Module E, Annotation G: Assess Level Of Risk For Exercise-Induced Event

OBJECTIVE

Determine the appropriate level of exercise and surveillance required in an exercise program.

ANNOTATION

Table 2. Risk Levels for Exercise-Induced Events
High Risk	Intermediate Risk	Low Risk
Severely depressed left ventricular ejection function (LVEF) (<0.3) Complex ventricular dysrhythmias 3 or greater consecutive monomorphic ventricular complexes at rate >100, appearing or increasing with exercise* Decrease in systolic blood pressure >15 mm Hg during exercise or failure to rise consistent with exercise workloads Functional capacity <3 METs MI complicated by congestive heart failure, cardiogenic shock, and/or complex ventricular dysrhythmias, recurrent ischemia Clinically significant depression Severe coronary artery disease and marked exercise-induced myocardial ischemia (>2mm ST-segment depression) Patient with severe valvular disease Survivor of sudden cardiac arrest	Mild to moderately depressed LVEF (0.31 to 0.49) Complex ventricular dysrhythmias Less than 3 consecutive ventricular complexes at a rate >100, appearing or increasing with exercise** Exercise-induced myocardial ischemia (1 to 2 mm ST-segment depression)or reversible ischemic defects (echocardiograhic or nuclear radiography) Functional capacity 3 to 5 METs, 3 or more weeks after clinical event Failure to comply with exercise prescription	No significant depression of LVEF (>0.5) No resting or exercise- induced complicated dysrhythmias No resting or exercise- induced myocardial ischemia manifested as angina and/or ST- segment displacement Functional capacity >5 METs on EST, 3 or more weeks after clinical event Uncomplicated MI, CABG, PTCA, stent, or arthrectomy Absence of clinical depression

* A combination of LVEF and increased ventricular actopy or non-sustained monomorphic ventricular complexes is a poor prognostic indicator (suggest evaluation by a cardiologist).