Exercise Test Flashcards
What is the purpose of exercise stress testing?
Exercise stress testing assesses a patient’s ability to tolerate increasing exercise intensity while monitoring for signs of myocardial ischemia or abnormal electrical conduction.
Why is testing cardiorespiratory fitness (CRF) important?
CRF testing evaluates disease severity, functional capacity, prognosis, and ability to return to physical activity.
What are the necessary steps for preparing a patient for exercise testing?
Steps include…
- obtaining informed consent
- taking resting vitals
- conducting symptom assessments
- explaining the test and expectations
What is the difference between a graded exercise test (GXT) and an exercise tolerance test (ETT)?
GXT measures increasing workload during exercise, while
ETT tests endurance and tolerance at a set workload.
What are the absolute contraindications to exercise testing?
Absolute Contraindications:
- Acute MI within 2 days
- Ongoing unstable angina
- Uncontrolled cardiac arrhythmia with hemodynamic compromise
- Symptomatic severe aortic stenosis
- Decompensated heart failure
- Acute pulmonary embolism, pulmonary infarction, or DVT
- Acute endocarditis, myocarditis or pericarditis
- Acute aortic dissection
- Physical disability that precludes safe and adequate testing
What are the relative contraindications to exercise testing?
Relative Contraindications:
- Known obstructive left main coronary artery stenosis
- Moderate to severe aortic stenosis with uncertain relationship to symptoms
- Tachyarrhythmias with uncontrolled ventricular rates
- Acquired advanced or complete heart block
- Recent stroke or transient ischemia attack
- Mental impairment with limited ability to cooperate
- Resting HTN with systolic >200mmHg or diastolic >110mmHg
- Uncorrected medical conditions such as significant anemia, important electrolyte imbalance, and hyperthyroidism
When is physician supervision recommended ?
- Moderate to severe aortic or mitral stenosis in an asymptomatic or questionably symptomatic patient
- Hypertrophic cardiomyopathy
- History of malignant or exertional arrhythmias
- History of exertional syncope or presyncope
- Intracardiac shunts
- Within 7 days of MI or another acute coronary syndrome
- NYHA Class III Heart Failure
- Severe left ventricular dysfunction and recent deterioration
- Severe pulmonary arterial HTN
- Other potential instabilities resulting from Non cardiovascular comorbidities (Frailty, dehydration, orthopedic limitations, COPD)
What are the…
- Borg RPE scale = ?
- Angina scale = ?
- Claudication scale = ?
The Borg RPE scale measures perceived exertion during exercise, helping monitor exercise intensity.
What are the indicators for stopping an exercise test?
Signs like severe angina, significant drop in systolic BP, cyanosis, or dizziness indicate the test should be stopped.
What are the absolute indicators for stopping a test?
Absolute indicators:
- Drop in SBP > 10 mmHg from baseline despite increase in workload with other evidence of ischemia
- Moderately severe angina (3-4 on angina scale)
- Increasing nervous system symptoms (ataxia, dizziness)
- Signs of poor perfusion (cyanosis, pallor)
- Sustained ventricular tachycardia
- > 1.0 mm ST elevation in leads without diagnostic Q wave (STEMI)
What is the difference between a maximal and submaximal exercise test?
Maximal tests require the patient to exercise to fatigue, while submaximal tests estimate VO2 max based on heart rate response.
How is VO2 max estimated in a submaximal test?
VO2 max is estimated using heart rate response to graded exercise, assuming a linear relationship between HR and work rate.
What are the characteristics of the Bruce Protocol?
The Bruce Protocol is a treadmill-based test with 3-minute stages, increasing speed and incline to assess CRF.
What is the Queens College Step Test, and how is it performed?
The Queens College Step Test involves stepping on a 16.25-inch step for 3 minutes to estimate VO2 max.
What is the purpose of the 1-Mile Walk Test, and how is it conducted?
The 1-Mile Walk Test assesses endurance by measuring the time and heart rate required to walk 1 mile as fast as possible.
What is the difference between a fixed distance test and a fixed time test?
Fixed distance tests assess how quickly a patient can complete a set distance, while fixed time tests measure how far they can go in a set time.
What is the YMCA Cycle Ergometer Test, and how is it performed?
The YMCA test involves cycling at a constant pace while increasing resistance, monitoring heart rate to estimate VO2 max.
What are field tests, and how do they differ from laboratory-based tests?
Field tests are completed in non-laboratory settings and are often less expensive and easier to perform than lab-based tests.
How is MET level tolerance determined through exercise testing?
MET level tolerance is determined by measuring the VO2 max during exercise and converting it to METs (1 MET = 3.5 mL O2/kg/min).
How are heart rate and VO2 max data interpreted in exercise testing?
Heart rate and VO2 max are used to assess the patient’s cardiovascular fitness and prescribe appropriate exercise intensity.
What is the Jackson Non-Exercise Test, and how is it used to estimate VO2 max?
The Jackson Non-Exercise Test uses demographic information and physical activity history to estimate VO2 max without exercise.
How is heart rate recovery measured and interpreted?
Heart rate recovery is measured by the decrease in heart rate after exercise, with slower recovery indicating potential cardiovascular risk.
What are the key safety considerations during exercise testing?
Safety considerations include monitoring for adverse symptoms, having medical equipment ready, and using proper test protocols.
How do you monitor heart rate, blood pressure, and other vitals during an exercise test?
Heart rate and blood pressure are monitored continuously, along with symptoms like fatigue, chest pain, and dyspnea.
What is the importance of reaching a steady-state heart rate during testing?
Reaching steady-state heart rate ensures accurate assessment of cardiovascular fitness and exercise tolerance.
How are exercise testing results used to guide exercise prescription?
Results from exercise testing help determine safe and effective exercise intensities for rehabilitation and fitness programs.
