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Discussion on pediatric exercise testing. Pediatric exercise testing may be used for evaluation of various disorders of cardiac rhythm rather than for inducible ischemia as in adults. In a child with suspected sinus node dysfunction, chronotropic incompetence from sinus node dysfunction can be assessed by exercise testing.
Autonomic dysfunction caused by spinal cord injury is associated with abnormalities in blood pressure, heart rate variability, arrhythmias and blunted cardiovascular response to exercise which can limit the capacity to perform physical activity [1]. Am J Phys Med Rehabil. 2007 Feb;86(2):142-52. doi: 10.1097/PHM.0b013e31802f0247. 2023.12.010.
When you exercise or are having a stress, the rate increases gradually. Occasionally there could be an irregular rhythm originating from the upper chambers of the heart known as atrialfibrillation. Atrialfibrillation, known in short as A-FIB causes almost standstill of the upper chambers.
Left ventricular hypertrophy, left atrial enlargement, QRS axis deviation (left more than right), conduction abnormalities like increased P-R interval and bundle branch block may be noted. Dynamic gradient may be sought by glyceryl trinitrate, Valsalva manoeuvre, standing position or even symptom limited exercise.
Other parameters which are thought to convey risk in Brugada syndrome are Tpeak-Tend >100 ms in chest leads, early repolarization pattern in inferior leads, post exercise ST segment elevation and diurnal burden of Type 1 ECG pattern on Holter monitoring [4]. Atrialfibrillation and Brugada syndrome. mV or R/q ≥ 0.75.
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