Cardiac Stress Testing Flashcards
Inpatient settings are more likely to use the _________ for assessment where outpatient settings are more likely to use ______.
6 MWT, GXT
____________ __________ in healthy individuals always needs to be looked into.
Abnormal, fatigue
Information from the EHR/Physician that is useful for assessment (5)
- Medical hx
- Physical exam (BP, cholesterol, hemat, electrolytes, ABG)
- PFT
- Previous GXT or EKG
- Body comp
List the information essential for conducting GXT (5)
- Medical hx
- Risk factor appraisal (CV risk screen)
- Level of supervision
- Absolute vs. relative contraindications
- Mode and extent of GXT
REVIEW CARDIOVASCULAR RISK SCREEN
YOU’LL DO IT
State the calculation for METS
VO2/3.5 = METS
List the components that are assessed with GXT (6)
- EKG [HR, ischemia, arrhythmia]
- VO2 max vs. peak [gas exchange]
- BP
- RPE [Angina/Dyspnea]
- Symptoms [Angina, dyspnea, claudication, non-cardiac limitation]
- Exercise capacity
List the ways in which stress testing can be used in cardiac patients (3)
- Diagnostic [no meds] for CAD - high risk for cardiac event
- Functional [with meds] - often for work clearance
- Therapeutic [w/w/o meds] - optimize medical management; what pt. can’t do
Data from GXT are your _________ to exercise progression.
limits
New York Heart Association Classification: Cardiac disease w/o limitations
Class I
New York Heart Association Classification: Cardiac disease slight limitation; PA results in fatigue, palpitations, SOBOE, angina
Class II
New York Heart Association Classification: Cardiac disease markled limitation; OK at rest, less than ordinary activity causes sx
Class III
New York Heart Association Classification: Cardiac disease but inability to perform PA w/o discomfot, Sx may be felt as rest and intensify w/activity
Class IV
List the New York Heart Association Classification that is the end goal for most cardiac patients.
Class II
With the 6 MWT you cannot rest in ____1____ during the test but you can rest in _____2_____ or ___3___ against a ___4___
- Sitting
- Standing
- Lean
- Wall
List the effect of the following medications on CHF
- Digoxin
- Diuretics
- Vasodilators
- ACE inhibitors
- Anti-arrhymthmics
- ST effect, may inc performance
- dec BP, inc performance
- inc HR, dec BP, inc performance [dec load on heart = higher work level]
- dec BP, inc performance
- may inc HR but little/no effect on performance
With CHF ventilation/perfusion inequalities cause ____1____ ___2___ ____3____ and _____4_____/_____5_____. Ventilation/perfusion mismatch will limit _____6_____ ______7______. Those with CHF are also at increased risk of ______8_______.
- Increased
- Dead
- Space
- Hyperventilation
- Dyspnea
- Overall
- Performance
- Dysrhythmia
List the PT essentials for MI (4)
- Have pt. keep NTG with during exercise
- Angina needs to be reported
- Always know what meds the pt. is taking [action and dosage]
- Monitor post-exercise recovery for 10 minutes [asx + HR<100 before leaving]
Lower level exercise testing (GXT) in MI
- < 5 METS or considerably below anticipated peak
- Hemodynamics measures end of stage
- Assess functional status
- Promote client confidence and reassurance that normal activities can be understaken safely [fear is a major factor]
Objectives of Stress Testing in MI (5)
- Chronotropic capacity and HR recovery [75-85% of capacity]
- Aerobic capacity [estimate]
- Myocardial aerobic capacity [i.e. RPP]
- Exertional symptoms [pain, SOB]
- Changes in electrical function
Indicators of adverse prognosis with MI (4)
- Ischemic ST segment depression at low level exercise
- Fucntional capactiy < 5 METS
- Low peak RPP
- Hypotensive BP response to exercise
Special considerations for MI GXT (4)
- Pt. w/PAD or DM2 have specific precautions
- Select equipment adjusted by 1 MET increments
- Minimum frequency of training = 3 nonconsecutive x/wk
- Safey Edu: monitor sx, medication, ADLs/return to work
Describe why you shouldn’t check one’s pulse over their carotids
If you push on the carotids too hard you can’t feel a pulse. Additionally, pushing on the carotids effects the baroreceptors and can increase HR.
List reasons why it’s important to understand the numbers from stress testting (3)
- Disease dx
- Prevention of complications
- Assist in monitoring progress/decline
Describe what BUN and Creatine assess
Both look at kidney function
For CK list the
- Onset
- Peak
- Return to Normal
- 3-4 hr
- 33 hr
- 3 days
For troponin list the
- Onset
- Peak
- Return to Normal
- 3-12 hr
- 18-24 hr
- Up to 10 days
For myoglobin list the
- Onset
- Peak
- Return to Normal
- 1-4 hr
- 3-15 hr
- –
For LDH list the
- Onset
- Peak
- Return to Normal
- 12-24 hr
- 72 hr
- 5-14 days
List normal values for
- HDL
- LDL
- Total Cholesterol
- > 40
- < 100
- < 200
List the normal hemoglobin values for
- Women
- Men
- 12-15.8g/100 mL
- 13.3-16.2g/100 mL
Define hematocrit and list the normal values for
- Women
- Men
Percent of blood that is cells; viscosity
- 38-47%
- 35-44%
List normal values for WBC
4500-11,000/micro L of whole blood
______ levels of hemoglobin and _______ blodd increases the stress on the heart.
Low, thick
List normal values for
- BUN
- Creatine
- 8-18 mg/dL (high = heart/renal failure; urea retention)
- < 1.5 mg/dL (> 4.0 = renal failure)
List the following fasting serum glucose values
- Normal
- Insulin Resistant/Pre-Diabetes
- Diabetes
- 70-100 mg/dL
- 100-125 mg/dL
- > 126 mg/dL
PET scans have ___1__ false positives and are very ____2____ in detetcing heart problems. PETs can be used to assess _____3_____ ___4___ ___5___. and detect ____6____.
- Low
- Accurate
- Coronary
- Blood
- Flow
- Stenosis
With SPECT a camera rotates __1__ degrees. This test can be used to detect ____2____ or _____3_____. If the space is gone after rest = ____4____. If the space is seen after rest = _____5_____.
- 360
- Ischemia
- Infarction
- Ischemia
- Infarction
