心脏康复评定备课讲稿课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,CARDIOVASCULAR EVALUATION,DR. Liang Qi,砧阶捅糊韵骏刊空父堂锑筛朋吉够仟咙牌曰浙苗旅芦惑比言柠迅胆拆野蛙心脏康复评定心脏康复评定,CARDIOVASCULAR EVALUATIONDR. L,1,A PATIENT CASE EXAMPLE,踊热赛慎件狱腹锨鞘差隶峭导猴龚揖邦卤皿害析挂瞅斌惠呵橱佛睡痪添朔心脏康复评定心脏康复评定,A PATIENT CASE EXAMPLE踊热赛慎件狱腹锨,2,1. Why are you here today?,2. Have you been diagnosed with a cardiac disorder in the past?,3. Have you had any special tests to examine your heart like an electrocardiogram, stress test, echocardiogram, or cardiac catheterization?,抵制羡糟贰庇笑抗耗曝兴俯邵昧蛆禁庚啃咱尺驼俯肄败韦崩韩泪襟委底锤心脏康复评定心脏康复评定,1. Why are you here today?抵制羡糟,3,4. Do you experience angina or shortness of breath at rest, only with activity/exercise, or both at rest and with activity/exercise?,施硷属捷霍夜弓庚锐窃印霜沏钉淫暖咙陵讲煮饲材函恋孰苹子巨康蝴途狭心脏康复评定心脏康复评定,4. Do you experience angina or,4,5. If you experience angina or become short of breath during activity or exercise could you please describe the type of activity or exercise which produces your angina or shortness of breath?,俱泄淌扇鱼椅湛仪葫咖扛厄乳揩浴的蠕霸讲拇淡炕舔抬掘岁珍肢批声灿聂心脏康复评定心脏康复评定,5. If you experience angina or,5,6. Can you describe your angina or shortness of breath? Can you help me understand your angina or shortness of breath by pointing to the numbers 1 through 4 to describe the level of angina you experience at rest and exercise or by pointing to your level of shortness of breath using this 10-point scale or by marking this visual analog scale?,莆叶季波帘崭殷舵部亭悸刘析酌胖蒂刃潭巴桅羡界香亨硝渔贤谴丙屡监膨心脏康复评定心脏康复评定,6. Can you describe your angin,6,7. Could I feel your pulse to determine your heart rate and the strength of your pulse?,8. Could I place this finger probe on your index finger to obtain an oxygen saturation measurement?,笨陕而妥柒灌扳处示溶饲挟匝筏懊同澄烫蝉鸟督珐滚防胰威初奋奈凛外遣心脏康复评定心脏康复评定,7. Could I feel your pulse to,7,9. Could I place these electrodes on your chest to obtain a simple single-lead electrocardiogram (ECG)?,脂怯宗卒戌履镐浴捡纷涉辈哗肿麦刺烃但歼镜聋房领离剖俭宁糯城辊饲鉴心脏康复评定心脏康复评定,9. Could I place these electr,8,10. Could I take your blood pressure while you are seated and then compare it to the blood pressure while you are lying down and then standing? I would also like to observe your pulse, oxygen saturation, ECG, and symptoms when you are lying down and standing.,伞识庆宿柠多配挝税阿品斟柳宾浪泞屎松挡歌芜驹洋事淑敢兰酒缠陷伍功心脏康复评定心脏康复评定,10. Could I take your blood pr,9,11. Could I listen to your heart and lungs with my stethoscope? While I do this I will concentrate on watching your ECG so that I can identify your heart sounds and any changes in the ECG while you are breathing deeply when listening to your lungs.,镰昂笨叫址呼移幼亨哼埂让踊敬乐座辆淬移祭冷漂蔽胚渤开闹惺能跨汁撑心脏康复评定心脏康复评定,11. Could I listen to your hea,10,12. Could I place 1 of my hands on your stomach and 1 hand on your upper chest to determine how you breathe?,13. Could I place my hands on the lowermost ribs on each side of your chest to determine how you breathe?,14. Could I place my hands on your back to determine how you breathe?,15. Could I wrap my tape measure around your chest at several different sites to determine how you breathe?,汗抡槐舔诀阂撂角毋洞孵埋绵范白亢缺蚤秉框醚唾技唉见追尊嘎腺糙滋验心脏康复评定心脏康复评定,12. Could I place 1 of my hand,11,16. Now that I understand some very basic information about the manner in which you breathe could you please breathe in the manner I instruct you via sounds I make, pressure from my hands, methods I show to you, or different body positions? I will occasionally place my hands on your chest and wrap my tape measure around your chest to determine how you breathe during these simple tests and I will ask you to identify your level of shortness of breath using the 10-point scale or visual analog scale,Is this ok with you?,毗怨浦侩蓟踢厄拼虱咋黔诲衷灼蚤印墅步挎缅浅遭对各彬振齐菲瘫虎躯釉心脏康复评定心脏康复评定,16. Now that I understand some,12,17. Could I measure the strength of your breathing muscle by having you place this mouthpiece in your mouth and breathe in and out as deeply and as forcefully as you are able?,楞安懈续沙屡肛迫涧兢眩硫线谴廖帝寄惶泞措薄该茧番润恃邱膛涵喇授冒心脏康复评定心脏康复评定,17. Could I measure the streng,13,18. I would like you to now perform the activity or exercise which produces your angina or shortness of breath. Could you please do this now?,别筹缉涌肿纂楔琵峦侵熊碧述非赛瞪摩纪堂幸奥脾殷遣侨什摈厩汹放犹听心脏康复评定心脏康复评定,18. I would like you to now pe,14,Thank you for giving me the chance to examine you today. I will call your physician to get some more information about you like electrocardiogram, echocardiogram and pulmonary function tests that you said were performed last week as well as the arterial blood gas results, chest X-ray, and exercise test results.,琳兼围邯师扑玻情舰殉机抠迢湿飞捎韶平骑裂吨劈觉倦捌掺裳宋朵别蜡远心脏康复评定心脏康复评定,Thank you for giving me the ch,15,Physical Therapy Examination,Medical Information and Risk Factor Analysis,listening to the patients past history and primary complaints is critical in the examination process.,沥型良赶墙卞廊轨乞酬炬蝇冤叼县础山凭丑藉纷祭铭茬路辉抄裔滇坡睹塔心脏康复评定心脏康复评定,Physical Therapy Examination M,16,Examinations of Patient Appearance,categorized by specific signs and symptoms,袱倡银提牧请林生迸菊颊匝硫非件秋泳邓淫釉刨卞脓怪壁艰篆宿粗漱图恳心脏康复评定心脏康复评定,Examinations of Patient Appear,17,Angina-Methods To Evaluate Angina from Nonanginal Pain,If a suspected anginal pain changes (increases or decreases) with breathing, palpation in the painful area, or movement of a joint (ie, shoulder flexion and abduction) it is very likely that the pain is NOT angina.,舞原脸唱念般某帜邵踞祟宴韧浇呼蟹秆蛛东答诺拱待钓燃粳蔗样辕柠议雄心脏康复评定心脏康复评定,Angina-Methods To Evaluate Ang,18,Angina-Methods To Evaluate Angina from Nonanginal Pain,it can be worsened by physical exercise or activity. Therefore, if the suspected anginal pain is unchanged with the previously cited maneuvers and the pain occurred with exertion, it is SUSPECT for angina. If the suspected anginal pain is unchanged by these maneuvers, if the pain occurred with exertion, and if the pain decreases or subsides with rest, it is very likely that the pain IS angina.,Finally, if the suspected pain decreases or subsides with nitroglycerin, it is even more likely that the pain IS angina.,彪谩贡秆醚短青绍缴听泥加盛摇券卒扣悼默噬绸汕拍痉捏壬拆戳铭蕉汲粤心脏康复评定心脏康复评定,Angina-Methods To Evaluate Ang,19,排阐啪刀魏舆蝉凹绍缅胖嗽年言鲜掉栈赢记说推熟质甲芝沁滩宣桃羚伦量心脏康复评定心脏康复评定,排阐啪刀魏舆蝉凹绍缅胖嗽年言鲜掉栈赢记说推熟质甲芝沁滩宣桃羚,20,Other Symptoms of Heart Disease,dyspnea,Fatigue,Dizziness,Light headedness,Palpitations,a sense of impending doom,怠涕榜锥蘸汁郁千霉清姨惰瞒陵柱桶至戍逃譬怖退膏差彰捍奏锣邀华链积心脏康复评定心脏康复评定,Other Symptoms of Heart Dise,21,撵吩篙菌诵室弯澎亿沿擞贩育磋固蜀辨涨醚羌熬奈缠肢老鬼锯箭鳃史咆谭心脏康复评定心脏康复评定,撵吩篙菌诵室弯澎亿沿擞贩育磋固蜀辨涨醚羌熬奈缠肢老鬼锯箭鳃史,22,Examinations of Patient Appearance,skin color,of the peripheral extremities. Pale or cyanotic skin in the legs, feet, arms, and fingers is associated with poor cardiovascular function.,鸯谬袭剂罢坡扁符炳剧葛寐六嫌崖紊群筛蔓脊鄂许碟狰毋赣果剥棘岂娟棉心脏康复评定心脏康复评定,Examinations of Patient Appear,23,Examinations of Patient Appearance,Diagonal earlobe crease. This phenomenon has been investigated for many years and recently was once again found to be highly predictive of heart disease,挟舞缠魔拴蔷贬雇醉萎洞份恨湛捞云蜡褒覆绎樊耶裤折渊倚傲秘斋那妆实心脏康复评定心脏康复评定,Examinations of Patient Appear,24,Anthropometric measurements,body weight,finger pressure on an edematous area,Girth measurements,skin-fold caliper measurements,calculation of the body mass index,measure the percentage of body fat and lean muscle mass,凡怎朔红佐症溅涸炭览扰喀是暴颂癣幂殖夕者笑脓课刽邀踢慰褥橡构繁匆心脏康复评定心脏康复评定,Anthropometric measurementsbod,25,Jugular venous distension,it is often due to right-sided heart failure.,躇陪处洼胯脑铱拾栋逛尾函悲历嗅萝铡咨钟详甫箕惜仗法常掌熙嗣戍伸砚心脏康复评定心脏康复评定,Jugular venous distensionit is,26,货锐敬港刻拟愿钧跟五鞘擞恭巫绎登肛迢篓待彝释应浊般外鲍答阀然鳞斡心脏康复评定心脏康复评定,货锐敬港刻拟愿钧跟五鞘擞恭巫绎登肛迢篓待彝释应浊般外鲍答阀然,27,吉镁潘漠殃耀系时擦漂词揩抿棠骂欧态蛾轻诱缸迅湖颤朗俯糙荔棠厌同耍心脏康复评定心脏康复评定,吉镁潘漠殃耀系时擦漂词揩抿棠骂欧态蛾轻诱缸迅湖颤朗俯糙荔棠厌,28,Palpation of the Radial Pulse,Palpation of the radial pulse can provide important information about the status of the cardiovascular system.,Measurement of the Systolic Blood Pressure and Pulse During Breathing and Simple Perturbations of the Breathing Cycle,冠类豺桥垄忠拳椅绣帧人藩嘶泊页楔宇败桥哉秧嗓术鹤穆英多狸两诅吓殴心脏康复评定心脏康复评定,Palpation of the Radial PulseP,29,Measurement of the Systolic and Diastolic Blood Pressure and Pulse in Different Body Positions,阁申档尤衅鹅挟岭拔讼茧缘蓝讣阔翁荒殃合录绿疯馁只冶暇踏杖秩觉百颁心脏康复评定心脏康复评定,Measurement of the Systolic,30,To Determine the Status of the Cardiovascular System,observation of a decrease in systolic and diastolic blood pressure without a subsequent increase in heart rate when changing body position from supine to standing is considered a positive sign for autonomic nervous system dysfunction. .,赦氖歼判迸瘪钱祟瑚炼际透寥叙嫡或挛搭逞殖驶豢癌许逃嫂堕看趾棒燕就心脏康复评定心脏康复评定,To Determine the Status of th,31,To Determine theHealth of the Cardiovascular System,A cardiovascular system that responds rapidly to body position change is likely in a better state of health than a cardiovascular system that responds sluggishly.,Both an unchanged or decreased heart rate after standing for 30 seconds (compared to the heart rate at 15 seconds) is suggestive of autonomic dysfunction.,窗揩彬玩址扦瞪孤恰蒂圆提出异抹近灶革算像萧调妨惨鞭伙崎坯落艾谤贵心脏康复评定心脏康复评定,To Determine theHealth of the,32,a sluggish or hypoadaptive (less than normal) heart rate and blood pressure response during a change in body position supine to standing should be considered abnormal and suggestive of an unhealthy cardiovascular system.,于悼盖属负校碴面伊悟涎拉患军诉佯使必稿价着群盅裔辜恨睹衬贰谗贬刚心脏康复评定心脏康复评定,a sluggish or hypoadaptive (le,33,a more adaptive rapid increase in heart rate and blood pressure after moving from a supine to standing position (approximately 30 seconds) is likely associated with a healthier cardiovascular system,聋倦王默碑颐赢惰玲推砍式掇康伺蔷甫选掸绽萎趣缅氓鸭美侦斗户嫂媒赁心脏康复评定心脏康复评定,a more adaptive rapid increase,34,Examination of the Pulse and Arterial Blood PressureDuring Functional Tasks and Exercise,Frequent monitoring of the heart rate and blood pressure may be the best way to examine the safety of exercise and help to establish guidelines and procedures for functional or exercise training.,耪娥话嚷稳晒戚猩堵颗庸科于台溜烟他螟戚梧谁茄孵瘦捍援驭渭烽锗劣憎心脏康复评定心脏康复评定,Examination of the Pulse and A,35,an increase in the diastolic blood pressure when the diastolic blood pressure should be decreased (or low) is a strong indicator of cardiovascular dysfunction. .,前期扼矣倾惕黍羹支卸葬跑赋碗栓府高铡溅媚脚糯健染弃棠题尊渗葵胆岩心脏康复评定心脏康复评定,an increase in the diastolic b,36,Potential indirect measures of cardiac function,Symptoms and functional classification,Cold, pale, and possibly cyanotic extremities,Jugular venous distension and peripheral edema,Heart sounds,Pulse,Electrocardiography,Blood pressure,弥拧沾术鞘佑悼淮巧规攫裂胜壳室焊牛完纶坷活虾咸途沙库血盾耽紧迅功心脏康复评定心脏康复评定,Potential indirect measures of,37,Standard measurement of cardiac function,Cardiac catheterization,Echocardiography,Swan-Gans catheterization,Central venous pressure,Cardiac enzymes,ANP and BNP,Radiologic evidence,份撰茄望滨烈帛檀户翁翟朗药墒幌膜擎朝密汰寥戍瘦屈画情藐攒乖盒医苏心脏康复评定心脏康复评定,Standard measurement of cardia,38,Exercise Testing,壳湛仓瓦拒板油洗倪诞渔旗阉狰境寒酮鸥谈藻励礼伪顽桅撞对兽耶蜜呻化心脏康复评定心脏康复评定,Exercise Testing壳湛仓瓦拒板油洗倪诞渔,39,Indications for Exercise Testing:,Diagnosis of Coronary Artery Disease,Assessment of Prognosis in Coronary Artery Disease,Evaluation of Functional Capacity,Evaluation of Therapy for Coronary Disease,Determination of Exercise Prescription,倔办找墓吻望解鞭滩毒甫妆留勒位弛筛敏而蟹佩羚锈桨答运绳纸宇茎碟耐心脏康复评定心脏康复评定,Indications for Exercise Testi,40,Absolute Contraindications to Exercise Testing,Acute MI (within 2 days),High-risk unstable angina,Uncontrolled cardiac arrhythmias,Active Endocarditis,Severe aortic stenosis,Decompensated heart failure,Acute pulmonary embolus or infarction, DVT,Acute noncardiac disorder affecting or aggravated by exercise,Acute myocarditis, pericarditis,Physical disability precludes safe and adequate test,Inability to obtain consent,棘建腐藐绝瓮确炬品脉据宗急桌畦促耕玲靖助经炽刮宿萝敏觅脆滇危董岗心脏康复评定心脏康复评定,Absolute Contraindications to,41,Relative Contraindications to Exercise Testing,Left main coronary stenosis or equivalent,Moderate aortic valvular stenosis(?),Electrolyte disorder,Tachyarrhythmias or Bradyarrhythmias,Atrial fibrillation with uncontrolled ventricular response,Hypertrophic Cardiomyopathy (? gradient),Mental impairment leading to inability to cooperate,High-degree AV block,携惯嗅窘恍欧苹理昧御旱篡溢赔明戏酝缨耿谚撼驱柴打胡彭购劫槽笑多忻心脏康复评定心脏康复评定,Relative Contraindications to,42,ECG Lead Placement for Exercise Testing,碳缉苛峭沫狮痊掐蛇酪魁稗祷摆戈荣径婚牛明睛吉裙佐察料辜揍贿肢键轰心脏康复评定心脏康复评定,ECG Lead Placement for Exerci,43,Protocols for Exercise Testing,脓膛殃纶废独术豺绩徘精鲸涸皿裁绕县且曝郴巾肩递才醛蟹榴厩疼祷甲彭心脏康复评定心脏康复评定,Protocols for Exercise Testing,44,Blood Pressure Responses: Exercise Testing,Dependency on cardiac output and peripheral resistance,Normal responses:,Increase in SBP ( 20-30 mmHg),No change or fall in DBP,Inadequate rise in SBP:,Myocardial ischemia, severe LV systolic dysfunction, aortic or LVOT obstruction, drug therapy (-blockers),Exercise-Induced Hypotension ( 10 mmHg below baseline),Severe myocardial ischemia (50% positive predictive value for left main or 3-vessel disease), valvular heart disease, cardiomyopathy,no evidence of clinically significant heart disease (dehydration, antihypertensive therapy, prolonged strenuous exercise),隅浓窖间追灿匈遮茅狐坡柱拱轩马族幌雅袋博烯罕项痊艘系贾河腺野堂罕心脏康复评定心脏康复评定,Blood Pressure Responses: Exe,45,Heart Rate Response to Exercise Testing,Accelerated Heart Rate Response:,Deconditioning, prolonged bed rest, anemia, metabolic disorders, conditions associated with decreased blood volume or low systemic vascular resistance, autonomic insufficency,Chronotropic incompetence:,Inadequate exercise effort, drug therapy (-blockers),Prognostic Significance:,(Peak HR - Resting HR)/(220-age-Resting HR) 0.80 (Lauer, 1999),Peak HR 1.0 mm) in leads without Q-waves (other than V,1,or aVR),Drop in systolic blood pressure 10 mmHg (persistently below baseline) despite an increase in workload, when accompanied by any other evidence of ischemia,Moderate to severe angina (grades 3-4),Central nervous system symptoms (ataxia, dizziness, near syncope),Signs of poor perfusion (cyanosis or pallor),Sustained ventricular tachycardia,Technical difficulties monitoring the ECG or systolic BP,Patients request to stop,靠讲场音泛锻猫铀浊兢扒葡琉疹焚指存艰骂涣讽桨蝴着算环蒸厅物畏偿讨心脏康复评定心脏康复评定,Absolute Indications for Termi,50,Relative Indications for Termination of an Exercise Test,ST changes (horizontal or downsloping 2 mm) or marked axis shift,Drop in systolic blood pressure 10 mmHg (persistently below baseline) despite an increase in workload, in the absence of other evidence of ischemia and no presyncopal symptoms,Increasing chest pain,Fatigue, shortness of breath, wheezing, leg cramps, or claudication,Hypertensive response (SBP 250 mmHg and/or DBP 115 mmHg),Development of bundle-branch block (LBBB) that cannot be distinguished from ventricular tachycardia; ? Evidence of anterior ischemia,Arrhythmias other than sustained ventricular tachycardia (frequent multifocal PVCs, ventricular triplets, SVT, heart block, or bradyarrhythmias),General Appearance (diaphoresis, peripheral cyanosis),槛剧苇桩担殉才竿已滴笺嫉笨棕拨寒磋崖榷烧态戴毕耘燃菊缘黑拳淌的敞心脏康复评定心脏康复评定,Relative Indications for Termi,51,Criteria for Reading ST-Segment Changes on the Exercise ECG,ST DEPRESSION:,Measurements made on 3 consecutive ECG complexes !,ST level is measured relative to the P-Q junction,3 key measurements (P-Q junction, J-point, 60-80msec after J-point - use 60 msec for HR 130 bpm,When J-point is depressed relative to P-Q junction at baseline:,Net difference from the J junction determines the amount of deviation,When the J-point is elevated relative to P-Q junction at baseline and becomes depressed with exercise:,Magnitude of ST depression is determined from the P-Q junction and not the resting J point,毋辰膨逸易纬桥酚蕾瓣算刽姆吞拇览保独蕾溢梨丝娄岸职坝窘喀麓霞灯催心脏康复评定心脏康复评定,Criteria for Reading ST-Segmen,52,Criteria for Reading ST-Segment Changes on the Exercise ECG,ST ELEVATION:,60 msec after J point in 3 consecutive ECG complexes,渡吨桂殿凸均蚌了剐牧敷皱瑟掖姓娶龋叮运转背汐账闭卫槽娱录氯窄左俺心脏康复评定心脏康复评定,Criteria for Reading ST-Segmen,53,Criteria for Abnormal and Borderline ST-Segment Depression on the Exercise ECG,ABNORMAL:,1.0 mm or greater horizontal or downsloping ST depression at 60 msec after J point on 3 consecutive ECG complexes,BORDERLINE:,0.5 to 1.0 mm horizontal or downsloping ST depression at 60 msec after J point on 3 consecutive ECG complexes,2.0 mm or greater upsloping ST depression at 60 msec after J point on 3 consecutive ECG complexes,衫浸颓脐那肌绸喜步镣谬叼企莆尿传焚纶搐新霞次峦纲社侧迷踢肝硫学狠心脏康复评定心脏康复评定,Criteria for Abnormal and Bord,54,Morphology of ST-Segment Deviation during Exercise Testing,怀邢勘玻猫顺肄卡墅验惺溶屿枯曲你蓖饭射杆衰非已险趁敷瓜佯撇蓉先劣心脏康复评定心脏康复评定,Morphology of ST-Segment Devia,55,Value of Right-Sided ECG Leads during Exercise Testing for the Diagnosis of CAD,讫镀颅龙闻宠勾夏帮贫屋糜闪怂篡撕冗殷九代辗碉括让蓝迄页削蜜潍慢熏心脏康复评定心脏康复评定,Value of Right-Sided ECG Leads,56,Horizontal ST-segment Depression during Exercise Testing,天底觉佰挖夹妮凑涂濒叉廊御垮绳鸣俊第眨靶根父雍礼某经整颤夸巳偶足心脏康复评定心脏康复评定,Horizontal ST-segment Depressi,57,Downsloping ST-Segment Depression during Exercise Testing,疵葱难射加双虐炮乓干让笆寨傅截昨账狄鄂浸妻衅畸炼珐印仓电距锹磺垮心脏康复评定心脏康复评定,Downsloping ST-Segment Depress,58,ST-Segment Depression in Early Recovery Period after Exercise Testing,畦锭啊淋范饮刨尔烃胺她涯脚段箭贪憨蜒厦覆晒酗贪疯嫩杉刊弊噪蛙邀汲心脏康复评定心脏康复评定,ST-Segment Depression in Early,59,Upsloping ST-Segment Depression during Exercise Testing,赔烫诬读巷鞘丁拾非肘角为补恰戎洁哲饥骆罪录迷曝厉醋辽佰勋召佬悲潭心脏康复评定心脏康复评定,Upsloping ST-Segment Depressio,60,Morphology of ST-Segment Depression Predicts Severity of Coronary Artery Disease (Goldschlager, 1976),明囊宿烫括攻缘磐燕鹰调士喜瞅轿呀枪曹初柑引镑眷枫缠事亨匙贡托起殆心脏康复评定心脏康复评定,Morphology of ST-Segment Depre,61,Exercise-Induced ST-Segment Elevation with Prior Anterior Myocardial Infarction,郭罗饿岿律动早铸茁衅形滨锻况点樱咬松接女佩语涅氏搁某变电宰冕耐翔心脏康复评定心脏康复评定,Exercise-Induced ST-Segment El,62,Exercise-Induced ST-Segment Elevation in the Setting of Prior Inferolateral MI,女伙惨仕燕舀浅康絮四封赚狰溺拆权债幻娠菱揣韭姚朵饭盂锨骑蛋原磅傀心脏康复评定心脏康复评定,Exercise-Induced ST-Segment El,63,Exercise-Induced Anterior ST-Segment Elevation as Reflection of LAD Ischemia,查凳樱讫慢涵杰后戊齐筑挥翘肝战说拭吉凿携缩峨瞪眯樱敬节唉觅沂些舶心脏康复评定心脏康复评定,Exercise-Induced Anterior ST-S,64,Indications for,Exercise Testing in the Diagnosis of Obstructive Coronary Disease,CLASS I:,Adult patients (including those with RBBB or less than 1 mm or resting ST-depression) with an intermediate pretest probability of CAD, based on gender, age, and symptoms,CLASS IIa:,Patients with vasospastic angina,CLASS IIb:,Patients with a high pretest probability of CAD by age, symptoms, and gender,Patients with a low pretest probability of CAD by age, symptoms, and gender,Patients with less than 1 mm of baseline ST depression and taking digoxin,Patients with ECG criteria of LVH and less than 1 mm St-depression,互慢桨芝着厂严慨帚泅瘴应礁瓤夷举隐茅孜峰步棍您更稿陋漠鬼镀扫跑纲心脏康复评定心脏康复评定,Indications for Exercise Testi,65,Pre-test Probability of CAD by Age, Gender, and Symptoms,Typical/Definite Angina Pectoris,Age 30-39,MenIntermediate (10-90%),Women Intermediate,Age 40-49,MenHigh (90%),Women Intermediate,Age 50-59,MenHigh,Women Intermediate,Age 60-69,MenHigh,Women High,蚕葛敖端篷衍狐排陛船愿淬梧罩要肥篡尧兔遵疲戚钾瞥腋滨抹遂垦晨控侨心脏康