A pilot study of the effect of spironolactone therapy on exercise capacity and endothelial dysfunction in pulmonary arterial hypertension: study protocol for a randomized controlled trial

Table 6 American College of Cardiology/American Heart Association indications for terminating exercise testing

Absolute indications	Relative indications
1. Decrease in systolic blood pressure >10 mmHg from baseline, accompanied by evidence of ischemia	1. Decrease in systolic blood pressure >10 mmHg from baseline, in the absence of evidence of ischemia
2. Moderate to severe angina	2. ST or QRS changes such as excessive ST-depression (>2 mm of horizontal or down-sloping ST-segment depression) or marked axis shift
3. Increasing nervous system symptoms (ataxia, dizziness, or near-syncope)
4. Signs of poor perfusion (cyanosis or pallor)	3. Arrhythmias other than sustained ventricular tachycardia, including multifocal PVCs, triplets of PVCs, supraventricular tachycardia, heart block, or bradyarrhythmias
5. Technical difficulties in monitoring ECG or systolic blood pressure
6. Participant’s desire to stop	4. Fatigue, shortness of breath, wheezing, leg cramps or claudication
7. Sustained ventricular tachycardia	5. Development of bundle-branch block or IVCD that cannot be distinguished from ventricular tachycardia
8. ST elevation (≥ 1.0 mm) in leads without diagnostic Q-waves (other than V₁or aVR)	6. Increasing chest pain
	7. Hypertensive response^a

^aIn the absence of definitive evidence, the committee suggests systolic blood pressure of >250 mmHg and/or a diastolic blood pressure of >115 mmHg. ECG, electrocardiography; IVCD, intraventricular conduction delay; PVCs, premature ventricular contractions.

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