Contraindications to CPX in CHF

Some conditions remain contraindications to exercise testing in CHF: very recent myocardial infarction, unstable angina, severe ventricular arrhythmias, symptomatic hypotension, and mobile intracardiac thrombus. Caution is warranted if there is severe pulmonary hypertension, aortic stenosis, or hypertrophic cardiomyopathy, although exercise testing is increasingly being used in these conditions. Left bundle branch block remains a contraindication unless coronarogra-phy is known to be normal. Heart failure per se clearly is no longer a contraindication but CPX has little value when done very recently after an acute decompensation or prolonged bedrest.

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