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ECG is recorded periodically during the test in addition to documenting any specific events like arrhythmias. The recording in early phase of recovery at 1 minute, shows very little ST segment depression, making us suspect further whether the earlier recording was really due to myocardial ischemia.
ST segment elevation in aVR in proximal LAD occlusion before first septal is thought to be due to transmural ischemia of the basal part of the septum. In a case reported by Shinde RS et al, coronary angiography documented total occlusion of left coronary artery and the patient underwent emergency coronary artery bypass surgery.
Pediatric exercise testing may be used for evaluation of various disorders of cardiac rhythm rather than for inducible ischemia as in adults. Ventricular arrhythmias during exercise can be documented in congenital long QT syndromes as well as in catecholaminergic polymorphic ventricular tachycardia.
They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. These are the conditions which have to be considered or excluded as they can sometimes manifest Brugada pattern on ECG.
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