Exercise testing should not be done if the risk of testing exceeds the expected benefit, especially if testing can be deferred until after the patient's condition has stabilized or improved. All patients should give informed consent.


Absolute Contraindications


(1) A recent significant change in the resting electrocardiogram suggesting infarction or other acute cardiac event.

(2) Recent complicated myocardial infarction (unless the patient is stable and pain-free).

(3) Unstable angina.


(4) Uncontrolled ventricular arrhythmia.


(5) Uncontrolled atrial arrhythmia that compromises cardiac function.


(6) Third degree atrioventricular heart block without pacemaker.


(7) Acute congestive heart failure.


(8) Severe aortic valve stenosis.


(9) Suspected or known dissecting aneurysm.


(10) Active or suspected myocarditis or pericarditis.


(11) Thrombophlebitis or intracardiac thrombi.


(12) Recent systemic or pulmonary embolus.


(13) Acute infections.


(14) Significant emotional distress and/or psychosis.


Relative Contraindications


(1) Resting diastolic blood pressure > 115 mm Hg or resting systolic blood pressure > 200 mm Hg.


(2) Moderate valvular heart disease.


(3) Known electrolyte abnormalities (hypokalemia, hypomagnesemia).


(4) Fixed-rate pacemaker (now rarely used).


(5) Frequent or complex ventricular ectopy.


(6) Ventricular aneurysm.


(7) Uncontrolled metabolic disease (such as diabetes, thyrotoxicosis, or myxedema).


(8) Chronic infectious disease (such as infectious mononucleosis, viral hepatitis, or AIDS).


(9) Neuromuscular, musculoskeletal or rheumatoid disorders that are exacerbated by exercise.


(10) Advanced or complicated pregnancy.


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