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Exercise and the HeartExercise Testing in Patients with Aortic Stenosis
Section snippets
CASE REPORT
A 68-year-old retired, physically active high school teacher was evaluated in an emergency room with the complaint of syncope. He had no history of chest pain, symptoms of congestive heart failure, palpitations, or myocardial infarction. A heart murmur had been present since childhood. He quit smoking in 1956, his cholesterol level was 268, and his hypertension had been treated intermittently for five years; there was no diabetes mellitus or family history of heart disease. He was receiving no
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 underwent successful valve replacement Recent studies have improved our understanding of the patient with AS, and this knowledge will help prevent such
EXERCISE TESTING IN SUBJECTS WITH AORTIC STENOSIS
Although studies have delineated possible mechanisms for effort syncope in aortic stenosis, a review of the literature (Table 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 and the need for surgical therapy, exercise testing has more recently been performed in adults to resolve disparities between history and clinical findings. With the
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