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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.
Treadmill Exercise ECG is usually done with a computerized treadmill unit which controls the motor speed of the treadmill as well as monitors the ECG. ECG is recorded periodically during the test in addition to documenting any specific events like arrhythmias. ECG recording in stage 1 of Bruce protocol of treadmill exercise test.
Dynamic gradient may be sought by glyceryl trinitrate, Valsalva manoeuvre, standing position or even symptom limited exercise. Obstruction may occur during recovery and post exercise monitoring of gradient is mandatory. Degree of outflow obstruction can be documented along with the classical Brockenbrough-Braunwald-Morrow sign.
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]. Opinion is divided on the need for electrophysiology study. mV or R/q ≥ 0.75.
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