Chapter 11

Question 1

Exercise Electrocardiography

Answer 1

Performed to determine cardiac problems not captured by the ECG.
Also known as exercise tolerance test, a treadmill stress test, a cardiac stress test, a stress ECG, or an exercise treadmill test.
Procedure is performed with a cardiologist. Pt is carefully monitored.

Question 2

Exercise electrocardiography procedure

Answer 2

Pt is asked to walk on the treadmill. ECG is continuously monitored. Pt is asked to increase the level of exertion of eves ice as the test progresses. We monitor the ECG, BP, heart rate, skin temperature, oxygen level, and physical appearance.

Question 3

How is the monitoring of exercise electrocardiography measured?

Answer 3

Using a ergometer

Question 4

What is done after each exercise stage?

Answer 4

Take the blood pressure and a 12 lead ECG recorded

Question 5

What must the pt report during an exercise electrocardiography?

Answer 5

Chest pain, dizziness, SOB, or any other sx’s

Question 6

What do MAs do for an exercise ECG?

Answer 6

Providing pt instructions an monitoring the pt during the procedure by taking BP, other measurement, observing for pain, discomfort, fatigue, or difficulty breathing, applying and removing electrodes. Be ready for emergencies.

Question 7

Why is exercise ECG used?

Answer 7

To evaluate how the heart and blood vessels respond to physical activity. Usually when there is suspicion for cardiac problems, most commonly coronary vascular disease. To asses pt’s BP maintenance during exercise. Determination of pt’s risk of a MI. Functioning of the heart after a cardiac surgery or after a MI. Evaluates effectiveness of heart medications

Question 8

What is coronary artery disease (CAD)?

Answer 8

Due to atherosclerosis which occurs when plaque forms in the blood vessels from an accumulation of excess fat.

Question 9

Reasoning behind using exercise ECG

Answer 9

When the heart is exercised, it requires additional blood to provide oxygen to the myocardium. The exercise increases the myocardial oxygen demand. If the pt’s arteries are obstructed or narrowed due to CVD, blood flow to the heart will not increase in response to the exercise. The additional workload may change the ECG tracing.

Question 10

Changes in the ECG seen during exercise stress test

Answer 10

ST segment depression which indicate a myocardial ischemia. ST segment depression may be caused by digitalis medications as well

Question 11

What sx’s may the pt get when performing exercise ECG?

Answer 11

chest pain (angina), weakness, SOB, palpitations, or dizziness.

Question 12

Variations of exercise ECG?

Answer 12

Chemical stress test and Pharmacologic stress test.

Question 13

What is chemical stress test?

Answer 13

Invasive procedure. Similar to exercise stress test, exercise and monitoring portion are the same; however during a chemical stress test, the pt is injected IV with thallium or other nuclear isotopes such as Cardiolite 1 to 2 minutes before the end of the exercise period.

Question 14

What is Thallium and Cardiolite?

Answer 14

They are radiopaque substances, they do not let xray penetrate so they can be traced by an X-ray machine. As the chemical flows the cardiologist can monitor its flow into the heart using a camera or scanner.

Question 15

How long is the monitoring during chemical stress test?

Answer 15

20 minutes

Question 16

How to perform a chemical stress test?

Answer 16

Pt lies on table whit both arms above the head and the scanner above them. The heart is viewed immediately after the test as well as 3 to 4 hours later, when the pt has rested. The san is then interpreted by the cardiologist.

Question 17

Reading a scan from a chemical stress test

Answer 17

The chemicals flow more easily through non-diseased arteries. The purpose of the procedure is to determine if exercise causes a decrease in blood flow to any area of the heart.

Question 18

What is pharmacologic stress test?

Answer 18

Variation of exercise electrocardiography. Similar except instead of actual exercise the pt is given medication to induce cardiovascular stress similar to exercise. IV is injected over time to stimulate the heart. Pt is also injected with imaging agent such as thallium and one of the cardioactive drugs.

Question 19

What medications are used in pharmacologic stress test?

Answer 19

adenosine, dipyridamole (Persantine), dobutamine, or regadenoson (Lexiscan).

Question 20

Why would it be necessary to use chemical stress testing?

Answer 20

Cardiologist the pictures to determine if blood flow to the heart improves with rest.

Question 21

Preparing the pt before exercise ECG

Answer 21

Describe the procedure
Verify that the medical hx is complete
Explain the procedure, including the reason for the test.
Possible complications, and safety measures that will be followed during procedure
Explain “informed consent”, and ask the pt to sign consent form
Inform pt that on the day of the test they should wear comfortable clothing. Female pts should not wear an underwire bra. Restrain form use of tobacco, caffeine, or alcohol for at least 3 hours prior to test. The pt should eat a light meal 2 hours prior to the test.
Check with physician’s orders agains the pt medication list to provide information as to what medications the pt should not take the day of the test.
Go over all instructions and information with the pt. Encourage questions; make sure the pt fully understands the procedure.
Provide a detailed list of instructions, making sure that your facility telephone number and your name appear on the list. Encourage pts to call if they have any questions prior to test day.

Question 22

Instructions for exercise ECG day of test.

Answer 22

Verify is working properly
Gather supplies-electrodes, alcohol, gauze sponges, razor, adhesive tape, blood pressure cuff, and so on.
Crash cart is ready and fully supplied
Verity physician’s orderes, medical hx should be completed, and informed consent signed.
Bring the pt into the room
Verify with the pt that he/she has complied with all instructions
Instruct pt to change into gown with opening to the front
Assist pt to lie down on the table
Prep pts skin and apply electrodes as indicated by the protocol
Connect cables, apply the BP cuff, and chef the eCG tracing for artifacts
Obtain pt’s BP in all required positions
Demonstrate the treadmill
Explain test protocol : speed should increase every 3 minutes
Pt should report any SOB, faintness, tingling sensations, numbness, or extreme fatigue immediately
Explain again that the test will be completed when the target heart rate is reached or when pt cannot continue
Start test.
At the 2 1/2 minute mark of each phase, take the pt’s BP and enter data in computer.
When test is done help pt to a chair.

Question 23

When should the BP and ECG tracings be obtained during the test?

Answer 23

Supine, sitting, sitting post 30 minute hyperventilation, standing

Question 24

What is the target heart rate during an exercise ECG

Answer 24

(220-age) x 0.85

Question 25

Preparing the pt before exercise ECG

Answer 25

Describe the procedure
Verify that the medical hx is complete
Explain the procedure, including the reason for the test.
Possible complications, and safety measures that will be followed during procedure
Explain “informed consent”, and ask the pt to sign consent form
Inform pt that on the day of the test they should wear comfortable clothing. Female pts should not wear an underwire bra. Restrain form use of tobacco, caffeine, or alcohol for at least 3 hours prior to test. The pt should eat a light meal 2 hours prior to the test.
Check with physician’s orders agains the pt medication list to provide information as to what medications the pt should not take the day of the test.
Go over all instructions and information with the pt. Encourage questions; make sure the pt fully understands the procedure.
Provide a detailed list of instructions, making sure that your facility telephone number and your name appear on the list. Encourage pts to call if they have any questions prior to test day.

Question 26

Instructions for exercise ECG day of test.

Answer 26

Verify is working properly
Gather supplies-electrodes, alcohol, gauze sponges, razor, adhesive tape, blood pressure cuff, and so on.
Crash cart is ready and fully supplied
Verity physician’s orderes, medical hx should be completed, and informed consent signed.
Bring the pt into the room
Verify with the pt that he/she has complied with all instructions
Instruct pt to change into gown with opening to the front
Assist pt to lie down on the table
Prep pts skin and apply electrodes as indicated by the protocol
Connect cables, apply the BP cuff, and chef the eCG tracing for artifacts
Obtain pt’s BP in all required positions
Demonstrate the treadmill
Explain test protocol : speed should increase every 3 minutes
Pt should report any SOB, faintness, tingling sensations, numbness, or extreme fatigue immediately
Explain again that the test will be completed when the target heart rate is reached or when pt cannot continue
Start test.
At the 2 1/2 minute mark of each phase, take the pt’s BP and enter data in computer.
When test is done help pt to a chair.

Question 27

When should the BP and ECG tracings be obtained during the test?

Answer 27

Supine, sitting, sitting post 30 minute hyperventilation, standing

Question 28

What is the target heart rate during an exercise ECG

Answer 28

(220-age) x 0.85