Exercise Testing

Question 1

purpose of incremental exercise tests

Answer 1

1. Diagnosis (CAD, Pulmonary disease)
2. Prognosis (Post-MI, CHF transplant decisions, post-procedure)
3. Functional capacity/Exercise prescription

Question 2

Cycle tests vs. treadmill tests

Answer 2

Cycle: easier to monitor BP and ECG, easier to perform
Cycle: VO2 max 5-10% lower
Cycle: systolic BP tends to be higher

Question 3

Variables to measure

Answer 3

RPE (Borg scale, Likert scale, Angina scale)
Heart rate
BP
ECG (diagnostic/prognostic)

Question 4

Borg scale

Answer 4

subjective sense of exercise difficulty
6 (very very light) - 20 (maximal)
good gauge of exercise intensity

Question 5

If exercise test is too hard, problems with….

Answer 5

safety

Question 6

If exercise test is too easy…

Answer 6

Underestimate functional capacity, exercise prescription will be too easy
False negative diagnoses
Overestimate severity of diseases

Question 7

Chronotropic incompetence

Answer 7

HR is excessively attenuated during exercise

Can make rate pressure product information less informative

Question 8

Rate Pressure Product

Answer 8

index of myocardial O2 demand
RPP = HR x Systolic
RPP <14k is poor prognosis

Question 9

When to stop an exercise test

Answer 9

1. Subject is at max effort based on RPE, VO2 (mainly)

2. Subject meets termination criteria/indications

Question 10

Absolute indications

Answer 10

1. Exercise induced hypotension with evidence of ischemia
2. Moderate to severe angina (3 fingers)
3. Nervous system symptoms
4. Poor perfusion
5. ECG/BP technical problems
6. Subject’s desire to stop
7. Sustained ventricular tachycardia (3+ PVCs)
8. ST elevation

Question 11

Relative indications

Answer 11

1. Exercise induced hypotension w/o evidence of ischemia
2. ST or QRS changes
3. Arrythmias (other than sustained V tach)
4. Fatigue, shortness of breath, wheezing, leg cramps, claudication
5. Increasing chest pain
6. Hypertensive response (systolic >250, diastolic > 115)

Question 12

Exercise induced hypotension

Answer 12

decreased systolic BP with increased workload
Precedes V tach and fibrillation
Uncertain etiology
Predicts poor prognosis, high-risk CAD

Question 13

ST elevation

Answer 13

Absolute indication
>1 mm in leads w/o Q wave - transmural ischemia, arrythogenic
ST elevation w/ Q waves - transmural infarction

Question 14

ST depression

Answer 14

Relative indication
>2 mm or downsloping - ischemia
Classic indicator of myocardial ischemia

Question 15

Prognosis for CAD

Answer 15

10 METs - excellent survival

Question 16

Prognosis for heart failure

Answer 16

VO2 peak < 10 - poor 1 year mortality

VO2 peak > 14 - survival of transplant recipients, can defer transplant

Question 17

Assumptions of submax testing

Answer 17

Achieve steady state HR at each power
Linear relationship between HR and power
Max HR = 220-age
Mechanical efficiency is same across people