ECHOCARDIOGRAPHIC . Exercise-induced electrocardiographic changes in patients with chronic respiratory diseases: differential diagnosis

Exercised –Induced Electrocardiographic
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Abstract
The underlying aim of the study is to explain the changes that occur in exercises due to the pathophysiology of electrocardiographic (ECG) and the chances of patients being infected with coronary artery disease in those patients with CRD and have never shown any signs of having myocardial ischemia. Notably, the analysis of the possibility of occurrence of cardiac complications is important in rehabilitating the patients who have been diagnosed with chronic respiratory diseases. Analysis of capability of the cardiovascular system as well as ventilatory systems requires the application of cardiopulmonary exercise testing. The administration of CPET to patients diagnosed with chronic respiratory diseases also known as CRDs patients is traced to 1989 and it helps in determining the rehabilitation programs of a patient and it also assists in selecting the activities which are permissible in life. The data generated by several researchers show that the prevalence of ST depression have been recorded in patients who have never shown symptoms nor had records of coronary artery disease(Hirotani, Maekura, Okuda, et al (2003).
Inferences
The study was of great significance especially in advising the patients on the kinds of healthy exercises which are necessary for body fitness. In a patient who has been diagnosed with COPD to improve the tolerance of exercise, the exercise training proves to be the only effective option.

The exercises are administered as one way of practicing respiratory rehabilitation. An effective and accurate analysis is done for patients with symptoms of myocardial ischemia to ensure that the respiratory rehabilitation is done in a safe and efficient manner taking into consideration the life of the patient. The diagnosis is made because subjecting a patient to intense exercise may lead to induction of myocardial ischemia hence the existence of the patient will be at high risk. Consequently, the outcome of the study would serve as a guide for safety during exercises being done to patients (Hirotani, Maekura, Okuda, et al (2003).
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The research was done by studying forty-two CRD patients diagnosed with exercise-induced ST depression. The study was done using cardiopulmonary exercise testing (CPET).The patients were drawn from people who were tested for CPET between 1999 and 2001.The patients to be studied in the research were carefully selected from a group of two hundred and forty-nine patients were had undergone CPET testing. Precisely, three patients who had been tested positive for ST depression were chosen to act as disease control subjects. The chosen patients had to be tested to ensure that they did not any complication related to respiratory diseases. The study of myocardial SPECT was done to investigate myocardial ischemia. The study also included the evaluation of right ventricular overload which was measured by examining how the uptake of right ventricular was increasing (Hirotani, Maekura, Okuda, et al (2003).
Results
A positive test for ST depression occurred in forty-two out of 249 Patients who had never been diagnosed with CAD selected for the study. In the forty-two patients selected for the survey, only two were found to be having ST depression. The CRD patients showed a lower prevalence of myocardial ischemia with 26.2% .on the other hand the disease control subjects posed 78.8% occurrence of myocardial ischemia. The cases of RV overload with no signs of ischemia recorded a prevalence of 61.9%.Eleven patients tested positive for ischemia .ten of these patients had RV overload. Only five patients tested negative for both ischemia and RV overload. The five patients were later diagnosed as normal (Hirotani, Maekura, Okuda, et al (2003).
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Conclusion
The data generated from the study indicated that the occurrences of myocardial ischemia were low in the case of CRD patients.RV overload was the common observation in most cases.it was deduced that Cardiac perfusion SPECT is an important technique when it comes to evaluation of RV overload as well as cardiac ischemia (Hirotani, Maekura, Okuda, et al (2003).
Weakness in Methodology
Monitoring of CRD patients was not done as required during respiratory rehabilitation .the exercise training was done without taking into consideration CPET monitoring. Another weakness with the methodology is that no further examination was done to spot CAD or RV in the patients who tested positive for ST depression (Hirotani, Maekura, Okuda, et al (2003).
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Recommendation
The CRD patients should be monitored with CPET before respiratory rehabilitation especially when the exercise training is to be done. In case patient tests positive for ST depression, then further analyzing of the test should be done .such examination involves the use of myocardial scintigraphy which detects the RV or CAD overloads in patients (Hirotani, Maekura, Okuda, et al (2003).
Reference
Hirotani, A., Maekura, R., Okuda, Y., Yoshimura, K., Moriguchi, K., Kitada, S., & Ogihara, T. (2003). Exercise-induced electrocardiographic changes in patients with chronic respiratory diseases: differential diagnosis by 99mTc-tetrofosmin SPECT. Journal of Nuclear Medicine, 44(3), 325-330.
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