Tag: exercise testing

Aortic Stenosis

Exercise Testing in Patients with Aortic Stenosis: Exercise Testing

Exercise Testing in Subjects with Aortic Stenosis Although studies have delineated possible mechanisms for effort syncope in aortic stenosis, a review of the literature (Thble 1) demonstrates rare complications from exercise testing when performed with appropriate caution and monitoring. Although used predominantly in pediatric cardiology to assess congenital aortic stenosis…

Aortic Stenosis

Exercise Testing in Patients with Aortic Stenosis: Syncope—carotid hyperreactivity

Exercise Testing in Patients with Aortic Stenosis: Syncope—carotid hyperreactivity

Four mechanisms leading to decreased cerebral perfusion and syncope—carotid hyperreactivity, left ventricular failure, arrhythmia, and left ventricular baroreceptor stimulation—were addressed by Richards et al. They studied four subjects with aortic stenosis (three with syncope, one with heart failure) using electrocardiographic and pressure monitoring of the pulmonary and brachial arteries. During…

Aortic Stenosis

Exercise Testing in Patients with Aortic Stenosis: Syncope during exercise

Perhaps the most plausible explanation for syncope during exercise in patients with aortic stenosis is left ventricular stretch baroreceptor or mechano-receptor stimulation with concomitant arterial hypotension, reduced venous return, and bradycardia. Ross and colleagues demonstrated that elevation of left atrial and left ventricular pressures in dogs caused a decrease in…

Aortic Stenosis

Exercise Testing in Patients with Aortic Stenosis: Discussion

Exercise Testing in Patients with Aortic Stenosis: Discussion

In this patient, inadequate attention had been paid to warning signs. The initial heavy workload of the Bruce protocol (5 METs), infrequent blood pressure monitoring, continuation of the test despite a blunted blood pressure response, and physician inexperience may all have contributed to this catastrophe. Fortunately, the patient survived and…