosis(?ischemia,prognosis)第70頁，講稿共92頁，2023年5月2日，星期三ExerciseTesting;SensitivityandSpecificityfortheDiagnosisofCADSensitivity=[Truepositives/truepositives+falsenegatives]x100Specificity=[Truenegatives/falsepositives+truenegatives]x100StandardExerciseTest(mostlymen)*Sensitivity=68% Specificity=77%PredictiveAccuracy=73%*Basedon1.0mmST-segmentdepression第71頁，講稿共92頁，2023年5月2日，星期三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第72頁，講稿共92頁，2023年5月2日，星期三RiskAssessmentandPrognosiswithExerciseTestinginPatientswithSymptomsandPriorHistoryofCADClassI:PatientundergoinginitialevaluationwithsuspectedorknownCADincludingthosewithcompleteRBBBandlessthan1mmofrestingECG(exceptions-ClassIIb)PatientswithsuspectedorknowCADpreviouslyevaluated,nowpresentingwithsignificantchangeinclinicalstatusLow-riskacutecoronarysyndromepatients8-12hoursafterpresentationwhohavebeenfreeofactiveischemiaorheartfailuresymptoms(LevelofEvidence=B)Intermediate-riskacutecoronarysyndromepatients2-3daysafterpresentationwhohavebeenfreeofactiveischemiaorheartfailuresymptoms(LevelofEvidence=B)第73頁，講稿共92頁，2023年5月2日，星期三RiskAssessmentandPrognosiswithExerciseTestinginPatientswithSymptomsandPriorHistoryofCADClassIIa:Intermediate-riskacutecoronarysyndromepatientswhohaveinitialcardiacmarkersthatarenormal,arepeatECGwithoutsignificantchange,andcardiacmarkers6-12hoursaftertheonsetofsymptomsthatarenormalandnootherevidenceofischemiabyobservation(LevelofEvidence=B)ClassIIb:PatientswiththefollowingECGabnormalities:WPWsyndrome,electronicallypacedventricularrhythm,1mmormoreofrestingST-depression,completeLBBBorIVCDwithaQRSduration>120msecPatientswithastableclinicalcoursewhoundergoperiodicmonitoringtoguidetreatment第74頁，講稿共92頁，2023年5月2日，星期三RiskAssessmentandPrognosiswithExerciseTestinginPatientswithSymptomsandPriorHistoryofCADClassIII:Patientswithsevereco-morbiditylikelytolimitlifeexpectancyand/orcandidacyforrevascularizationHigh-riskacutecoronarysyndromepatients(LevelofEvidence=c)第75頁，講稿共92頁，2023年5月2日，星期三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第76頁，講稿共92頁，2023年5月2日，星期三Short-termRiskAssessmentforDeathorNonfatalMIinPatientswithAcuteCoronarySyndromeINTERMEDIATERISK:Nohigh-riskfeaturebutmusthaveoneofthefollowing:History:PriorMI,peripheralorcerebrovasculardisease,CABGorprolongedaspirinuseCharacterofPain:Prolonged(>20min)restangina,nowresolved,withmoderatetohighlikelihoodofCADRestangina(<20min)orrelievedbysublingualNTGClinicalFindings:age>70yrsECGFindings:T-waveinversionsgreaterthan0.2mV,pathologicalQ-wavesBiochemicalMarkers:Borderlineelevatedtroponin-I第77頁，講稿共92頁，2023年5月2日，星期三Short-termRiskAssessmentforDeathorNonfatalMIinPatientswithAcuteCoronarySyndromeLOWRISK:Nohighorintermediateriskfeaturesbutanyofthefollowing:CharacterofPain:

New-onsetorprogressiveCCSCIIIorIVanginainpast2weekswithmoderatetohighlikelihoodofCADECGFindings:

NormalorunchangedECGduringanepisodeofchestdiscomfortBiochemicalMarkers:

Normal第78頁，講稿共92頁，2023年5月2日，星期三PrognosticFactorsfromExerciseTestingElectrocardiographic:MaximumST-depressionMaximumST-elevationST-depressionslope(morphology)NumberofleadsshowingSTchangesDurationofSTdeviationintorecoveryST/HRindexesExercise-inducedventriculararrhythmiasTimetoonsetofSTdeviation第79頁，講稿共92頁，2023年5月2日，星期三PrognosticFactorsfromExerciseTestingHemodynamic:MaximumexerciseheartrateMaximumexerciseSBPMaximumexercisedoubleproduct(HRxSBP)Totalexerciseduration(functionalcapacity)ExertionalhypotensionChronotropicincompetenceAbnormalheartraterecovery第80頁，講稿共92頁，2023年5月2日，星期三HeartRateRecoveryAfterExerciseTestingPredictsOutcomeinCAD

第81頁，講稿共92頁，2023年5月2日，星期三PrognosticFactorsfromExerciseTestingSymptomatic:Exercise-inducedanginaExercise-inducedsymptoms(SOB,dizziness)Timetoonsetofangina第82頁，講稿共92頁，2023年5月2日，星期三PrognosticScoreinAssessmentofCardiacEventRiskduringExerciseTestingDukePrognosticScore:TreadmillScore=exercisetimex5(amountofST-segmentdeviation)-4xexerciseanginaindex(0=none,1=presentbutnotlimiting,2=reasontostopthetest)HighRisk:<-11 (5%annualmortality)LowRisk:>+5 (0.5%annualmortality)InformationadditivetocoronaryanatomyandLVEF第83頁，講稿共92頁，2023年5月2日，星期三DukePrognosticScoreNomogram第84頁，講稿共92頁，2023年5月2日，星期三CombinedPrognosticFactorsIncreasePredictiveValueofExerciseTestingDatainCAD第85頁，講稿共92頁，2023年5月2日，星期三IndicationsforExerciseTestingafterMyocardialInfarctionClassI:Beforedischargeforprognosticassessment,activityprescription,evaluationofmedicaltherapy(submaximalversusmaximal,submaximal4-6days)Earlyafterdischargeforprognosticassessment,activityprescription,evaluationofmedicaltherapy,andcardiacrehabilitationifpre-dischargeexercisetestwasnotdone(symptom-limited,about14-21days)Lateafterdischargeforprognosticassessment,activityprescription,evaluationofmedicaltherapy,andcardiacrehabilitationiftheearlyexercisetestwassubmaximal(symptom-limited3-6weeks)第86