cardiovascular assesment

Question 1

Cardiopulmonary exercise testing (CPET)

Answer 1

provides a global assessment of the integrative exercise responses involving the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems, which are not adequately reflected through the measurement of individual organ system function.

Question 2

WHY UNDERTAKE CARDIOPULMONARY EXERCISE TESTING? INDICATIONS.

Answer 2

1. elevation of exercise tolerance
2. Evaluation of undiagnosed exercise intolerance
3. Evaluation of patients with cardiovascular diseases
4. Evaluation of patients with respiratory diseases/symptoms
5. Preoperative evaluation
6. Exercise evaluation and prescription for pulmonary rehabilitation 7. Evaluation of impairment/disability
7. Evaluation for lung, heart, and heart–lung transplantation

Question 3

PRE-EXERCISE HEALTH SCREENING

Answer 3

Essential to conduct pre-exercise health screening before administering an exercise test and/or before prescribing physical activity
Purpose of screening is to identify individuals with:
– Medical contraindications to exercise
– Who demonstrate signs and symptoms of clinical disease
– Who may have risk factors that need to be considered when prescribing exercise
– With special needs
Structured method to assess risk for conducting exercise and exercise testing:
ESSA Adult Pre-Exercise Screening System (APSS)

Question 4

ABSOLUTE CONTRAINDICATIONS

Answer 4

Unstable or uncontrolled cardiac, cardiovascular or respiratory condition or infection !
Ischaemia, myocardial infarct or acute cardiac event in past 2 days
• Unstable angina
• Uncontrolled arrhythmias causing symptoms or hemodynamic compromise
• Symptomatic severe aortic stenosis
• Uncontrolled heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Suspected dissecting aneurysm
• Acute systemic infection (fever, body aches, swollen lymph glands)

Question 5

RELATIVE CONTRAINDICATIONS (1)

Answer 5

Risk vs benefit of testing needs to be evaluated.
Severe untreated arterial hypertension at rest (>180 mm Hg systolic, >110 mm Hg diastolic)
• Uncontrolled metabolic disease (e.g. diabetes)
• Orthopaedic impairment that compromises exercise performance
• Mental or physical impairment resulting in inability to exercise
• Hypertrophic cardiomyopathy
• Left main coronary artery stenosis
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities
• Tachyarrhythmias or bradyarrhythmias
• High degree atrioventricular bock
• Ventricular aneurysm

Question 6

TYPES OF EXERCISE TESTING - Aerobic power - VO2max

Answer 6

– Until volitional fatigue
– Useful for diagnostic purposes e.g. cardiac disease
– Includes physiological investigations e.g. gas analysis, blood lactate analysis
– More accurate estimate of VO2max
– Requires medical supervision

Question 7

TYPES OF EXERCISE TESTING • Submaximal

Answer 7

– Until predetermined point e.g. 85% max HR
– Measures response to exercise (eg HR)
– Predict VO2max

Question 8

TYPES OF EXERCISE TESTING - exercise capacity

Answer 8

Require less expensive equipment, less skill and faster to administer
– Generally use either self-paced exercise or a graded exercise (where intensity is progressively increased)
– Generally only provide a single measure of that evaluates the integrated responses of the physiological systems
– Not diagnostic – but correlate well with VO2 peak (e.g. fitness measured using max tests)

Question 9

PRE/POST EXERCISE TESTING MEASURES

Answer 9

Standard pre/post testing measures for submaximal and exercise capacity tests:
• Heart rate (HR)
• Blood pressure (BP)
• Rate of perceived exertion (RPE)
Patient should be seated/rested for pre-test measures

Question 10

Normative resting heart rate values

Answer 10

Normal rate: 60-100 bpm
Tachycardia (fast rate): > 100 bpm
Bradycardia (slow rate): < 60 bpm

Question 11

Normative resting values for BP

Answer 11

Normal: 120/80 mmHg Hypertension (high): >140/90 mmHg Hypotension (low): < 90/60 mmHg *Categorising, not diagnostic.

Question 12

RATE OF PERCEIVED EXERTION (RPE)

Answer 12

Self-report measure of exercise intensity
• “How hard you are working” during the exercise
Modified Borg’s Rating of Perceived Exertion (RPE) scale
– Category (original) – 6-20
– Revised 0-10
– Verbal anchors
– Correlated with HR and VO2 however there is inter-individual variability
– Influenced by many factors: fatigue, environment, fitness levels etc.

Question 13

WHEN TO STOP A TEST: NON-TEST SPECIFIC

Answer 13

Angina or angina-like symptoms
• A large drop in systolic blood pressure (10 mmHg) with increasing workload
• Systolic blood pressure > 250 mmHg, or diastolic > 115 mmHg
• Shortness of breath, wheezing, leg cramps, claudication
• Poor perfusion: Light-headedness, nausea, confusion, ataxia, pallor, cold/clammy skin
• No increase in heart rate with increasing work load
• Change in heart rhythm
• On subject request or indication of extreme fatigue

Question 14

STANDARD PRE-TEST CRITERIA

Answer 14

Standardising pre-test criteria ensures reproducibility. Does violating one of these criteria mean you can not complete the test?
• No vigorous exercise the day of the test
• No stimulants (caffeine, cigarettes) or depressants (alcohol) 3 hours prior to testing
• No heavy meals 3 hours prior
• Drink plenty of water in 24 hour prior to testing
• Ensure 6-8 hours of sleep the night before the test
• Record room temperature