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Boards Prep- Cardiovascular > Intervention 1 > Flashcards

Intervention 1 Flashcards

1
Q

Purpose of Exercise Tolerance Test (ETT, GXT)

A
  • to determine physiological responses during a measured exercise stress (increasing workloads)
  • allows the determination of functional exercise capacity of an individual and detects present of ischemia
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2
Q

What does ETT/GXT serve as?

A

Basis for exercise prescription
- used as a screening measure for CAD in asymptomatic individuals

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3
Q

What is typically administered prior to start of Phase II outpatient cardiac rehab?

A
  • Symptom limited exercise tolerance test
  • also used following cardiac rehab as an outcome measure
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4
Q

ETT with radionuclide perfusion

A
  • A pharmacological stress test is used when pt is unable to perform regular ETT
  • common medicals used to increase cardiac demand are adenosine (increases HR), dobutamine (increases contractility), and persantine (vasodilates)
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5
Q

GXT Testing Modes

A
  • Treadmill and cycle ergometry (arm or leg) allow for precise calibration of the exercise workload
  • step test (upright or sitting) can be used for fitness screening, healthy population
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6
Q

Maximal GXT

A
  • defined by target endpoint hear rate
  • should only be completed in settings with advanced cardiac life support trained individuals with appropriate equipment to handle abnormal responses
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7
Q

When does risk of abnormal response increase significantly during GXTmax?

A

when working at intensities >85% of HRmax

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8
Q

Age predicted HRmax

A
  • 220-age has high degree of error, esp with older and younger adults
  • 208- (0.7xage) has less error associated across different populations
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9
Q

Heart Rate Range

A
  • Karvonen’s formula
  • 60% to 80%
    (HRmax - HRresting) + resting HR = target HR
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10
Q

Submaximal GXT

A
  • symptom limited or terminated at 85% of age predicted HRmax
  • safe in all settings
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11
Q

when is submaximal GXT used?

A
  • to evaluate the early recovery of patients after MI, coronary bypass, or coronary angioplasty
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12
Q

Continuous GXT

A
  • workload is steadily progressed
  • Two types: step test and ramp test
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13
Q

Continuous GXT - step test

A

workload increases every 2-3 mins, allowing patient to reach steady state

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14
Q

Continuous GXT - ramp test

A

workload increased every minute so patient is not permitted to reach steady state

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15
Q

Discontinuous (interval) GXT

A
  • allows rest in between workloads/stages
  • used for patients with more pronounced CAD
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16
Q

positive GXT

A
  • indicates myocardial oxygen supply is inadequate to meet the myocardial oxygen demand
  • positive for ischemia
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17
Q

Negative GXT

A
  • indicates that at every tested physiological workload there is a balanced oxygen supply and demand
18
Q

What is functional 6MWT highly correlated to?

A
  • other exercise tolerance testing, submaximal and maximal VO2
19
Q

Things to monitor during exercise and recovery

A
  1. patients appearance
  2. changes in HR
  3. changes in BP
  4. Rate pressure product
  5. RPE
  6. pulse oximetry
  7. ECG changes
20
Q

When monitoring patient appearance, sxs of excessive effort and exertion intolerance, examine for:

A
  • persistent dyspnea
  • dizziness or confusion
  • anginal pain
  • severe leg claudication
  • excessive fatigue
  • pallor, cold sweat
  • ataxia, incoordination
  • pulmonary rales
21
Q

Monitoring changes in HR

A
  • HR increases linearly as a function of increasing workload and oxygen uptake
  • plateaus just before maximal oxygen uptake (VO2max)
22
Q

Monitoring changes in BP

A
  • systolic BP should rise with increasing workloads and VO2
  • diastolic VPB should remain about the same
23
Q

Monitoring rate pressure product

A
  • RPP is the product of systolic BP and HR (last two digits of 5 digit number are dropped)
  • is often used as an index of myocardial oxygen consumption (MVO2)
  • increased MVO2 is the result of increased coronary blood flow
  • angina is usually precipitated at given RPP
24
Q

RPE

A
  • Borg Scale or Borg CR
  • Allows subjective rating of feelings during exercise and impending fatigue
  • important to use standardized instructions
25
Q

Monitoring RPE

A
  • increases linearly with increasing exercise intensity
  • correlates closely with exercise heart rate and work rate
26
Q

RPE reliability

A
  • has intra-user reliability over time, but not inter-user reliability
  • ratings can be influenced by psychological factors, mood states, environmental conditions, exercise modes, and age
27
Q

when is RPE important to use

A
  • when pts do not exhibit typical rise in HR with exercise
  • ie on beta blockers
28
Q

Borg scale

A

6-20

29
Q

Borg CR 10

A

0-10

30
Q

monitoring pulse oximetry

A
  • measure arterial oxygen saturation levels before, during, and after exercise
31
Q

5 ECG changes with exercise in a healthy individual

A
  • tachycardia: HR increase is directly proportional to exercise intensity and myocardial work
  • rate -related shortening of QT interval
  • ST segment depression, upsloping, less than 1 mm
  • reduced R wave, increased Q wave
  • exertion arrhythmias: rate, single PVC
32
Q

3 ECG changes with exercise in an individual with myocardial ischemia and CAD

A
  • significant tachycardia: occurs at lower intensities of exercise or with reconditioned individuals with out ischemia
  • exertion arrhythmias: increased frequent of ventricular arrhythmias during exercise and/or recovery
  • ST segment depression, greater than 1 mm below baseline is indicative of myocardial ischemia
33
Q

Delayed, abnormal responses to exercise

A
  • can occur hours after exercise
  • prolonged fatigue
  • insomnia
  • sudden weight gain due to fluid retention
  • hypotension, especially in pts with heart failrure
34
Q

What is ambulatory monitoring (telemetry)

A
  • continuous 24 hour eCG monitoring
  • allows documentation of arrhythmias and of ST segment depression or elevation, silent ischemia (if 12 leads)
35
Q

What is transtelephonic ECG monitoring used for

A

monitoring patients as they exercise at home

36
Q

What is an MET

A

the amount of oxygen consumed at rest (sitting)
- equal to 3.5 mL/kg per min

37
Q

Direct measurement of MET

A
  • MET levels (multiples of resting VO2) can be directly determined during ETT using collection and analysis of expired air
  • not routinely done
38
Q

MET estimation

A
  • can be estimated during ETT during steady states exercise
  • the max VO2, achieved on ETT is divided by resting VO2
  • highly predictable with standardized testing modes
39
Q

See MET activity chart

A

pg 267
table 4-15

40
Q
A

Boards Prep- Cardiovascular (21 decks)

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