MRCP revision battle 19.7: Exercise tolerance tests

Exercise tolerance tests are starting to go out of fashion but are still currently a mainstay of assessment of angina. 

I'd recommend this BMJ article for a comprehensive discussion; what follows below are just a few salient MRCP points.


ETTs are carried out according to the Bruce protocol, which is 7 sections each 3 minutes long so a maximum of 21 minutes of exercise.  A modified bruce can be used in higher risk/frailer patients.


Beta blockers must be stopped the day before an ETT
Digoxin should be stopped a week before.



The test is deemed to be positive if:

• anginal symptoms
• BP decreases by 15mmHg or fails to increase on exercise
• arrhythmia
• ST depression
• failure to achieve target heartrate (220-age in men, 210-age in women)
• ST elevation

Now for the last battle of the day, lead poisoning