An ECG treadmill stress test should
achieve 100% of predicted maximal heart
rate unless medically contraindicated or
prevented either by symptoms or
medications. Studies of
less than 85% of
maximum predicted heart rate and less
than 8 minutes of exercise (6 minutes
for age 70 or greater) may serve a basis
for denial. Beta blockers and calcium
channel blockers (spec. diltiazem and
verapamil), or digitalis preparations
should be discontinued for 48 hours
prior to testing (if not
contraindicated) in order to obtain
maximum heart rate and only with consent
of the treating physician.
The worksheet with blood pressure/pulse
recordings at various stages,
interpretive report, and actual ECG
tracings must be submitted. Tracings
must include a rhythm strip, a full
12-lead ECG recorded at rest (supine and
standing) and during hyperventilation
while standing, one or more times during
each stage of exercise, at the end of
each stage, at peak exercise, and every
minute during recovery for at least 5
minutes or until the tracings return to
baseline level. Computer generated,
sample-cycle ECG tracings are
unacceptable in lieu of the
standard tracings. If submitted alone,
it may result in deferment until this
requirement is met.
In patients with bundle branch blocks,
LVH, or diffuse ST/T wave changes at
rest, it will be necessary to provide a
stress
echo or nuclear perfusion study
Reasons for Unfitness:
-
The applicant is unable to make at least 85% of maximal heart rate on stress testing or less than 8 minutes (6 minutes if age 70 or greater);
-
The applicant develops 1 mm or greater ST segment depression at any time during stress testing. Unless the applicant has additional medical evidence such as a nuclear imaging study or a stress echocardiogram showing the absence of reversible ischemia or wall motion abnormalities reviewed and reported by a qualified cardiologist;
-
The nuclear stress testing shows evidence of reversible ischemia, a stress echocardiogram shows exercised induced wall motion abnormalities, or either study demonstrates a negative change from the prior study of the same type;
-
The ejection fraction on a nuclear stress test or stress echocardiogram is 40% or less; or a 10% decrease from a prior study; or
-
The applicant reports any other disqualifying medical condition or undergoes therapy not previously reported.