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EXS 450 > Clinical Exercise Testing > Flashcards

Clinical Exercise Testing Flashcards

1
Q

Gold standard textbook

A

ACSM’s guidelines for exercise testing and prescription

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2
Q

Guidelines for exercise testing

A

Provide a habituation period with exercise mode

Utilize large muscle groups unless an ortho. or peripheral limitation present

Avoid isometric contractions (handrails)

Start well below max levels

Should last 8-12 minutes

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3
Q

Guidelines for exercise testing: should last 8-12 minutes

A

1 to 3 minutes per stage

Ramped protocols should have a gradual and regular increase in workload (1 MET/minute)

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4
Q

Guidelines for exercise testing: environment

A

Room temperature should be 72F with less than 60% humidity

General movement of air (fan)

Proper exercise morality equipment, monitoring equipment, and emergency items

Trained personnel

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5
Q

Exercise testing indicators

A

Eval. cause of symptoms

ID CAD before it presents

Eval. effectiveness of therapy interventions

Develop exercise prescription

Return of work

Rule of MI

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6
Q

Exercise testing indications: risk stratifications

A

Post MI patients to help with follow up therapy and intervention options

Patients considered for coronary revascularization

Before noncardiac surgery in patients with CAD

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7
Q

Pretesting

A

Review medical history/reason for test and meds they are on

Explain test

Informed consent

Resting BP (supine and standing)

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8
Q

Most accurate diagnosis of CAD

A

Made at or near max HR

Don’t stop just because they achieved age predicted max HR

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9
Q

Overall ABSOLUTE contraindications to exercise testing

A

Recent change in resting ECG indicative of ischemia (recent MI within past 2 days)

Unstable angina

Uncontrolled cardiac dysrhythmia

Symptomatic sever aortic stenosis

Uncontrolled symptomatic heart disease

Acute systemic infection

Acute pulmonary embolism/infarction

Suspected or known dissecting aneurysm

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10
Q

Overall RELATIVE contraindications to exercise testing

A

Left coronary stenosis

Moderate stenotic valvular disease

Electrolyte abnormalities

Arterial hypertension at rest > 200/110

Tachy or brady

Hypertrophic cardiomyopathy

NM, MS, or rheumatoid disorders exacerbated by exercise

High degree AV block/arrhythmia

Ventricular aneurysm

Uncontrolled metabolic disease (diabetes)

Chronic infection

Mental or physical impairment

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11
Q

During the test

A

Use protocol with 2-3 minute stages

Begin at submax level

Progress in stages long enough to allow accommodations

Have increments between stages that are reasonable to person’s exercise capacity

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12
Q

During the test: heart rate

A

HR should increase 10 +/- 2 BPM with each 1 MET increase

Know effects of medications (beta blockers)

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13
Q

During the test: heart rate concerns

A

If HR fails to increase linearly with an increased workload or peak HR is less than 20 BPM below predicted max

Failure of HR to decrease appropriately (more than 12 BPM in the first minute) during recovery, whether sitting or performing low intensity exercise

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14
Q

During the test: SBP

A

Should be a 10 +/- 2 mmHg increase in SBP with each 1 MET level increase

Realize medication impacts

Stop test if patient’s SBP rises above ~250mmHg

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15
Q

During the test: concerns SBP

A

Flat or hypotension response in SBP to an increased workload

Following exercise, SBP should decrease in an orderly way and be checked 1 minute post and 3 minutes post exercise then compared

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16
Q

During the test concerns SBP: flat or hypotension response in SBP to an increased workload

A

Less than 20mmHg increase in SBP from rest, max SBP less than 140mmHg

A decrease below resting SBP values

A 10mmHg decrease in SBP with an increase workload

17
Q

Indicators to stop the test

A

Any occurrence of ABSOLUTE indications

RELATIVE indications

Purpose of test is achieved

18
Q

Indicators to stop the test: purpose of the test

A

Evaluation presenting symptoms

Screening of occult CAD

Obtaining max MET level for return to work

PRIMARY CONSIDERATION

19
Q

Indicators to stop the test: any occurrence of an ABSOLUTE contraindication

A

HR

SBP

20
Q

Indicators to stop the test: any occurrence of RELATIVE contraindications

A

How the patients feels and looks

21
Q

Post test

A

Obtain max BP, HR, RPE, and ECG readings

Decrease workload slowly and have patient continue to exercise to prevent post exercise hypotension

Monitor pattern of recovery as failure of BP and HR to recover adequately is an unfavorable sign

Continue ECG monitoring until HR is less than 100 BPM and ECG has normalized

22
Q

Alternative test considerations

A

COPD and other pulmonary diseases should be considered for nuclear testing

LBBB should be considered for pharmacological testing

23
Q

Nuclear testing

A

Looks at contrast in the lungs

Used for COPD and pulmonary disease patients

24
Q

Vasodilator pharmacological testing

A

Medication given to stimulate heart as if they were actually exercising

Used for LBBB patients

25
Q

Treadmill based testing

A

Commonly used

Uses greater amount of muscle compared to biking=higher metabolic demand and higher max HR and BP

More difficult to take BP and ECG

Handrails May impact results

26
Q

Treadmill based testing: protocol

A

Bruce protocol

3 minute stages that increase in speed and grade each stage

27
Q

Modified Bruce protocol

A

Designed for individuals who are unable to exercise vigorously

Stages are short and increased more progressively

Commonly used to assess MI

28
Q

Modified Balke protocol

A

Submax protocol constant speed and increasing grade

Can be taken to max is desired but testing normally exceeds 8-12 minutes

Terminate at predetermined RPE of 17

29
Q

Modified Naughton protocol

A

Very commonly used with CAD patients

Highly effective at detecting ischemic abnormalities following MI

30
Q

Cycle ergometer testing

A

Good for patients who have ambulatory, ortho, or peripheral vascular limitations

Less expensive, portable, easier to take BP and ECG

Lower HR and higher SBP

31
Q

Cycle ergometer testing: concerns

A

Localized leg fatigue before reaching CV max

Difficult to track pedal rate

32
Q

Arm ergometer testing

A

Used if precinct can’t perform lower body exercise

Has been replaced by pharmacological stress testing

33
Q

Arm ergometer testing: concerns

A

Less muscle mass involved

Lower VO2 peak

Difficulty in taking BP and ECG

Test ends due to arm pain, not CV max

EXS 450 (5 decks)

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