Performing a Stress ECG/EKG

Procedure

PERFORMING A STRESS ECG/EKG

Before beginning a STRESS Test, the following is suggested:

  • Check the STRESS Patient Cable to make sure that the Electrode Connectors have the SNAP Adapters
  • Check that the Treadmill has been properly and securely connected to the host PC at the Serial Connection
  • Check that ALL cords are out of "harms way"
  • Check to see that the general Treadmill area is CLEAR
  • Check to see that the Treadmill Belt is positioned at the center of the running area
  • As a general rule, never turn the Treadmill power on with someone standing on the running belt!

Electrode Placement and Site Preparation

The proper location of the Stress Lead Electrodes AND the proper Skin Preparation of the Electrode site is critically important to achieving good ECG Signal during a Stress Test! Refer to operations 2.0 and 3.0 in the Stress Index for more details.

Taking a Stress Test

  • CLICK the Yellow "S" Icon on the tool bar (or "STRESS" button if present) to start the process (Figure 19)
  • Patient Demographics Box appears. To facilitate DataBase Retrieval the Patient Name, Social Security and Age MUST be entered. Also, enter blood pressure. Make sure the correct protocol has been selected
  • CLICK "OK", ECG Complex will be Displayed (Figure 20)
  • The STAGE (information) Box is displayed. It is possible to move the Stage Box to any part of the screen by Clicking and Holding the Title Header with your mouse and dragging it to the desired location

Pre-Test: Resting ECGs

  • Monitor ECGs on screen for quality of contact. Check for proper electrode connection by using the "Tap an Electrode Test" and noting the quality of the connection on the monitor
  • If the ECG heart rate is significantly lower or higher than you expected, based on the ECG displayed, it is usually caused by an amplitude problem. If too low, the amplitude of the "Real-time Analysis Lead" is likely too low. The remedy is to either increase the gain or select a different analysis lead by clicking "Options" then "Real-time Analysis Lead". If too high, the T-wave of the Analysis Lead is likely too high. The remedy is to lower the gain or increase the "R" amplitude minimum" under the "options" menu. (the R amplitude minimum rejects any wave part smaller than the percentage set of the last known good R wave) The rule of thumb for good R wave detection is for the R wave amplitude to be positive and greater than 1.5 divisions (which is 1.5 large squares or 0.75 mV)

Examples of normal ECGs, noise, baseline "wander", PVCs, Holter "Marks", etc. are in (Figure 13)

  • The System will automatically store one (1) resting ECG strip. If storage of more strips is desired, the operator can select numerous resting strips from the Stress-opt Menu (this stores the last 12 seconds of any of the selections made. eg. resting supine stores the last 12 seconds, etc.). If a blood pressure and or note is desired with these "stores", add them under the Stress-opt menu before each store. Custom stores can be achieved by clicking the "store strip" button also (stores the last 12 seconds). It is possible to take as many ECG’s as desired by Clicking the "Store Strip"
  • You will notice that the STAGE designation remains 0: 0' 0" indicating that the Protocol has not yet begun

Warm-up

  • After Resting ECG’s have been taken, CLICK "Warm Up" to begin the WARM UP Stage of the Stress Test. This will START the Treadmill based on the values of the Protocol
  • Normally, the Treadmill Speed is set very low, it is at this time that the Patient becomes comfortable with walking on the Treadmill. Also, confirm that the "hookup" is good during motion. Make sure patient only uses the hand rails if needed and does not tense upper body. This will affect the quality of the ECGs
  • For Current Stress Settings: Stage Box and Definitions (Figure 21)

Exercise

  • To move from the Warm Up to the Exercise Phase, CLICK "Start Test". The Screen in (Figure 22) is displayed.
    Definitions appear below the screen in Figure_22
  • Within 5 seconds of the start of each stage, blood pressure and annotation / notes prompts will appear at the bottom of the screen

Note 1: the System will store one strip per Exercise stage by default. In "stress setup" this can be changed to "continuous if desired. (continuous will consume a significant amount of hard drive space)

Note 2: the Stage Box automatically updates when progressing through the Exercise Protocol

Key options available during Exercise off the general screen (buttons):

  • Recovery button is always available
  • Real-time printing
  • Treadmill speed/grade control
  • Stop and restart belt
  • Next exercise stage
  • Gain settings

Key options available during Exercise under "Stress-opt" menu:

  • Enter blood pressure and annotation notes
  • Hold/resume current stage
  • Mark injection time

Recovery

  • To move from Exercise to Recovery, click the "go to recovery" button. The CARDIO System will move to the treadmill speed and grade values in "Stress Setup"

Note 1: the system will store one 12 second strip every minute during recovery
Note 2: it is good practice to store at least 3 to 4 minutes of recovery
Note 3: active recoveries are available at this time also

End Test

  • To move from Recovery to End Test the USER CLICKS "End Test"
  • The CARDIO System will ask if you would like to STORE to the database, click "Ok".(Summaries and ECG strips are available for printing at this time)
  • Now that the information is stored in the database, you are able to "edit" and "print" as described in the database
    section. To print now, click on the printer icon and select "Summary Reports" (as selected in Stress setup) or "ECG Reports"

Note: if System Setup does not contain "full interpretations" selected, interpretation abbreviation definitions can be
obtained in (Figure_4)