Exercise Testing - Flash Cards
What is the primary indication for stress testing?
Bonus: name 2 others
Chief complaint of dyspnea on exertion
determine ventilatory limitations to work
determine cardiac limitations to work
*page E-5
There are many contraindications to stress testing. Name as many as you can.
*page E-5
PaO2 < 45 PCO2 > 70 FEV1 < 30% of predicted Recent MI Unstable angina 2nd or 3rd degree heart block Rapid ventricular or atrial arrhythmias Orthopedic problems that impair activity Severe aortic stenosis CHF Uncontrolled hypertension Neurological disorders that limit ability to perform Dissecting aneurysms Severe pulmonary hypertension
How do you adjust workload on a cycle ergometer (stationary bicycle)?
*page E-6
pedal frequency
pedal resistance
How do you adjust workload on a treadmill?
*page E-7
treadmill speed treadmill grade (incline)
note: you cannot adjust the resistance of a treadmill.
True or False:
Handrails on a treadmill should only be used for balance.
*page E-7
True. The patient should never lean on the handrails in any way or try to support their weight with them.
How do you calculate % incline on a treadmill.
For example you have a 100 inch ruler, and the high end is 5 inches higher.
*page E-8
You measure the difference in height, in this case 5 inches. Now you find the percentage of the height relative to the total length of the ruler, in this case 100 inches.
5 out of 100 is 5%
The treadmill is at an incline (grade) of 5%
How many watts would the following workloads show on a stress test?
Low workload
Medium workload
High workload
Too high for stress testing
*page E-8
Low workload is less than 50 watts
Medium workload is 50-100 watts
High workload is greater than 100 watts
Too high for stress testing is greater than 200 watts
Define METS (metabolic equivalents)
What is 1 MET at rest?
*page E-9
a unit that measures oxygen consumption per kg of body weight
1 MET = 3.5 ml of oxygen consumption, per minute, per kg.
True or False:
If a patient reaches anaerobic threshold, you should stop the stress test
True
*page E-9
True or False:
Ve will continue to increase at anaerobic threshold (AT) primarily by increasing respiratory rate instead of volume.
VCO2 (CO2 production) will rise above VO2 (oxygen consumption) and the RER (respiratory exchange ratio) will rise from a normal of about 0.8 to 1.
True
*page E-9
True or False:
If BP doesn’t rise during a stress test, or rises dramatically, you should stop the test.
True
*page E-10
- What is the ventilatory equivalent for O2 (Ve/VO2)?
2. What is the ventilatory equivalent for CO2 (Ve/VCO2)?
- The ratio of oxygen consumed per minute of ventilation
2. The ratio of CO2 produced per minute of ventilation.
What is the Borg scale? What is the modified Borg scale?
*page E-12
“It’s the patient’s own evaluation of their level of dyspnea”
Borg scale is 1-20
Modified Borg scale is 1-10
What 4 vitals should always be measured in a stress test?
*page E-13
SpO2
Blood Pressure
Ventilation
Heart rate and rhythm (ECG)
Steady State or Multi-stage/Incremental?
Which type of test would involve gas analysis?
Steady state
*page E-11
gases measured will include O2, CO2, temperature of gases, volume of gases, respiratory rate, and collection time.
SpO2 should remain above what level during a stress test?
90%
*page E-13
Note: You should terminate a test at below 85%, but that is not what this question specifically asked.
Common exam question:
The exam implies your patient is obese (high BMI, high body weight, etc) and says when measuring a resting BP, that the pressures were incredibly high. What would you suspect?
The BP cuff is too small for the patient.
- What questions should you ask when interpreting an ECG rhythm strip?
- A normal HR (60-100) should have 2 R waves between __ to ___ large boxes on the rhythm strip.
*page E-15
1. Is there a p wave? Is is positive? Is it regular? What is the rate?
2.
A normal HR should have 2 R waves between 3-5 large boxes.
What drug would you give for any cardiac arrhythmia?
What drug would you give for bradycardia?
What drug would you give for pulseless Vtach, Vfib, or asystole?
Always give oxygen
Atropine for bradycardia
Epinephrine (if pulseless)
*page E-15 to E-17
How would you identify a PVC on a rhythm strip?
Can a strip with a PVC be considered a normal sinus rhythm?
*page E-15
A wide QRS.
A strip with a PVC can be considered NSR if it has a positive p wave with regular rhythm.
How would you identify a motion artifact on a rhythm strip?
*page E-17
There is a baseline shift on the strip.
Heart Blocks:
How would you generally identify the following heart blocks?
1st degree
2nd degree
3rd degree
1st degree - elongated PR interval. there should never be more than 1 big box between the start of the P wave and the QRS
2nd degree - normal P waves, but there’s a missing QRS on the strip
3rd degree - No relationship between p wave rate and QRS rate. (2 different rates seen)
*page E-18
- Define:
Ischemia
Injury
Infarction
- What indicates
Ischemia
Injury
Infarction
on an ECG rhythm strip?
- Ischemia - reduced blood flow to tissue
Injury - acute damage to tissue
Infarction - necrosis or death of tissue. may be recent or old. - Ischemia - depressed or inverted T wave
Injury - elevated ST segment
Infarction - “significant Q waves”
See images on *page E-19
What would indicate that a patient has a primary ventilatory limitation to exercise?
The patient hits their MVV during testing.
FEV1 x 35
*page E-21
Define RER (respiratory exchange ratio)
The ratio of CO2 produced over O2 consumed. Normally 0.8
VCO2
______
VO2
*page E-23
Stress testing should be terminated if SpO2 is < ___?
85%
Careful with this value. Testing should stop at 85%. SpO2 should remain above 90% during a stress test. Below 90% indicates cardiac disease.
*pge E-25
Common exam question:
How would you monitor ___?
right atrial pressure right atrial filling pressure right side pre-load right ventricular filling pressure right ventricular end-diastolic pressure
aka anything “right”.
CVP (central venous pressure)
any question asking how to monitor hemodynamic values the “right” of the heart should be answered with CVP.
- page E-29
note: normal is 2-6. Hemodynamics are not commonly on the current exam.
Hemodynamics:
“mixed venous blood samples must be drawn from the ___”
Pulmonary artery.
note: you should have the balloon deflated so that you do not draw oxygenated blood from the capillaries.
* page E-30
PCWP monitors blood moving into the ___ ___.
Left heart.
*page E-31
How would you monitor ___?
left atrial pressure left atrial filling pressure left side pre-load left ventricular filling pressure left ventricular end diastolic pressure
aka anything “left”.
PCWP.
any questions asking for hemodynamic monitoring on the “left” should be answered with PCWP.
If your CI (cardiac index) looks like a Qt (cardiac output) what should you suspect?
That the cardiac output was not divided by BSA.
To get CI, you must divide Qt by BSA.
A decreasing O2 pulse (HR increases but O2 consumption stays the same) suggests what?
Cardiac limitation to stress testing.
note: any negative cardiac change without pulmonary change should be considered a cardiac limitation.
* page E-35
___ is present with increased HR at low watts with a normal ECG
Poor conditioning
*page E-35
this may be important on the exam
___ is present when the ECG, SaO2, and HR are normal, the anaerobic threshold is not achieved, and the Ve is less than 70% of MVV.
Poor effort
*page E-35
this may be important on the exam
