Cardiac Exam

Question 1

What is the PAR-Q used for

Answer 1

screening for CVD - if any questions are answered “yes” then the pt needs medical clearance

Question 2

what are the 8 CVD risk factors defined by the ACSM

Answer 2

age, fam hx, smoking, HTN, dyslipidemia, pre-DM, obesity, sedentary lifestyle

Question 3

how can you stratify a patient’s risk for getting CVD per the ACSM 8 risk factors?

Answer 3

low risk: asymptomatic and < 2 RFs
mod risk: asymptomatic and 2 or more RFs
high risk: symptomatic or known disease

Question 4

if a patient is at moderate risk for CVD do they need medical clearance to exercise?

Answer 4

not usually for low-mod intensity activity but medical clearance should be considered for high intensity training

Question 5

what is normal pulse pressure and what does it mean if its narrowing?

Answer 5

normal 40-60; narrowing means acute heart failure

Question 6

describe JVD positioning and interpret a positive sign

Answer 6

supine with HOB elevated to 45 deg; positive venous distention is an early sign of R CHF

Question 7

how do you know that a patient’s chest pain is MSK in origin?

Answer 7

pain present during palpation, deep breathing, and activity

Question 8

how do you know that a patient’s chest pain is pulmonary in origin?

Answer 8

pain present during deep breathing, and activity

Question 9

how do you know that a patient’s chest pain is cardiac in origin?

Answer 9

pain presents during activity only

Question 10

the diaphragm picks up ____ pitch sound, and the bell picks up _______ pitch sound

Answer 10

high; low

Question 11

mnemonic for remembering where to auscultate heart sounds

Answer 11

APT-M 2245

aortic, pulmonary, tricuspid, mitral

Question 12

what is the lub sound? where is it loudest on auscultation? what phase of the heart does it signal?

Answer 12

S1

• closure of the mitral and tricuspid valves
• loudest at the apex or tricuspid
• begins ventricular systole

Question 13

what is the dub sound? where is it loudest on auscultation? what phase of the heart does it signal?

Answer 13

S2

• closure of the aortic and pulmonic valves
• loudest at A and P regions
• begins ventricular diastole

Question 14

What is the S3 sound? where can you hear it? what does it mean?

Answer 14

S3

• ventricular gallop
• loudest at mitral area
• early sign of ventricular failure (but common and benign in late pregnancy)

Question 15

what is the S4 sound? where can you hear it? what does it mean?

Answer 15

S4

• atrial gallop
• loudest in mitral area
• assoc with resistance to ventricular filling, LV hypertrophy, and MI

Question 16

with what pathologies do you tend to hear murmurs?

Answer 16

valvular stenosis and regurgitation

Question 17

what is the advantage of max exercise testing

Answer 17

better estimate of VO2 max and increased sensitivity to dx coronary artery disease in asymptomatic individuals

Question 18

What is VO2max

Answer 18

measurement of cardiorespiratory fitness that is closely related to functional capacity of the heart

Question 19

how long does a max exercise stress take?

Answer 19

8-12 minutes total of steadily progressive 2-3 minute stages

Question 20

A VO2 max below the ____ percentile, often indicative of a sedentary lifestyle, is associated with increased risk of death from all causes

Answer 20

20th

Question 21

why is submax exercise testing used

Answer 21

it is used to evaluate early recovery of patients after an MI or cardiac event

Question 22

For 40-80 year old men, what is the 5th percentile, median, and 95th percentile for the 6MWT

Answer 22

399, 576, 778 meters

think (400, 600, 800)

Question 23

for 40-60 year old women, what is the 5th percentile, median, and 95th percentile for the 6MWT

Answer 23

310, 494, 664 meters

think (300, 500, 650)

Question 24

write a goal for the 6MWT

Answer 24

Pt will improve 6MWT distance from x to y to minimize risk of future cardiac event/dysfunction