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  I agree with you about asking about cardiac disease and asking the
referring physician, I'm still not sure that alleviates the need for a
release.  I don't currently have patients sign release forms, I just
worry
about it.
  I  do know of a case where the patient said "no" to questioning about
cardiac disease, indeed had no known history of any, he still arrested
on the
treadmill and died. In fact the only deaths I have ever heard of in
Vascular
Labs have been during treadmill exercise.
  Interesting considering how we have rarely seen a thrombus float off
during
venous examination.  I've seen 2 and there have been 1 or 2 others in
the
last ten years here, all without associated symptoms curing the exam or
later.
Lee Nix
________________________________________________________________________
_______
_
From: mark kahn on Fri, Jun 27, 1997 1:55 PM
Subject: Re: exercise testing
To: [log in to unmask]


>--- "Lee Nix@CARDIAC" wrote:
>Does anyone routinely have patients sign a release before exercising
patients
>on the treadmill in a non-cardiac setting?
>Lee Nix
>--- end of quoted material ---
>Good point.  We do not, but I think every vascular lab should ask the
question,
>"Do you have a history of heart disease?" before submitting a patient to
>treadmill testing.  If there is ever any question, the referring physician
>should be called prior to testing.
>
>Joe Zaweski


Exercise testing is not necessarily a cardiac stress test.  In the
vascular
lab we are asking patients to reproduce the exercise that they perform
in
their every day activities. which is why they are being evaluated for
claudication (presumably "disabling" claudication), rather than chest
pain.

In a cardiac stress test they are being asked to perform at a level they
may not ordinariy perform at.

In the vascular lab, asking whether they get chest pain when walking
should
suffice, but of course, when in doubt, ask the refering MD.

Mark B. Kahn,MD
TJUH, Phila.