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Clincal Exercise Testing & Prescription > Lecture 2: Health Screening > Flashcards

Lecture 2: Health Screening Flashcards

1
Q

What are the three parts of a comprehensive pre-exercise evaluation?

A
  1. Past medical history
  2. Physical exam
  3. Laboratory testing
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2
Q

When reviewing a patient’s medical history, what are two things we look for?

A
  1. Medical diagnosis: known cardiovascular, pulmonary, or metabolic diseases.
  2. Previous physical examination findings: signs or symptoms of the three main diseases. Examples: angina, heart murmurs, wheezing, edema, or high blood pressure
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3
Q

Name 6 common things that would be provided in a medical history that is important to keep in mind when prescribing exercise?

A
  1. orthopedic problems (arthritis, joint swelling, or anything that could make exercise more challenging)
  2. medications
  3. drug abuse
  4. exercise history (type of ex., duration, and intensity)
  5. work history (expand on physical demand of job)
  6. family history
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4
Q

9 components of a physical exam

A
  1. body weight/ BMI/ body fat
  2. apical pulse rate and rhythm
  3. resting BP (seated, supine, standing)
  4. listening lungs
  5. Palpation of cardiac apical pulse
  6. listen for heart sounds
  7. testing neurological function
  8. checking skin
  9. palpation for edema
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5
Q

What are the three S’s of Blood Pressure measuring

A
  1. seated
  2. supine
  3. standing
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6
Q

Define: Apical pulse

A

the heartbeat as heard with a stethoscope placed on the chest wall

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7
Q

Define: Auscultation

A

listening for sounds within the body

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8
Q

When should high risk patients have a physical exam?

A

BEFORE exercise testing

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9
Q

Recommended lab tests for low-mod risk patients

A
  1. fasting plasma glucose
  2. fasting serum total cholesterol (ldl, hdl, triglycerides)
  3. thyroid function (especially w/ dyslipidemia)
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10
Q

recommended lab tests for high risk patients

A
  1. cardio lab tests (resting 12 lead ECG, holter monitoring, angiography, echocardiography, radionuclide)
  2. carotid ultrasound
  3. measure C-reactive protein
  4. chest radiograph
  5. comprehensive blood panel
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11
Q

Define: Holter monitoring

A

Use of a holter monitor (portable 12 lead ecg) for 24+ hours

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12
Q

recommended tests for pulmonary disease patients

A
  • chest radiograph
  • pulmonary function tests (FEV1& FVC)
  • blood gas analysis
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13
Q

Define: Echocardiography

A

Echocardiography is a diagnostic test that uses ultrasound waves to create an image of the heart muscle.

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14
Q

Blood pressure is determined by:

A

average of 2+ properly measured seated BP readings recorded on different office visits

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15
Q

Stages of blood pressure:

A

normal: 160 sbp OR >100 dbp

all have lifestyle changes except normal

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16
Q

4 components of antihypertensive therapy

A
  1. lifestyle change (increase PA & weight reduction)
  2. DASH eating plan (high fruit & veggies low dairy and saturated fat)
  3. decrease sodium consumption <100mmol
  4. decrease alcohol consumption
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17
Q

Define DASH diet

A

Dietary Approach to Stopping Hypertension

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18
Q

hypertensive patients require X bp meds.

target goal bp?

A
  1. 2+ meds

2. (<130/80 for patients w/ diabetes or chronic kidney disease)

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19
Q

LDL cholesterol 5 levels

A
  1. optimal 190
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20
Q

Total cholesterol 3 levels

A
  1. desirable <200
  2. borderline high 200-239
  3. high 240+
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21
Q

HDL cholesterol 2 levels

A
  1. low 60
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22
Q

Triglycerides 4 levels

A
  1. normal <150
  2. borderline high 150-199
  3. high 200-499
  4. very high 500+
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23
Q

Pulmonary function testing recommendations

A
  • all smokers over 45

- symptoms: dyspnea, wheezing, chronic cough, excessive mucus production)

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24
Q

Commoly used Spirometry measurements:

A

1-forced vital capacity FVC (maximal air in and out as long as it takes. top of lungs to residual volume)

  1. FEV1 Forced expiratory volume (in 1 second)
  2. FEV1/FVC ratio (.8 is considered normal)
25
Q

What diseases cause FEV1/FVC ratio to decrease

A

obstructive airway diseases (asthma, COPD, emphysema,)

-remains normal in restrictive disorders (kyphoscoliosis, pumonary fibrosis, etc)

26
Q

4 stages of Chronic Obstructive Lung Disease

A
  • stage 1 mild FEV1 >80% predicted

- stage 2 moderate 50%< FEV1 < FEV1 <50% w/ chronic respiratory failure

27
Q

Contraindications to Exercise Testing

A
  • Absolute contraindication: uncontrolled, acute, unstable conditions
  • Relative contraindications: may be tested after careful evaluation of risk/benefit
  • contraindications may not apply in specific scenarios: after acute mi, or bypass surgery
28
Q

3 Useful info gathered from Ex. tests

A
  1. exercise capacity
  2. dysrhythmias
  3. hemodynamic response to exercise
29
Q

Emergency departments may perform Ex tests on low risk patients with angina to rule out what?

A

Myocardial infarction

30
Q

5 Absolute Contraindications to ex. testing

A
  1. Acute Cardiac event/ ischemia/ recent MI
  2. unstable angina
  3. uncontrolled cardiac dysrhythmias
  4. symptomatic severe aortic stenosis
  5. uncontrolled heart failure
31
Q

4 Relative Contraindications to ex. testing

A
  1. left main coronary stenosis
  2. moderate stenotic valvular heart disease
  3. electrolyte abnormalities
  4. severe arterial hypertension (SBP >200, DBP >110 at rest)
32
Q

last 4 Absolute Contraindications to ex. testing

A
  1. acute pulmonary embolus/infarction
  2. acute myocarditis or pericarditis
  3. suspected or known aneurysm
  4. acute systemic infection
33
Q

2nd 4 Relative Contraindications to ex. testing

A
  1. tachycardia or bradycardia
  2. hypertrophic cardiomyopathy
  3. neuro, musculoskeletal, or rheumatoid disorders
  4. High-degree atrioventricular block
34
Q

last 4 Relative Contraindications to ex. testing

A
  1. Ventricular Aneurysm
  2. uncontrolled metabolic disease (diabetes, etc)
  3. Chronic infectious disease (aids, mono)
  4. Mental or physical impairment
35
Q

3 biomarkers for Myocardial damage

A
  1. Creatine Kinase
  2. Cardiac Troponin T
  3. Cardiac Troponin I
36
Q

6 arteries used for HR checking?

A
  1. Brachial Artery
  2. Popliteal Artery
  3. Femoral Artery
  4. Posterior Tibial Artery
  5. Dorsal Pedis
  6. Carotid Artery
37
Q

6 steps for BP assessment

A
  1. No cigarette or caffeine 30 minutes prior
  2. Make sure patient is seated for 5 minutes w/ feet on floor and arm supported.
  3. Wrap cuff firmly at heart level, aligned with Brachial artery
  4. use correct sized cuff. Bladder should encompass 80% of upper arm
  5. standing or supine may be used in special cases
  6. stethoscope below antecubital space over brachial A.
38
Q

Last 5 steps for BP assessment

A
  1. Inflate cuff quickly to 20 MM HG after korotoff sound
  2. release at 2-5 mmHG/ second
  3. Systolic= first sound diastolic point right before no sound
  4. 2+ measurements
  5. Verbalize and write BP and goals
39
Q

4 stages of BP

A
  1. Normal SBP 160 or >100
40
Q

What stages of BP management require life changes

A

normal-encouraged

prehypertensive, stage 1-2 hypertension yes

41
Q

4 phases of Korotkoff sounds

A
  1. SBP intial sound of faint, tapping
  2. soft tapping or murmur 10-15mmHG after SBP
  3. return of loud tapping
  4. true DBP sound muffled and less audible (soft blowing)
  5. Complete disappearance of sound 8-10mmHG after 4.
42
Q

Purpose of Informed consent

A
  1. Info that is important for ethical and legal consideration.
  2. ensures participant understands the purpose and risk associated.
43
Q

Informed consents must be presented how?

A
  1. verbally to subject with an opportunity for questions
44
Q

Informed consent’s must include (2 things)

A
  1. A clause for withdrawal at anytime

2. protection of privacy for subject (HIPAA)

45
Q

Participants instructions: 7 things

A
  1. No food or drugs for 3 hours prior
  2. no heavy exertion on the day of
  3. workout clothing
  4. inform subject they may want a ride home
  5. if for diagnostics: halt cardio meds w/ doctor approval
  6. taper hypertensive meds if use mod-high doses
  7. if test is for functionality: continue medication
  8. bring list of meds and dosage
  9. drink water for 24+ hours
46
Q

10 drug types you need to know

A
  1. beta blockers
  2. diuretics
  3. ace inhibitors
  4. calcium channel blockers
  5. anticoagulants
  6. digitalis
  7. nitrates
  8. aspirin
  9. statins
  10. combos
47
Q

Diuretics effects

A
  1. decrease blood pressure or (little to no effect)
  2. no effect on heart rate
  3. may show false positive “ischemic strain” (ECG)
48
Q

Diuretics are for

A

Blood pressure reduction

49
Q

Calcium Channel Blocker effects

A
  1. decrease resting & exercise BP
  2. decrease heart rate
  3. decrease ischemic response on ECG
  4. Increase exercise tolerance in patients with exertional angina
50
Q

Calcium channel blocker are for

A

Blood pressure reduction

51
Q

Coumadin/warfarin (anticoagulant) effects

A

no effects on heart rate or bp

52
Q

Anti-coagulants are for

A

clotting risk & A Fib.

53
Q

Statins Effects

A
  1. no effect on HR, BP, or exercise tolerance

2. may cause muscle soreness

54
Q

Statins are for

A

lowering lipid levels

55
Q

B-Blockers effects

A
  1. decrease Q, HR, BP, Ischemia (rest and ex.), and VO2 intially
56
Q

B-Blockers are used to

A

block adrenaline which controls fight or flight response

57
Q

Ace inhibitors effects

A

Decrease BP & HR at rest & ex.

does not effect Q or ex. performance

58
Q

Ace inhibitors are for

A

Stage 2 Blood pressure reduction

59
Q

Nitrates effects

A
  1. decrease BP (rest & ex.) & ex. ischemia

2. increase HR (rest & ex.) & ex. capacity

Clincal Exercise Testing & Prescription (2 decks)

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