Cardiac Stress Testing

Question 1

Inpatient settings are more likely to use the _________ for assessment where outpatient settings are more likely to use ______.

Answer 1

6 MWT, GXT

Question 2

____________ __________ in healthy individuals always needs to be looked into.

Answer 2

Abnormal, fatigue

Question 3

Information from the EHR/Physician that is useful for assessment (5)

Answer 3

1. Medical hx
2. Physical exam (BP, cholesterol, hemat, electrolytes, ABG)
3. PFT
4. Previous GXT or EKG
5. Body comp

Question 4

List the information essential for conducting GXT (5)

Answer 4

1. Medical hx
2. Risk factor appraisal (CV risk screen)
3. Level of supervision
4. Absolute vs. relative contraindications
5. Mode and extent of GXT

Question 5

REVIEW CARDIOVASCULAR RISK SCREEN

Answer 5

YOU’LL DO IT

Question 6

State the calculation for METS

Answer 6

VO2/3.5 = METS

Question 7

List the components that are assessed with GXT (6)

Answer 7

1. EKG [HR, ischemia, arrhythmia]
2. VO2 max vs. peak [gas exchange]
3. BP
4. RPE [Angina/Dyspnea]
5. Symptoms [Angina, dyspnea, claudication, non-cardiac limitation]
6. Exercise capacity

Question 8

List the ways in which stress testing can be used in cardiac patients (3)

Answer 8

1. Diagnostic [no meds] for CAD - high risk for cardiac event
2. Functional [with meds] - often for work clearance
3. Therapeutic [w/w/o meds] - optimize medical management; what pt. can’t do

Question 9

Data from GXT are your _________ to exercise progression.

Answer 9

limits

Question 10

New York Heart Association Classification: Cardiac disease w/o limitations

Answer 10

Class I

Question 11

New York Heart Association Classification: Cardiac disease slight limitation; PA results in fatigue, palpitations, SOBOE, angina

Answer 11

Class II

Question 12

New York Heart Association Classification: Cardiac disease markled limitation; OK at rest, less than ordinary activity causes sx

Answer 12

Class III

Question 13

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

Answer 13

Class IV

Question 14

List the New York Heart Association Classification that is the end goal for most cardiac patients.

Answer 14

Class II

Question 15

With the 6 MWT you cannot rest in ____1____ during the test but you can rest in _____2_____ or ___3___ against a ___4___

Answer 15

1. Sitting
2. Standing
3. Lean
4. Wall

Question 16

List the effect of the following medications on CHF

1. Digoxin
2. Diuretics
3. Vasodilators
4. ACE inhibitors
5. Anti-arrhymthmics

Answer 16

1. ST effect, may inc performance
2. dec BP, inc performance
3. inc HR, dec BP, inc performance [dec load on heart = higher work level]
4. dec BP, inc performance
5. may inc HR but little/no effect on performance

Question 17

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_______.

Answer 17

1. Increased
2. Dead
3. Space
4. Hyperventilation
5. Dyspnea
6. Overall
7. Performance
8. Dysrhythmia

Question 18

List the PT essentials for MI (4)

Answer 18

1. Have pt. keep NTG with during exercise
2. Angina needs to be reported
3. Always know what meds the pt. is taking [action and dosage]
4. Monitor post-exercise recovery for 10 minutes [asx + HR<100 before leaving]

Question 19

Lower level exercise testing (GXT) in MI

Answer 19

1. < 5 METS or considerably below anticipated peak
2. Hemodynamics measures end of stage
3. Assess functional status
4. Promote client confidence and reassurance that normal activities can be understaken safely [fear is a major factor]

Question 20

Objectives of Stress Testing in MI (5)

Answer 20

1. Chronotropic capacity and HR recovery [75-85% of capacity]
2. Aerobic capacity [estimate]
3. Myocardial aerobic capacity [i.e. RPP]
4. Exertional symptoms [pain, SOB]
5. Changes in electrical function

Question 21

Indicators of adverse prognosis with MI (4)

Answer 21

1. Ischemic ST segment depression at low level exercise
2. Fucntional capactiy < 5 METS
3. Low peak RPP
4. Hypotensive BP response to exercise

Question 22

Special considerations for MI GXT (4)

Answer 22

1. Pt. w/PAD or DM2 have specific precautions
2. Select equipment adjusted by 1 MET increments
3. Minimum frequency of training = 3 nonconsecutive x/wk
4. Safey Edu: monitor sx, medication, ADLs/return to work

Question 23

Describe why you shouldn’t check one’s pulse over their carotids

Answer 23

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.

Question 24

List reasons why it’s important to understand the numbers from stress testting (3)

Answer 24

1. Disease dx
2. Prevention of complications
3. Assist in monitoring progress/decline

Question 25

Describe what BUN and Creatine assess

Answer 25

Both look at kidney function

Question 26

For CK list the 1. Onset 2. Peak 3. Return to Normal

Answer 26

1. 3-4 hr 2. 33 hr 3. 3 days

Question 27

For troponin list the 1. Onset 2. Peak 3. Return to Normal

Answer 27

1. 3-12 hr 2. 18-24 hr 3. Up to 10 days

Question 28

For myoglobin list the 1. Onset 2. Peak 3. Return to Normal

Answer 28

1. 1-4 hr 2. 3-15 hr 3. --

Question 29

For LDH list the 1. Onset 2. Peak 3. Return to Normal

Answer 29

1. 12-24 hr 2. 72 hr 3. 5-14 days

Question 30

List normal values for 1. HDL 2. LDL 3. Total Cholesterol

Answer 30

1. \> 40 2. \< 100 3. \< 200

Question 31

List the normal hemoglobin values for 1. Women 2. Men

Answer 31

1. 12-15.8g/100 mL 2. 13.3-16.2g/100 mL

Question 32

# Define hematocrit and list the normal values for 1. Women 2. Men

Answer 32

Percent of blood that is cells; viscosity 1. 38-47% 2. 35-44%

Question 33

List normal values for WBC

Answer 33

4500-11,000/micro L of whole blood

Question 34

\_\_\_\_\_\_ levels of hemoglobin and _______ blodd increases the stress on the heart.

Answer 34

Low, thick

Question 35

List normal values for 1. BUN 2. Creatine

Answer 35

1. 8-18 mg/dL (high = heart/renal failure; urea retention) 2. \< 1.5 mg/dL (\> 4.0 = renal failure)

Question 36

List the following fasting serum glucose values 1. Normal 2. Insulin Resistant/Pre-Diabetes 3. Diabetes

Answer 36

1. 70-100 mg/dL 2. 100-125 mg/dL 3. \> 126 mg/dL

Question 37

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\_\_\_\_.

Answer 37

1. Low 2. Accurate 3. Coronary 4. Blood 5. Flow 6. Stenosis

Question 38

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\_\_\_\_\_.

Answer 38

1. 360 2. Ischemia 3. Infarction 4. Ischemia 5. Infarction