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Clinical ECG Interpretation

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  1. Introduction to ECG Interpretation
    6 Chapters
  2. Arrhythmias and arrhythmology
    24 Chapters
  3. Myocardial Ischemia & Infarction
    22 Chapters
  4. Conduction Defects
    11 Chapters
  5. Cardiac Hypertrophy & Enlargement
    5 Chapters
  6. Drugs & Electrolyte Imbalance
    3 Chapters
  7. Genetics, Syndromes & Miscellaneous
    7 Chapters
  8. Exercise Stress Testing (Exercise ECG)
    6 Chapters
Section 2, Chapter 8
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Chronotropic incompetence (inability to increase heart rate)

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Chronotropic incompetence: inability to adequately increase heart rate

Chronotropic incompetence is an independent predictor of overall and cardiovascular mortality. The condition is very common among individuals with heart failure. Notably, beta-blockers actually increase chronotropic competency in patients with heart failure, despite its negative chronotropic effect. Among persons who do not suffer from heart failure, chronotropic incompetence may be caused by beta-blockers, amiodarone or digitalis. Sinus node dysfunction (SND) is a common cause of chronotropic incompetence.

Definition of chronotropic incompetence: the age expected maximal heart rate

Chronotropic incompetence is defined as failure to reach 80% of the expected maximum heart rate (age-adjusted). To determine this it is necessary to perform an exercise stress test, during which it is fundamentally important that the patient performs maximally. Only two variables are needed to determine whether chronotropic incompetence exists, namely age and heart rate. The following equation is used:

Figure 1. Maximum heart rate equation.
Figure 1. Maximum heart rate equation.

The numerator is the achieved increase in heart rate and the denominator is the expected increase in heart rate (220 – age estimates the age-adjusted max heart). Thus, the formula yields how large (%) the increase in heart rate was in relation to the expected increase. The cut-off for chronotropic incompetence is 80% (i.e less than  80% diagnoses chronotropic incompetence)

Management of chronotropic incompetence

Treatment of chronotropic incompetence and other bradyarrhythmias are discussed in Treatment of bradyarrhythmias.

Next chapter

Sinoatrial Arrest, Sinus Inhibition, Sinoatrial Pause

Related chapters

Exercise Stress Testing & Exercise Physiology

Sinus node dysfunction (SND) and sick sinus syndrome (SSS)

Sinus Bradycardia

Sinoatrial block (SA Block)

View all chapters in Cardiac Arrhythmias.


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