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107 Unit 1
Exercise Stress Testing
| Term | Definition |
|---|---|
| What is Exercise Testing used to obtain? | -Cardiovascular abnormalities not present at rest -Determine the adequancy of cardiac function |
| What does Exercise Testing used to Determine? | -estimate prognosis -Functional capacity -The likelihood and extent of CAD -The effects of therapy |
| Another Name for Exercise Stress Testing | -Graded Exercise Test |
| What does the Magnitude of Hemodynamic response during exercise depend on? | -Severity of the exercise -Amount of muscle mass involved |
| Amount of mass involed | -exercise workload -amount of body surface area being exercised |
| What happens after the second minute of exercise? | -steady-state conditions are reached -heart rate, cardiac output, blood pressure, and pulmonary ventilation are maintained at reasonably constant levels |
| What happens as Exercise Progress | -Skeletal muscle blood flow is increased -Oxygen extraction increases -Total Calculated Peripheral resistance decreases -Systolic BP, Mean Arterial BP increases -Pulse pressure increases -Diastolic blood pressure does not change significantly |
| Functional Class I | > 7 mets -recreation activities -skiing, basketball, sports, jog/walk 5 mph |
| Functional Class II | >5 Mets -garden, rake, wee, roller skates, walk 4 mph on level ground -cannmot complete activities around greater than or equal to & Mets |
| Functional Class III | >2 Mets -make bed, clean windows, walk 2.5 mph, play golf, dress without stopping -cannot do activities requiring equal to or greater than 5 Mets |
| Functional Class IV | -patients cannot perform activities requiring equal to or greater than 2 mets |
| What does a change from supine to upright posture cause a decrease in? | -Venous Return -Left Ventricular end-diastolic volume and pressure -stroke volume |
| The net effect of exercise performance while in the upright as compared with the supine position | 10% increase |
| 3 factors that affect the net effect of exercise | Time HR Cardiac Index |
| 3 Main types of Exercise | -Static (isometric) -Dynamic (isotonic) -Resistive (both) |
| what happens 8-12 minutes of continuous progressive exercise? | -myocardial oxygen demand is elevated to the patient's maximal level -optimal for diagnostic and prognostic purposes |
| Static Exercise (Isometric) | -exerts muscles at high intensities without movements of the joints -produces a greater blood pressure response than dynamic exercise -increase in HR and BP almost proportional to the force exerted |
| What the does the patient sustain in an isometric (static) exercise? | 20-30% of maximal force for 3-5 minutes |
| What occurs when heavy dynamic exercise such as lifting weights is performed? | -the cardiovascular response is a combination of the responses that occur during both dynamic aerobic exercise and isometric exercise |
| Dynamic Exercise | -keeps joints and muscles moving -swimming, walking, bicycling, weight training |
| What does dynamic Exercise Improve? | -blood circulation -strength -Endurance |
| Treadmill Protocol | -should be consistent with patients physical capacity and purpose of the test -standard bruce protocol |
| What happens when patients grab the handrails of the treadmill during exercise? | -functional capacity can be overestimated by as much as 20% |
| The Bruce Multistage Maximal treadmill Protocol | -3 minute periods to allow achievement of a steady state before workload is increased |
| Modified Brue Protocol | -older individuals -those whose exercise capacity is limited by cardiac disease -modified by two 3-minutes warm-up stages |
| Warm up Stages of Modified Bruce Protocol | -two 3 minute warm-up stages -1.7 mph at 0% grade -1.7 mph at 5% grade |
| Stage I Bruce Protocol | 1.7nmph 10% Class III |
| Stage II Bruce Protocol | 2.5 mph 12% Functional Class I |
| Stage III Bruce Protocol | 3.4 mph 14% Functional Class I |
| Stage IV Bruce Protocol | 4.2 mph 16% Functional Class I |
| Stage V Bruce Protocol | 5 mph 18% Functional Class I |
| Stage VI Bruce Protocol | 5.5 mph 20% Functional Class I |
| Stage VII Bruce Protocol | 6 mph 22% Functional Class I |
| Naughton and Weber Protocols | -use 1-2 minute stages with 1 met increments between stages -more suitable for patients with limited exercise tolerance -patients with compensated heart failure |
| Arm Ergometry | -increment workloads of 10-20 (W) -2-3 minutes stages |
| What is increased in Arm Ergometry vs Leg exercise? | -HR -BP |
| The most common frequency of Arm Ergometry | 50 rpm |
| Bicycle Ergometry | -workloads in W or Kilopond-meters per min (Kpm) -1 W = 6 Kpm -work is determined by force and distance -constant pedaling rate of 60-80 rpm |
| Electronically Braked Bicycles | -provide a constant workload despite changes in pedaling rate and are less dependent on a patients cooperation |
| Walk Test | -older patients -heart failure -orthopedic limitations - |
| What is recorded form a 6 minute walk test? | -total distance walked -symptoms experienced |
| When should a test not be performed on a patient? | Hypertensive (>220/120) Hypotensive (<80 systolic) |
| the minimum amount of leads that should be displayed continuously throughout the test | 3 |
| Electrocardiograph Measurements | -Pericardial inflammation -non-shortening of PR, QRS, & QT Intervals -P wave amplitude increase J-Point Depression ST Segment depression ST Segment depression with Inverted T Waves |
| When the degree of resting ST Segment depression is 0.1 mV/1 mm (ischemia) or greater what happens? | -Exercise ECG Becomes less specific -Myocardial imaging modalities should be considered |
| What does .5 mm in leads V2 and V3 signify? | ischemia |
| Upsloping ST Segments | -J point depression is normal during maximal exercise -rapid upsloping segment more than 1 mV/sec -depressed less than 0.15 mV (1.5 mm) |
| Upsloping ST Segments in patients with a high CAD prevalence | -a slow upsloping ST Segment depressed 0.15 mV (1.5 mm) or more than 80 milliseconds (.08 or two small boxes) after the J point -abnormal |
| ST Segment Elevation | -0.10 mV (1 mm) or more of J Point elevation is abnormal -occurs more in patients with anterior myocardial infarctions (MI) |
| T wave changes | -morphology can be influenced by several factors -respiration -drug therapy -ischemia -necrosis |
| Normal Response of BP | -increase systolic BP progressively with increasing workloads to a peak response ranging from 160-200 mmHg |
| Abnormal BP Response | -Failure to increase systolic BP beyond 120 mmHg -sustained decrease greater than 10 mmHg repeatable within 15 seconds -a fall in systolic BP below standing resting values during progressive exercise |
| Causes of a Fall in Systolic BP below standing resting values during progressive exercise | -inadequate elevation of cardiac output -could be due to left ventricular systolic pump dysfunction -excessive reduction in systemic vascular resistance |
| Maximal Work Capacity | -one of the most important prognostic measurements |
| Influences of Maximal Work Capacity | -familiarization with the exercise test equipment -level of training -environmental conditions at the time of testing |
| What is known or suspected CAD associated with? | -increased risk of fatal and nonfatal cardiovascular event regardless of age, gender, race or abdominal adiposity -acute coronary syndromes -stroke |
| Submaximal Exercise | -Max x .85 |
| Maximal Hr | 220-age |
| Who Nondiagnostic Test results are more common with? | -peripheral vascular disease -orthopedic limitation -neurologic impairment -patients with poor motivation |
| Pharmacologic Stress Imaging Studies | -Vasodilator nuclear stress testing -Inotrope (increase in HR) Stress Echo |
| Vasodilator nuclear stress Testing | -radioactive substance is added and x rays are taken before and after stress test |
| Heart Rate Response | -Sinus Rate increases progressively with each exercise |
| Inappropriate Increases in HR | -anxiousness -A-fib -Physically deconditioned -hypovolemia -anemia -LV Failure (Marginal LV Function) |
| Beta-Adrenergic Response | -decreased in older patients -decrease in Max HR and cadiac output |
| Abnormal HRR | -relatively slow deceleration of heart rate following exercise cessation -associated with increased abnormal and high-risk myocardial perfusion scans |
| HRR | Peak HR - HR 1 minute later |
| HRR in upright cool-down position | 13 or more is normal |
| HRR in supine position | 19 or more is normal |
| HRR 2 Minutes into recovery | 23 or more is normal |
| Prognostic Value of abnormal HR independent of exercise level | -Beta-blocker usage -Severity of CAD -Left Ventricular Function -Presence of Exercise-Induced Angina -Ischemic electrocardiographic abnormalities |
| Wht is abnormal HRR associated with? | -Increased abnormal and High-risk myocardial perfusion scans |
| When does exercise-induced chest comfort usually occur? | -occurs after the onset of ischemic ST segment abnormalities -may be associated with diastolic hypertension |
| The most frequent indication for exercise testing | coronary artery disease |
| Patient's Risk Status | -aymptomatic population -symptomatic patients -silent myocardial ischemia -acute coronary syndromes -myocardial infarction -CHF |
| Increased Catecholamine Levels | -accelerates the impulse conduction -velocity -shortened myocardial refractory period -increase the slope of phase 4 depolarization of the action potential |
| Cardiac Rhythm Disturbances | -metabolic acidosis -Exercise-Induced myocardial Ischemia |
| What is Exercise Testing useful for evaluating the effects of? | -Ventricular Arrhythmias -Supraventricualr Arrhythmias -Atrial Fibrillation -Sinus Node Dysfunction -Atrioventricular Block -Left Bundle Branch Block -Right Bundle Branch Block -Preexcitation Syndrome -Cardiac Pacemakers and defib devices |
| Absolute Contraindications to Exercise Testing | -recent significant changes in the ECG --significant ischemia --acute cardiac event -acute systemic infection accompanied by fever, body aches -acute MI (within 2 days) -High-risk unstable angina -uncontrolled cardiac arrhythmias |
| Absolute Contraindications to Exercise Testing | -symptomatic severe aortic stenosis -uncontrolled symptomatic heart failure -acute pulmonary embolus or pulmonary infarction -acute myocarditis or pericarditis |
| Relative Contraindications to Exercise Testing | -asymptomatic at rest -left main coronary stenosis -Moderate Stenotic Valvular Heart Disease -Electrolyte Abnormalities -Severe Arterial Hypertension -Tachyarrhythmias or bradyarrhythmias -Mental or phyiscal impairment -High-Degree AV Block |
| Relative Contraindications to Exercise Testing | -uncontrolled endocrine disorder (diabetes, thyroid) -chronic infectious disease (hepatitis, Aids) |
| Absolute Reasons to Terminate Exercise | -Drop in systolic BP >10 mmHg from baseline BP with signs and symptoms -Moderate to severe Angina -Ataxia, Dizziness, near-syncope -cyanosis -techinal difficulties -subject's desire to stop -sustained Vtach -ST elevation above or equal to 1.0 mm |
| Relative Reasons to Terminate Exercise | -asymptomatic -drop in systolic BP >10 mmHg with no evidence of ischemia -ST or QRS Changes -Arrhythmias other than sustained Vtach -fatigue, SOB, wheezing, leg cramps, claudication -devlopment of BBB or intraventricular conduction delays |
| Relative Reasons to Terminate Exercise | -increasing chest pain -hypertensive response (systolic bp at or above 250 mmHg and/or diastolic blood pressure at or above 115 mmHg |
| Medications available to treat these cardiac arrhythmias in Crash Cart | -A-V block -Hypotension -Persistant chest pain |
| How often are emergency equipment and supplies checked? | daily basis |
Created by:
Mdarrielle09
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