AHA EST 2013

Question 1

How does stroke volume and HR contribute to increasing level of exercise?

Answer 1

• Lower intensity -> Increase SV
• At 50-60% max -> SV maxes out
• Above this -> HR has to increase

Question 2

About how much does HR increase per one MET?

Answer 2

10 beats per MET

Question 3

What is 10th percentile for double product? (HR x SBP)

Answer 3

-25 000 (40 000 90th percentile)

Question 4

How much does coronary blood flow increase by during exercise?

Answer 4

-5 fold above resting value.

Question 5

What level of VO2max is submaximal?

Answer 5

-60-80%

Question 6

What does 1 MET equal?

Answer 6

3.5ml O2 per KG of body weight per minute

Question 7

Name 10 absolute contraindications to exercise?

Answer 7

• Acute MI within 2 days
• Ongoing unstable angina
• Uncontrolled arrhythmia with hemodynamic compromise
• Active endocarditis
• Symptomatic severe AS
• Decompensated heart failure
• Acute PE
• Acute myo/pericarditis
• Acute aortic dissection
• Physical disability that precluded testing

Question 8

What are some instructions for patients before stress testing?

Answer 8

• Should not eat for three hours
• Explained the purpose of the test
• Should get a history and physical for excluding contraindications

Question 9

What is the sensitivity for the lateral precordial leads?

Answer 9

-90% of all ST depression

Question 10

What is the Cornell protocol?

Answer 10

Reduces the large workload changes between stages, reduces the stage duration to 2 minutes while interpolating additional half stages

Question 11

What is arrest risk per 10 000 tests? what about MI risk?

Answer 11

• 0-6 deaths

- 2-10 MIs

Question 12

What is maximal exertion on the BORG scale?

Answer 12

• > 18 rating

Question 13

What 8 indications to stop the EST?

Answer 13

• STE > 1mm in leads without pre-existing Q waves
• Drop in SBP > 10mmhg with accompanied by any other evidence
• Moderate to severe angina
• CNS abnormalities
• Signs of poor perfusion
• Sustained VT
• Technical difficulty monitoring
• Patients request to stop

Question 14

What is poor METS for men and women?

Answer 14

• Men 7

- Women 5

Question 15

Chronotropic incompetence definition

Answer 15

Inability of the HR to increase commensurate with increased activity or demand.

Question 16

definition of Chronotropic Index?

Answer 16

• <85% of APMHR

-

Question 17

Definition of abnormal HR recovery?

Answer 17

HR drop less than 12 beats in the first minute of recovery

Question 18

Two hypotensive response definitions?

Answer 18

• Decline in SBP below resting value

- Initial increase in BP and then >10mmhg decrease from top with increasing exertion

Question 19

What is relative indication for termination for high BP?

Answer 19

• > 250/115 mmhg

Question 20

4 different ways to prescribe exercise?

Answer 20

• 40-80% of Heart rate reserve
• 40-80% of peak VO2 reserve
• 65-80% of peak HR achieved
• RPE 11-16 on BORG scale

Question 21

Review pretest probability prior to EST

Answer 21