SummaryThis pilot study compared oxygen consumption during arm crank and cycle ergometer tests in 15 women. The mean (SD) peak oxygen consumption was less with arm cranking (25 (5) ml.kg À1.min À1) than with cycling (40 (7) ml.kg .min À1 ), p < 0.0001. There was moderate correlation, r 2 = 0.60, between the anaerobic thresholds determined by arm and leg exercise, p = 0.0007. This study suggests that arm crank cardiopulmonary exercise testing could be used for pre-operative assessment in those unable to cycle.

The implantable cardioverter defibrillator (ICD) is an electrical medical device designed to monitor the electrical activity of the heart and is set to deliver a programmed, corrective defibrillatory discharge, or shock, on encountering abnormal cardiac rhythms. Adjustment factors: Individual characteristics, including age, gender, support and personality, impact on how an individual adjusts to the device. It is clear that adjustment to the device is a personal and individual process. Coping strategies, attitude towards and perception of the ICD also influence acceptance. Vulnerability factors: Chronic stress has a negative impact on the heart and the vascular system. Stress is a natural bodily response to danger and is mediated by the sympathetic and parasympathetic system. In relation to the cardiovascular system, constant stress, mediated by catecholamines such as adrenaline, elevate heart rate and blood pressure causing increased oxygen demand, electrical instability of the heart muscle and spasm of coronary blood vessels. Role of the nurse: The nurse needs to recognise the signs and symptoms of stress and distress, and use their knowledge and skills to provide both values and evidence based practice. Referral for psychosocial support should be considered, particularly where risk factors are identified. Reflection and collaborative working can support the adjustment process.