Exam 2: Graded Exercise Testing

Question 1

GXT

Answer 1

graded exercise testing

Question 2

how do you perform GXT

Answer 2

screening
mode/protocol
equipment
procedure
stopping points

Question 3

why do a clinical exercise test

Answer 3

diagnostic
severity and prognosis
functional testing-return to work
exercise

Question 4

age RF

Answer 4

men greater than or equal to 45, women 55

Question 5

family history age of CVD

Answer 5

-men less than 55, women less than 65

Question 6

hypertension RF

Answer 6

> /= 140/90 mmHg twice or on meds

Question 7

Dislipidemia RF

Answer 7

> /= 200 total, <40 HDL, >/= 130 LDL

Question 8

what is a positive RF for CVD

Answer 8

more than 40 HDL

Question 9

Pre diabetes RF for impaired fasting glucose

Answer 9

> /= 100 mg/dL but = 125 mg/dL

Question 10

Obesity RF for CVD

Answer 10

BMI: >/=30
Waist: >102 cm males and >80 cm female
W to H ratio: >.95 men and >.86 women

Question 11

Sedentary RF for CVD

Answer 11

<30 min exercise 3x/wk < 3 months

Question 12

Signs and Symptoms of CVD

Answer 12

• Pain/Pressure in chest, jaw, neck and arms
• SOB, orthopnea, Paroxysmal nocturnal dyspnea
• Dizziness or syncope (loss of consciousness from decreased blood pressure
• palpations or Tachycardia, Murmur
• Ankle edema, claudication, fatigue

Question 13

younger than 45 males, 55 females
asymptomatic
1 or less RF

Answer 13

Low risk

Question 14

asymptomatic

older OR 2 or more RF

Answer 14

Moderate Risk

Question 15

one or more signs/symptoms of RF chart

cardiac, pulmonary or metabolic disease

Answer 15

High Risk

Question 16

Absolute Contraindications

Answer 16

• recent EKG changes
• Unstable angina
• uncontrolled arrhythmias
• Severe aortic stenosis
• symptomatic Heart Failure
• Pulmonary embolus/infarction
• acute myocarditis or pericarditis
• dissecting aneurysm
• acute infections

Question 17

Relative Contraindications

Answer 17

• left main CAD
• moderate stenotic valve disease
• electrolyte abnormalities
• severe HBP >200/110 mmHg
• Tachy or Bradydysrhythmia
• hypertrophic cardiomyopathy
• Dx exacerbated by ex
• AV block
• ventricular aneurysm
• uncontrolled metabolic dx
• chronic infectious dx.
• mental or physical impairment resulting in instability

Question 18

T or F: both acute infections and chronic infectious disease are absolute contraindications for GXT

Answer 18

F; acute is absolute

Question 19

What needs to be discussed in informed consent

Answer 19

• purpose and explanation
• risks and discomforts
• responsibilities
• beneftis expected
• questions/inquiries
• confidentiality/use of medical record
• statement of consent

Question 20

What is important to make sure when getting informed consent

Answer 20

they are giving you accurate information

Question 21

What should be avoided before GXT and for how long

Answer 21

food, alcohol, caffeine or tobacco

3 hours

Question 22

How many stages are in GXT not including warm up and cool down

Answer 22

5

Question 23

what are the five stages of GXT

Answer 23

Stage I: light
Stage II: moderate
Stage III: high
Stage IV: higher
Stage V: if needed

Question 24

how long is a general procedure

Answer 24

8-12 min

Question 25

End of stage exam

Answer 25

``` BP EKG RR/SaO2 Rate of Perceived Exertion Dyspnea Index ```

Question 26

On the 6-20 RPE scale, what is somewhat hard?

Answer 26

13

Question 27

on the revised RPE scare 0-10, what is moderate?

Answer 27

3

Question 28

Dyspnea Scale stages

Answer 28

+1: mild, difficulty, noticeable to patient but not observer +2: Mild difficulty, noticeable to the observer +3: Moderate difficulty, Patient can continue +4: Sever difficulty, patient cannot continue (stop)

Question 29

+1 dyspnea

Answer 29

mild difficulty, noticeable to patient but not the observer

Question 30

+2 dyspnea

Answer 30

mild difficulty, noticeable to the observer

Question 31

+3 dyspnea

Answer 31

moderate difficulty, patient can continue

Question 32

+4 dyspnea

Answer 32

sever difficulty, patient cannot continue

Question 33

Angina Scale:

Answer 33

+1: light, nearly noticeable +2: moderate bothersome +3: moderately sever, very uncomfortable +4: most sever or intense pain ever experienced

Question 34

+1 Angina

Answer 34

light, barely noticeable

Question 35

+2 Angina

Answer 35

moderate, bothersome

Question 36

+3 angina

Answer 36

moderately sever, very uncomfortable

Question 37

+4 angina

Answer 37

most sever or intense pain ever expereinced

Question 38

Absolute stopping points

Answer 38

- decreased SBP > 10 mmHg + ischemia - mod to sever angina - increased nervous system sx - cyanosis or pallo - technical problems - subject wants to stop - sustained V-tach - ST elevation

Question 39

Relative stopping points

Answer 39

- decreased SBP >10 mmHg - ischemia - ST or QRS changes - arrhythmias - fatigue, SOB, Claudication, wheezing - BBB or other delay - Increased Chest Pain - Hypertension ( 250/ 115 mmHg) (healthy person)

Question 40

If the ST segment depresses what happens

Answer 40

more ischemia