Evaluation of ischaemia, blood pressure, QT interval, and arrhythmias

Exercise is a major stress for the cardiovascular system, and therefore many adverse cardiac events can occur during intense exercise. Thus it makes sense to perform maximal exercise testing when assessing an athlete presenting with exertional symptoms, with a known cardiac disease, or for pre-participation evaluation. Nevertheless, the limits of exercise testing must be kept in mind. Exercise testing has a high rate of false-positive results for identifying ischaemia in an asymptomatic athlete. The value of exercise testing in the evaluation of arrhythmias is proved, but the constraints of an exercise test in a laboratory do not reflect those induced on the field. It seems more appropriate to analyse the kinetics of blood pressure (BP) responses during exercise testing rather than to check only the maximal systolic BP. Regular intense training may prolong QTc duration; nevertheless, because of the lack of specific studies on athletes, the same interpretation of QT responses to exercise validated in the general population is used for athletes.