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Chronotropic Assessment Exercise Protocols

Chronotropic assessment exercise protocols, commonly referred to as stress testing, are a set of regulations and testing procedures used to test a patient's heart rate and blood pressure response to exercise. Chronotropic indicates something which affects heart rate. Patients with diagnosed or suspected heart problems are subjected to an exercise protocol with increasing difficulty to achieve maximum exertion without inducing arrhythmia or heart failure.

  1. Equipment Requirements

    • Basic equipment includes a treadmill or bicycle with ergometer, blood pressure cup, echocardiogram (ECG) with three to 12 leads, and a medical crash cart. For patients with limited ability to stand or walk, an arm-cycle may be used.

    Staff Requirements

    • Either a physician or clinician will administer the test. This person must be clinically certified in exercise stress testing. In addition, at least one other person should be present who is trained in CPR and the use of a crash cart, should the patient go into arrest.

    Who Should be Tested

    • According to the American Academy of Family Physicians (AAFP), stress testing by exercise is recommended in patients that have had or possess risk factors for heart attack. In addition, patients who qualify for chronotropic exercise stress testing include those with frequent or persistent chest pain, chronic obstructive pulmonary disease, or high risk of coronary artery disease.

    Exercise Stress Testing

    • The test itself is based on a protocol developed by Dr. Robert Bruce. The patient is attached to the ECG by either three or 12 leads. The test is conducted in three-minute intervals, wherein the incline increases by two percent and the speed increases along a predetermined course. At each interval, blood pressure and heart rate readings are recorded before moving to the next stage. Testing continues for 27 minutes, or until the patient is no longer able to perform. The Cleveland Clinic Journal of Medicine (CCJM) indicates the "[a]verage time for a middle-aged adult is 8 to 10 minutes."

    Data Assessment

    • Chronotropic assessment analyzes increase or decrease in blood pressure and heart rate, resting heart rate, the time required to return to resting heart rate, and abnormalities in the ECG. The CCJM and European Heart Journal declare chronotropic incompetence if the patient fails to reach between 80 and 85 percent of the age-predicted maximal heart rate, defined as 220 minus the patient's age.

    Additional Testing

    • Chronotropic exercise assessment can also be performed with the addition of scintigraphy to allow for radiographic analysis of heart valves or blood vessels during exercise. The patient is injected with a radioactive tracer and subjected to standard exercise testing. Scintigraphy helps to identify restricted blood vessels, or damaged or leaking heart valves.

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