A 48-year woman is referred to the rapid access chest pain clinic by her GP with chest tightness.
This occurs on exertion but also occasionally after meals. Her only past medical history is hypertension and permanent atrial fibrillation. Her only medication is digoxin and warfarin.
Question: Which of the following regarding exercise tests is true?
A A fall in BP with increasing exercise is a non-significant finding
B Providing that a heart rate >75% of that predicted is achieved and no ECG changes are documented, ischaemic heart disease can be confidently excluded
C Digoxin therapy makes interpretation of exercise tests difficult
D Exercise testing should not be performed in patients with a previous history of ventricular arrhythmias
E There is a higher false-positive rate in males compared with females
Answer:
C Digoxin therapy makes interpretation of exercise tests difficult
Discussion:A reduction in haemodynamic performance with exercise may represent significant
coronary artery disease and should be investigated further.
Generally, a heart rate >85% of that predicted is accepted as a target to achieve.
The ST-segment changes associated with digoxin use make the exercise ECG very difficult to interpret, a matter further complicated by this patient’s atrial fibrillation.
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