Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Procedures and Treatments
Treadmill testing without imaging is an appropriate procedure for many patients being evaluated for chest pain, palpitations, or arrhythmias. The sensitivity of treadmill testing for the diagnosis of coronary artery disease is 60-70%, with a specificity of 70-80%. Thus, physicians must recognize that there is both a relatively high false positive rate (that is higher in women than in men) and a high false negative rate. Many physicians will want to incorporate imaging with treadmill testing.
The exercise protocol most commonly employed by our group is the standard Bruce protocol. We perform symptom limited testing on all patients except those with a recent myocardial infarction.
Exclusion Criteria for Treadmill Testing (relative)
- Patients whose exercise capacity will only allow a sub-maximal test that is associated with a high false negative rate
- Patients with recent myocardial infarction
- Patients with unstable angina
- Patients with significant left main coronary artery disease
- Patients with greater than moderate aortic stenosis
- Patients with left bundle branch block (this makes the ECG uninterpretable for detection of ischemia)
- Patients with fixed rate pacemakers
- Patients with left ventricular hypertrophy (LVH) evident on the ECG or patients taking digoxin (these patients have a high rate of false positive ECG responses to exercise)
- Patients with stroke or orthopedic problems preventing them from walking
- Patients with limiting peripheral vascular disease
- Patients with severe asthma or obstructive lung disease