1. Cardiovascular Testing Techniques

2. Methods of Testing Cardiac Function Holter Monitors Non-exercise stress testing –Dobutamine induced increases in HR Echocardiography –Stress Echocardiogram Graded Exercise Testing Nuclear (thallium or technetium) chemical tests Coronary angiography

3. Relative Contraindications Severe hypertension Mild-to- moderate aortic stenosis, Hypertrophic obstructive cardiomyopathy Frequent ectopy Orthopedic limitations Other conditions that may increase relative risk

4. Absolute Contraindications Acute CHF Acute MI Active myocarditis Ongoing unstable angina Recent embolism Dissecting aneurysm Acute illness, Thrombophlebitis Moderate-to-severe aortic stenosis EKG that cannot be interpreted

5. EKG Contraindications Conditions that preclude reliable ECG interpretation: 1.Left bundle branch block 2.Wolff-Parkinson-White 3.Physiological rate adaptive pacing 4.Left ventricular hypertrophy with ST segment changes 5.Extensive anterior wall infarction Exercise testing may still provide useful information on exercise capacity and hemodynamic responses

6. Left Bundle Branch Block

7. Wolff-Parkinson-White Syndrome Electrically active muscle fibers bridge the atria and ventricles and cause pre-excitation of the ventricles. This accessory pathway is able to conduct faster than the AV node. WPW is a reentry mechanism with an accessory pathway. –Can be difficult to diagnose in some children because of the higher normal sinus rates and rapid AV node conduction.

8. Wolff-Parkinson-White Syndrome

9. LVH with ST segment changes

10. Pharmacological Impact on CV Response to Exercise Beta-blockers –peak HR may be 50 to 60% less than predicted max HR –systolic rise of only 20 to 30 mm Hg Vasodilators –restricted BP increases