Excersise and Post Occlusive Reactive Hyperemia (PORH) Testing. Flashcards
What is the purpose of exercise testing?
It can identify disease that is hemodynamically insignificant at rest.
What can an exercise test determine?
It can determine true claudication from pseudoclaudication.
What are some examples of pseudocladication?
- Spinal stenosis
- Musculo-skeletal problems.
What does exercise do?
- It increases flow, resulting in a greater pressure gradient in the presence of an obstruction.
- Results in temporary limb ischemia which results in pain due to a decrease in arterial flow because of the obstruction causing an inability to meet the demands of an exercising muscle.
What are 4 exercise methods?
- Treadmill testing/ walking in the highway.
- Post-occlusive reactive hyperemia (PORH)
- Toe-raising
- Walking.
What are the contraindiction with treadmill testing?
- Questionable cardiac status
- Known cardiac disease
- Severe pulmonary disease
- Inability to walk at treadmill speed
- Ischemic rest pain
- Ischemic ulceration
- Risk is small, but EKG monitoring should be used if possible.
- Emergency procedures should be known and practiced.
How should you preform a treadmill exercise testing technique?
- Measure resting ankle and brachial pressure.
- Keep cuffs on limbs.
- Treadmill: 1.2, 2.0, 2.5 MPH or natural pace.
- 10-12% grade
- Note WHEN and WHERE symptoms occur.
What do you do for a patient after the exercise test?
- Record the highest ankle or PT pressure.
- Mark the side, pressure and time after walking.
- Measure 1 brachial pressure each cycle. (use highest pressure)
- Continue until resting values are met or 20 minutes, whichever comes first.
How do you interpret treadmill exercising testing results?
- Normal: Ankle pressure increases or remains stable after exercise.
- Abnormal: If the pressure decreases. If the disease is severe, the lower the pressure and the longer the recovery time.
What is the indicator of muscle ischemia that was achieved during exercise?
The length of time it takes the pressure to return to the resting state.
What is the indicator of single-level disease?
Pressure returns within 2-6 minutes.
What is the indicator of a multi-level disease?
If the pressure remains decreased for up to 12 minutes.
What are the advantages of treadmill exercise testing?
- Natural way to elicit vascular problems that are not present at rest.
- Helps to discern vascular from musculo-skeletal problems.
What are the limitations to exercise testing?
- Pain tolerance
- Poor patient motivation and effort.
- Cardiac problems
- SOB
- Prior stroke
- Physical limitation
What is a PORH (post-occlusive reactive hyperemia)?
It is an alternative method for stressing the circulation.
