Why is active endocarditis an absolute contraindication to symptom-limited exercise testing?

Why is active endocarditis an absolute contraindication to symptom-limited exercise testing?

• A. Increased cardiac stress may precipitate embolisation, worsening valvular dysfunction, or haemodynamic instability.
• B. It improves with exercise.
• C. It has no effect.
• D. It only affects the lungs.

Answer: (A)

Active endocarditis means there are infected vegetations on the heart valves. Exercise raises heart rate and blood pressure, increasing shear stress on those vegetations. That makes it more likely for pieces to break off and travel to other parts of the body as septic emboli, potentially causing stroke, organ infarction, or rupture of new valvular dysfunction. It can also provoke sudden hemodynamic instability in a heart with ongoing infection and valve damage. Because of these serious risks, symptom-limited exercise testing is considered an absolute contraindication. It’s not that exercise would help or have no effect, and the danger isn’t limited to the lungs—the problem is systemic embolization and unstable cardiac function during active infection. Once infection is treated and the patient stabilizes, supervised, gradual rehabilitation may be considered with medical clearance.

Active endocarditis means there are infected vegetations on the heart valves. Exercise raises heart rate and blood pressure, increasing shear stress on those vegetations. That makes it more likely for pieces to break off and travel to other parts of the body as septic emboli, potentially causing stroke, organ infarction, or rupture of new valvular dysfunction. It can also provoke sudden hemodynamic instability in a heart with ongoing infection and valve damage. Because of these serious risks, symptom-limited exercise testing is considered an absolute contraindication. It’s not that exercise would help or have no effect, and the danger isn’t limited to the lungs—the problem is systemic embolization and unstable cardiac function during active infection. Once infection is treated and the patient stabilizes, supervised, gradual rehabilitation may be considered with medical clearance.