Manual of Exercise Testing, 2nd Edition

This short paperback book serves as an organized review of relevant studies in the field of exercise testing and as a complete manual for exercise testing, from the selection of testing equipment to the interpretation of tests. Since the first edition was published in 1989, Froelicher has improved upon this work by updating many references and including a section of 42 case presentations, with computer-generated electrocardiograms from actual exercise tests. The book is organized into seven major sections, covering topics such as methods of exercise testing, interpretation of hemodynamic and electrocardiographic responses to exercise testing, diagnostic and prognostic applications, post-myocardial infarction testing and screening asymptomatic individuals with exercise testing. Within each chapter, the author covers the topic in detail, including numerous references from the literature as well as helpful charts and tables highlighting important research findings. Particularly useful are the inclusion of nomograms for determining the prognosis for a patient, graphs depicting the expected heart rate and blood pressure responses to dynamic exercise and a description of the sensitivity and specificity of exercise testing for diagnosing ischemic heart disease in different subpopulations of patients. In addition to covering the basics of exercise testing and its scientific interpretation, Froelicher delves into some areas that are more advanced and controversial, such as the interpretation of exercise testing in patients with abnormal baseline electrocardiograms (e.g., intraventricular conduction delay or ST-segment abnormalities), patients on digoxin or patients who have recently suffered myocardial infarction. Conflicting findings are presented, and overall conclusions are clearly presented in brief summaries at the end of each chapter. The last section of this book is a series of 42 clinical cases, with electrocardiographic results from exercise testing. By providing useful background information, including pertinent facts from history and physical examination, in addition to an interpretation of test results and recommendations for follow-up in each case, this section is extremely useful in summarizing the major points discussed in the body of the book. The downside to such a comprehensive review of a subject matter and the pertinent findings in the scientific literature is that at times it can become tedious for the reader who is not intimately familiar with the subtleties of exercise testing. Specifically, the wealth of statistical data and its interpretation that is presented in this book can be somewhat overwhelming for the non-cardiologist. Froelicher has certainly succeeded in presenting a comprehensive review of exercise testing, addressing such complex issues as appropriate patient selection, timing of testing after cardiac events, stratification of patients for further invasive cardiac testing and prognostication. It is certainly useful as a reference book for all physicians, and perhaps as "required" reading for those clinicians directly involved in executing stress tests or interpreting the findings of such diagnostic tests.