Lesson 1Pre-test screening for contraindications and risk stratification (BP thresholds, unstable angina, recent MI)Reviews pre-test screening to identify contraindications and stratify risk, including blood pressure thresholds, unstable angina, recent myocardial infarction, and other conditions that may require postponing or modifying testing.
Reviewing medical history and diagnosesIdentifying absolute contraindicationsRelative contraindications and precautionsBlood pressure and rhythm screening checksRisk category assignment and test planningLesson 2Post-exercise recovery monitoring: ECG and vitals timeline, observation duration, criteria for dischargeCovers structured post-exercise observation, including ECG and vital sign monitoring timeline, criteria for extended recovery, and safe discharge decisions after treadmill testing, emphasizing detection of delayed ischemia or arrhythmias.
Immediate post-exercise ECG recording sequenceBlood pressure and heart rate recovery scheduleMonitoring for delayed ischemia or arrhythmiasObservation duration and documentation pointsClinical criteria for safe discharge homeLesson 3Operator actions for adverse events: ischemic changes, sustained arrhythmia, hypotension, syncopeCovers operator responsibilities when adverse events occur, including recognition and immediate management of ischemic ECG changes, sustained arrhythmias, hypotension, syncope, and coordination with emergency response teams.
Immediate actions for ischemic ST changesManagement of sustained tachyarrhythmiasResponse to hypotension and near-syncopeHandling syncope and patient falls safelyActivating emergency and code protocolsLesson 4ECG monitoring during stages: what ST changes, arrhythmias, and rate responses to watch forDetails ECG changes to monitor during each treadmill stage, including ST segment shifts, T-wave changes, arrhythmias, and heart rate responses, with emphasis on early recognition of ischemia and abnormal chronotropic or recovery patterns.
Expected heart rate and rhythm responsesST segment depression and elevation patternsT-wave and U-wave exercise-related changesRecognition of ventricular and atrial arrhythmiasChronotropic incompetence and recovery patternsLesson 5Blood pressure monitoring schedule and technique during exercise phasesExplains correct blood pressure measurement during exercise, including cuff selection, timing within each stage, technique to reduce motion artifact, and interpretation of normal and abnormal pressure responses.
Choosing cuff size and arm positionTiming BP readings within each stageAuscultatory technique on a moving patientNormal systolic and diastolic responsesRecognizing hypotensive and hypertensive trendsLesson 6Electrode setup for continuous monitoring and optimal lead selection for ischemia detectionExplains correct skin prep, electrode placement, and lead selection to optimize ischemia detection during treadmill testing, with emphasis on minimizing artifact and ensuring continuous, high-quality ECG monitoring throughout all stages.
Skin preparation and artifact reduction stepsStandard limb and precordial electrode positionsModified chest lead placement for stress testingSelecting monitoring leads for ST segment analysisCable management and motion artifact controlLesson 7Informed consent and patient briefing: test goals, stopping criteria, and expected sensationsOutlines obtaining informed consent and briefing patients on test purpose, procedure, expected sensations, and stopping criteria, ensuring understanding, cooperation, and reduced anxiety before treadmill stress testing.
Explaining test goals and clinical indicationsDescribing treadmill procedure step by stepDiscussing expected sensations during exerciseReviewing absolute and relative stop criteriaAddressing patient questions and anxietiesLesson 8Criteria for immediate escalation: absolute and relative indications to stop the testDefines absolute and relative indications to stop a treadmill test, including ECG changes, blood pressure abnormalities, severe symptoms, and equipment issues, and clarifies when to escalate to urgent medical evaluation.
Absolute indications to stop immediatelyRelative indications requiring judgmentECG-based triggers for terminationBlood pressure and symptom thresholdsPost-termination medical escalation stepsLesson 9Standard treadmill protocols (e.g., Bruce) and stage timing/parametersReviews commonly used treadmill protocols such as Bruce and modified Bruce, including stage durations, speed and grade changes, and selection based on patient fitness, age, and clinical indication for the stress test.
Bruce protocol stages, speed, and gradeModified Bruce and low-level protocolsRamp and individualized treadmill protocolsChoosing a protocol for patient conditionAdjusting or terminating stages safelyLesson 10Symptom and exertion monitoring: dyspnea, chest pain, dizziness, fatigue—use of Borg/RPE scaleExplains systematic monitoring of symptoms and exertion using structured questioning and the Borg or RPE scale, correlating patient-reported effort with ECG and hemodynamic responses during each treadmill stage.
Using Borg and RPE scales correctlyAssessing chest pain and anginal symptomsMonitoring dyspnea, dizziness, and fatigueCorrelating symptoms with ECG changesCommunicating with patients during stagesLesson 11Baseline measurements: resting ECG, blood pressure, symptom inventory, functional capacity estimateDescribes baseline assessments before exercise, including resting ECG, blood pressure, symptom review, medications, and functional capacity estimation, to identify pre-existing abnormalities and guide protocol selection and test safety.
Resting 12-lead ECG acquisition and reviewBaseline blood pressure and heart rate recordingSymptom history and current complaint checklistMedication review and timing before testingEstimating functional capacity and METsLesson 12Documentation items for stress test: baseline findings, stage-by-stage data, reasons for terminationDefines essential documentation for treadmill tests, including baseline data, stage-by-stage ECG, vitals, symptoms, workload, and reasons for termination, ensuring clear communication and medico-legal completeness.
Recording baseline ECG and vital signsStage-by-stage speed, grade, and METs logSymptom, arrhythmia, and BP event notesDocumenting termination reason and timingSummarizing key findings for the report
