American Board of Internal Medicine (ABIM) Certification Practice Exam

What are contraindications for performing an ECG stress test?

1. Hypertension, diabetes, and obesity

2. LBBB, paced rhythm, and baseline ST-segment depression greater than 1 mm

3. Infection, fever, and dehydration

4. Age over 75, history of stroke, and dyslipidemia

The correct answer is: LBBB, paced rhythm, and baseline ST-segment depression greater than 1 mm

Performing an ECG stress test, also known as an exercise tolerance test, has specific contraindications to ensure patient safety and the accuracy of the test results. The correct answer highlights conditions such as left bundle branch block (LBBB), paced rhythm, and baseline ST-segment depression greater than 1 mm as significant contraindications. Left bundle branch block can mask underlying ischemic changes on the ECG during stress testing, making it difficult to interpret the results accurately. In patients with a paced rhythm, the artificial pacing can also complicate the assessment of heart rate and rhythm during exercise, leading to potentially misleading results. Moreover, baseline ST-segment depression greater than 1 mm indicates pre-existing ischemia or other cardiac conditions, which can pose an increased risk of adverse events during the stress test. These factors make it essential to avoid conducting an ECG stress test in individuals presenting with these conditions to prevent misinterpretation of the results and to protect the patient from potential harm. Overall, understanding these contraindications helps ensure that stress tests are only performed on individuals who can benefit from them while minimizing risks.