Dunbar Christopher C, Saul Barry I, Kassotis John T
Department of Physical Education and Exercise Science, Brooklyn College, City University of New York, and Division of Cardiology, The New York Methodist Hospital, Brooklyn, NY 11210, USA.
Med Sci Sports Exerc. 2007 Sep;39(9):1452-6. doi: 10.1249/mss.0b013e3180dca188.
A 28-yr-old female presented for preoperative evaluation. The resting ECG revealed sinus arrhythmia with complete heart block with a junctional escape rhythm and a ventricular rate of 43 bpm. The patient was in no apparent distress, and resting blood pressure was 80/50 mm Hg. Physical examination was largely unremarkable, with the exception of a soft, nontender, movable abdominal mass. The patient complained of mild dyspnea with stair climbing, but she was otherwise asymptomatic. Although high-grade atrioventricular (AV) block is considered a relative contraindication for exercise testing, this patient was referred for an exercise ECG stress test to assist in determining whether a electronic pacemaker or other therapy was necessary. A symptom-limited maximal ECG treadmill test was performed using the Bruce protocol. The resting HR before the test was 47 bpm, and resting blood pressure was 70/50 mm Hg. Beginning with the first stage of the test, sinus rhythm with a first-degree AV block was observed. The patient achieved 10.2 METs, with an HRpeak of 122 bpm and a peak blood pressure of 122/70 mm Hg. No ectopy was noted during exercise, no ST segment changes occurred during exercise or recovery, and the patient remained asymptomatic. The test was terminated because of the patient's inability to keep pace with the treadmill. On the basis of these results, no medical therapy or electronic pacemaker was recommended at this time, and the patient was permitted to undergo surgery for uterine fibroid tumors. This case illustrates that although complete heart block is a relative contraindication to exercise testing in some patients, the benefits of testing outweigh the risks.
一名28岁女性前来进行术前评估。静息心电图显示窦性心律失常伴完全性心脏传导阻滞，有交界性逸搏心律，心室率为43次/分钟。患者无明显不适，静息血压为80/50 mmHg。体格检查基本无异常，只是有一个柔软、无压痛、可活动的腹部肿块。患者主诉爬楼梯时轻度呼吸困难，但其他方面无症状。尽管高度房室传导阻滞被认为是运动试验的相对禁忌证，但该患者仍被转诊进行运动心电图负荷试验，以协助确定是否需要植入电子起搏器或其他治疗。使用布鲁斯方案进行了症状限制的最大运动心电图平板试验。试验前静息心率为47次/分钟，静息血压为70/50 mmHg。从试验第一阶段开始，观察到窦性心律伴一度房室传导阻滞。患者达到了10.2代谢当量，心率峰值为122次/分钟，血压峰值为122/70 mmHg。运动期间未发现异位心律，运动及恢复过程中未出现ST段改变，患者仍无症状。试验因患者无法跟上跑步机节奏而终止。基于这些结果，此时不建议进行药物治疗或植入电子起搏器，患者被允许接受子宫肌瘤手术。该病例表明，尽管完全性心脏传导阻滞在某些患者中是运动试验的相对禁忌证，但试验的益处大于风险。
