Exercise Testing in Kids Flashcards
Cardiac output for healthy children increases ___ above resting levels
3-4 times
Most of the increase is due to heart rate, only 20-25% is due to stroke volume
Boys HR and SV
Boys: heart rate is lower and stroke volume slightly higher
No gender differences in cardiac output or in arterial-venous O2 difference
8 y/o vs 18 y/o HR
Submaximal HR in children decline with age
HR can be 30-40 beats higher in an 8 y/o than in an 18 y/o performing the same task
Due to lower SV at younger age
Normal Responses to Exercise
Heart Rate: max heart rate of 200 bpm (190-210)
The formula of (220-age) does not really work well until late teens or early twenties
BP: BSA 1.25 m2 = 140 mmHg
BSA 1.75 m2 = 170 mmHg
SBP > 220 mmHg is of increased concern
DBP should only vary ± 6-10 mmHg
Abnormal SBP: failure to increase appropriately or decreases with increasing exercise intensity
Abnormal DBP: increasing more than 20 mmHg
Bruce Protocol
Bruce is most traditional and has largest normative data set
Disadvantages: steep grades for young patients, large MET increases between stages, long stage durations
Uses 3 minute stages, with grade starting at 10%. The grade increases by 2% with each stage increase, along with a slight increase in speed.
Balke Protocol
Several variations exist
Often will see “modified Balke” protocols
Speed is usually kept constant at 3.0 or 3.5 mph
Grade is increased 2% every minute or 2.5% every 2 minutes
Good for children with perceived low aerobic capacity
Tilt Table Testing
Indications for tilt-table
Syncope or presyncope
Persistent dizziness
Tachycardia
Extreme fatigue
2 Modes:
Passive: 20 minutes supine followed by 20 minutes at 80° head up tilt
Active: exercise test followed by 20 minutes at 80° head up tilt
Parameters monitored:
Heart rate & rhythm, blood pressure, and oxygen saturation
Passive Tilt Testing
Used to evaluate patients whose symptoms occur with change of position, standing or other non-exercise related situations
Symptoms most common in slender, rapidly growing adolescents
Females more predominate
Patients frequently skip breakfast and have very little fluid intake to start the day
Overall daily fluid intake is also very limited
Exercise Tilt Testing
Used to evaluate patients with symptoms which occur during and after exercise, or only after exercise
Often seen in competitive athletes and normally active teenagers
Typically seen in distance runner
Males more predominant?
Positive Test Findings (tilt Test)
Loss of consciousness
Symptomatic hypotension
Symptomatic bradycardia/asystole
Persistent tachycardia without corresponding decrease in blood pressure
Hypotension with inappropriate heart rate response
Cardiac Causes of Acute Onset Chest Pain
Pericarditis
Trauma
Hemopericardium
Arrhythmias
Noncardiac Causes of Acute Onset Chest Pain and Shortness of Breath
Pulmonary Pneumothorax Pneumonia Pleurodynia Esophageal Acute esophagitis Foreign body Noncardiac/Nonorganic Idiopathic Psychogenic Cardiac conditions associated with pain Myocardial ischemia Coronary artery anomalies Pericarditis Mitral Valve Prolapse Other Causes Esophagitis Costochondritis Asthma Sickle Cell Disease Vocal Cord Dysfunction
Exercise-Induced Asthma
EIA symptoms
Coughing
Wheezing
Chest tightness
Shortness of breath
Symptoms frequently begin 5-20 minutes after exercise begins
EIA may occur more easily on cold, dry days than on warm, humid days
Most children with EIA should be able to exercise vigorously with proper diagnosis and treatment
FEV1
Primary value used to determine bronchodilator response
An increase of 200 ml or 12% is considered a positive response
FVC
An increase of 10% or more is considered a positive response
