Q: All of the following are absolute contraindications for cardiac stress test EXCEPT? (select one)
A) Active endocarditis
B) Myocardial infarction (MI) within 48 hours
C) Unstable angina
D) Acute decompensated heart failure
E) Hypokalemia with ST-T abnormalities
Answer: E
It is common for a chronically cardiac hospitalized patient to have hypokalemia. There are several relative contraindications/limitations to cardiac stress test. These include Wolff-Parkinson-White (WPW) pattern, paced rhythm, left bundle branch block (L-BBB), chronic digoxin use, severe left ventricular hypertrophy, and hypokalemia showing EKG changes.
Clinical conditions that can become fatal during the test are considered absolute contraindications. These include the first four choices (A to D) mentioned above as well as a lot of arrhythmia on monitor, hemodynamic instability, severe valvular stenosis, severe myocarditis, severe pericarditis, acute aortic dissection, acute pulmonary embolism (PE), deep venous thrombosis (DVT) and severe physical disability.
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References:
1. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002; 106:1883.
2. Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013; 128:873.
3. Modesto KM, Møller JE, Freeman WK, et al. Safety of exercise stress testing in patients with abnormal concentrations of serum potassium. Am J Cardiol 2006; 97:1247.
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