LECTURE 3 (Exercise stress testing)

Question 1

What is an exercise stress test?

Answer 1

Reveals the amount of stress that the heart can manage before showing symptoms of an abnormal rhythm or signs of ischemia

Question 2

What happens during the exercise stress test?

Answer 2

Walk on treadmill/pedal a stationary bike -> hooked up to ECG machine -> gradually increase the difficulty -> blood pressure, heart rate and ECG are monitored

Question 3

What can be determined from a stress test?

Answer 3

• Patient’s functional capacity
• Assess probability and extent of coronary artery disease (CAD)
• Assess risks prognosis and effects of therapy

Question 4

What are the different types of stress tests?

Answer 4

• Exercise stress test
• Nuclear stress test
• Stress echocardiogram

Question 5

What happens during a Nuclear stress test/Thallium stress test?

Answer 5

Receive dye via an IV line -> allows healthcare professionals to view images of your heart using a special camera

Question 6

What happens during a Stress echocardiogram?

Answer 6

Healthcare professional will hold a transducer against your chest -> wand-like device creates sound waves that make moving pictures of your heart

Question 7

What happens if a person cannot exercise?

Answer 7

The doctor might use a certain medication given through an IV line to trigger the same process

Question 8

Why do we need a stress test?

Answer 8

• Determine if there is adequate blood flow to heart muscles during activities
• Determine chances of suffering from CORONARY HEART DISEASE
• Assess effectiveness of drugs used to control ANGINA and ISCHEMIA
• Assess effectiveness of procedures done
• Look for abnormal rhythms
• Assist in devising a safe exercise plan
• Check for improperly functioning valves

Question 9

What is the age-predicted maximum heart rate?

Answer 9

Calculated by subtracting the patient’s age from 220

Question 10

What are the risks of an exercise stress test?

Answer 10

• Low BP
• Abnormal heart rhythms (arrhythmias)
• Heart attack (myocardial infarction)

Question 11

What are the indications for stress testing?

Answer 11

• Acute chest pain in patients excluded for actor coronary syndrome (ACS)
• Known CAD with worsening symptoms
• Certain cardiac arrhythmias
• Newly diagnosed heart failure

Question 12

What are contraindications for stress testing?

Answer 12

• Acute myocardial infarction within 2-3 days
• Uncontrolled cardiac arrhythmias
  -Uncontrolled symptomatic heart failure
• Acute aortic dissection
• Severe pulmonary hypertension

Question 13

What are the 4 preparation steps for a stress test?

Answer 13

• Do not eat
• Do not have caffeine
• Do not take blood pressure meds
• Wear comfortable clothes and shoes

Question 14

What are the absolute indications for termination of testing?

Answer 14

• A drop in systolic blood pressure of greater than 10 mmHg from baseline when accompanied by other ischemia indications
• Moderate-to-severe angina
• Ataxia & dizziness
• Cyanosis/Palloe
• Patient’s desire to stop

Question 15

What are abnormal findings that represent a positive stress test?

Answer 15

• Exercise-induced hypotension
• Exercise-induced chest pain
• Appearance of S3 and/or S4 sounds or heart murmur
• Abnormal ECG findings

Question 16

Which protocol is the most commonly used exercise treadmill stress protocol?

Answer 16

The Bruce protocol

Question 17

What is the J point?

Answer 17

The junction between the termination of the QRS complex and the beginning of the ST segment

Question 18

Which further tests are usually required?

Answer 18

• Cardiac catheterisation
• CT coronary angiography
• Nuclear stress test
• Stress echocardiogram