Cardiac Stress Test Protocol: Comprehensive Clinical Guide

Pre-Test Procedures

Patient Preparation

• Verify NPO status (4-6 hours)
• Review medications and hold as appropriate:
  • Beta-blockers (24-48 hours prior)
  • Nitrates (6 hours prior)
  • Caffeine (12 hours prior)
• Obtain informed consent
• Verify absence of contraindications

Equipment Check

• ECG machine calibration
• Blood pressure monitoring equipment
• Emergency cart verification
• Treadmill/ergometer inspection

Testing Protocols

Exercise Stress Test

Bruce Protocol

1. Stage 1
   • Speed: 1.7 mph
   • Grade: 10%
   • Duration: 3 minutes
2. Stage 2
   • Speed: 2.5 mph
   • Grade: 12%
   • Duration: 3 minutes
3. Subsequent Stages
   • Progressive increases every 3 minutes

Modified Bruce Protocol

• Begins at lower workload
• Recommended for elderly/deconditioned patients

Pharmacological Stress Test

Adenosine Protocol

• Dose: 140 μg/kg/min
• Duration: 6 minutes
• Monitor vital signs every minute

Dobutamine Protocol

• Starting dose: 5-10 μg/kg/min
• Increment: Every 3 minutes
• Maximum dose: 40-50 μg/kg/min

Monitoring Requirements

Vital Signs

• Continuous ECG monitoring
• BP every 3 minutes
• SpO2 as needed

Endpoint Criteria

• Target heart rate achieved
• Significant ST changes
• Limiting symptoms
• Severe hypertension/hypotension

Documentation Requirements

Essential Elements

1. Baseline vitals and ECG
2. Medications administered
3. Exercise time and capacity
4. Reason for termination
5. Recovery data

Emergency Procedures

Equipment Access

• Emergency medications
• Defibrillator
• Airway management supplies

Response Protocol

1. Immediate test termination
2. Team activation
3. ACLS protocol initiation if needed