S2 L2.8: Risk Stratification Criteria for Cardiac Pts by ACP and AACVPR

Question 1

American College of Physicians (ACP)

Match the following items:
1. Asymptomatic at rest with exercise capacity adequate for most vocational and recreational activities
2. Survivor of cardiac arrest
3. Recent MI (<6 months) complicated by serious ventricular arrhythmias
4. Shock or CHF during recent MI (<6 months) (EF* 31%–49%) Inability to self-monitor heart rate
5. No ischemia, left ventricular dysfunction, or complex arrhythmias

A. Low Risk
B. Intermediate (Moderate Risk)
C. High Risk

*EF = ejection fraction

Answer 1

1. A
2. C
3. C
4. B
5. A

Question 2

American College of Physicians (ACP)

Match the following items:
1. Uncomplicated MI or CABG
2. Exercise-induced ST-segment depression <2 mm
3. Failure to comply with exercise prescription
4. PVCs* appearing or increasing with exercise
5. Functional capacity ≥8 METs* 3 weeks after clinical event

A. Low Risk
B. Intermediate (Moderate Risk)
C. High Risk

*MET = metabolic equivalent
*PVC = premature ventricular contraction.

Answer 2

1. A
2. B
3. B
4. C
5. A

Question 3

American College of Physicians (ACP)

Match the following items:
1. Exercise-induced ST-segment depression >2 mm
2. Exertional hypotension (≥15 mm Hg decrease in systolic pressure during exercise)
3. Severely depressed LV* function (EF <30%)
4. Resting complex ventricular arrhythmias (low grade IV or V)
5. Functional capacity <8 METs* 3 weeks after clinical event

A. Low Risk
B. Intermediate (Moderate Risk)
C. High Risk

*LV = left ventricular
*MET = metabolic equivalent

Answer 3

1. C
2. C
3. C
4. C
5. B

Question 4

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

Match the following items:
1. Uncomplicated MI, CABG, angioplasty, or atherectomy
2. Functional capacity <5–6 METs* 3 or more weeks after clinical event
3. Severely depressed LV* function (EF ≤30%)
4. Survivor of cardiac arrest
5. Exercise-induced ST-segment depression of 1–2 mm or reversible ischemic defects (echocardiography or nuclear radiography)

A. Low Risk
B. Intermediate (Moderate Risk)
C. High Risk

*MET = metabolic equivalent
*LV = LV = left ventricular

Answer 4

1. A
2. B
3. C
4. C
5. B

Question 5

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

Match the following items:
1. Mild to moderately depressed left ventricular function
2. Functional capacity ≥6 METs* 3 or more weeks after clinical event
3. Failure to comply with exercise prescription
4. Complex ventricular arrhythmias at rest or appearing or increasing with exercise
5. Decrease in systolic blood pressure of >15 mm Hg during exercise or failure to rise consistent with exercise workloads

A. Low Risk
B. Intermediate (Moderate Risk)
C. High Risk

*MET = metabolic equivalent

Answer 5

1. B
2. A
3. B
4. C
5. C

Question 6

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

Match the following items:
1. No resting or exercise-induced myocardial ischemia manifested as angina and/or ST-segment displacement No resting or exercise-induced complex arrhythmias
2. No resting or exercise-induced myocardial ischemia manifested as angina and/or ST-segment displacement No resting or exercise-induced complex arrhythmias
3. Patients with severe CAD and marked (>2 mm) exercise induced ST-segment depression
4.MI complicated by CHF, cardiogenic shock, and/or complex-ventricular arrhythmias

A. Low Risk
B. Intermediate (Moderate Risk)
C. High Risk

Answer 6

1. A
2. A
3. C
4. C

Question 7

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Asymptomatic at rest with exercise capacity adequate for most vocational and recreational activities

Answer 7

ACP; low risk

Question 8

Identify which classification and what level of risk (e.g. AACVPR; low risk):

No significant left ventricular dysfunction (EF ≥ 50%)

Answer 8

AACVPR; low risk

Question 9

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Uncomplicated MI or CABG

Answer 9

ACP; low risk

Question 10

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Functional capacity ≥8 METs 3 weeks after clinical event

Answer 10

ACP; low risk

Question 11

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Uncomplicated MI, CABG, angioplasty, or atherectomy

Answer 11

AACVPR; low risk

Question 12

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Asymptomatic at rest with exercise capacity adequate for most
vocational and recreational activities

Answer 12

ACP; low risk

Question 13

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Functional capacity ≥6 METs 3 or more weeks after clinical event

Answer 13

AACVPR; low risk

Question 14

Identify which classification and what level of risk (e.g. AACVPR; low risk):

No significant left ventricular dysfunction (EF ≥ 50%)

Answer 14

AACVPR; low risk

Question 15

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Functional capacity <8 METs 3 weeks after clinical event

Answer 15

ACP; Intermediate (Moderate) Risk

Question 16

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Exercise-induced ST-segment depression of 1–2 mm or
reversible ischemic defects (echocardiography or nuclear radiography)

Answer 16

AACVPR: Intermediate (Moderate) Risk

Question 17

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Exercise-induced ST-segment depression <2 mm

Answer 17

ACP; Intermediate (Moderate) Risk

Question 18

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Failure to comply with exercise prescription

Answer 18

AACVPR: Intermediate (Moderate) Risk

Question 19

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Mild to moderately depressed left ventricular function

Answer 19

AACVPR: Intermediate (Moderate) Risk

Question 20

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Failure to comply with exercise prescription

Answer 20

ACP; Intermediate (Moderate) Risk

Question 21

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Shock or CHF during recent MI (<6 months) (EF 31%–49%)
Inability to self-monitor heart rate

Answer 21

ACP; Intermediate (Moderate) Risk

Question 22

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Functional capacity <5–6 METs 3 or more weeks after clinical event

Answer 22

AACVPR: Intermediate (Moderate) Risk

Question 23

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Severely depressed LV function (EF <30%)

Answer 23

ACP; high risk

Question 24

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Severely depressed LV function (EF ≤30%)

Answer 24

AACVPR; high risk

Question 25

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Survivor of cardiac arrest

Answer 25

ACP and AACVPR; high risk

Question 26

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Recent MI (<6 months) complicated by serious ventricular arrhythmias

Answer 26

ACP; high risk

Question 27

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Complex ventricular arrhythmias at rest or appearing or increasing with exercise

Answer 27

AACVPR; high risk

Question 28

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Exertional hypotension (≥15 mm Hg decrease in systolic pressure during exercise)

Answer 28

ACP; high risk

Question 29

Identify which classification and what level of risk (e.g. AACVPR; low risk):

PVCs appearing or increasing with exercise

Answer 29

ACP; high risk

Question 30

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Decrease in systolic blood pressure of >15 mm Hg during exercise or failure to rise consistent with exercise workloads

Answer 30

AACVPR; high risk

Question 31

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Resting complex ventricular arrhythmias (low grade IV or V)

Answer 31

ACP; high risk

Question 32

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Exercise-induced ST-segment depression >2 mm

Answer 32

ACP; high risk

Question 33

Identify which classification and what level of risk (e.g. AACVPR; low risk):

MI complicated by CHF, cardiogenic shock, and/or complex-ventricular arrhythmias

Answer 33

AACVPR; high risk

Question 34

Identify which classification and what level of risk (e.g. AACVPR; low risk):

Patients with severe CAD and marked (>2 mm) exercise induced ST-segment depression

Answer 34

AACVPR; high risk

Question 35

LOW RISK

Match the following items:
1.Uncomplicated MI or CABG
2. No significant left ventricular dysfunction (EF ≥ 50%)
3. Asymptomatic at rest with exercise capacity adequate for most vocational and recreational activities
4. Functional capacity ≥6 METs 3 or more weeks after clinical event
5. No resting or exercise-induced myocardial ischemia manifested as angina and/or ST-segment displacement No resting or exercise-induced complex arrhythmias
6. No ischemia, left ventricular dysfunction, or complex arrhythmias
7. Functional capacity ≥8 METs 3 weeks after clinical event
8. Uncomplicated MI, CABG, angioplasty, or atherectomy

A. American College of Physicians (ACP)
B. American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

Answer 35

1. A
2. B
3. A
4. B
5. B
6. A
7. A
8. B

Question 36

INTERMEDIATE (MODERATE) RISK

Match the following items:
1. Exercise-induced ST-segment depression <2 mm
2. Failure to comply with exercise prescription
3. Shock or CHF during recent MI (<6 months) (EF 31%–49%)
Inability to self-monitor heart rate
4. Functional capacity <8 METs 3 weeks after clinical event
5.Functional capacity <5–6 METs 3 or more weeks after clinical event
6. Mild to moderately depressed left ventricular function
7. Failure to comply with exercise prescription
8. Exercise-induced ST-segment depression of 1–2 mm or reversible ischemic defects (echocardiography or nuclear radiography)

A. American College of Physicians (ACP)
B. American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

Answer 36

1 - 4. A
5 - 8. B

Question 37

HIGH RISK

Match the following items:
1. Severely depressed LV function (EF ≤30%)
2. Resting complex ventricular arrhythmias (low grade IV or V)
3. Severely depressed LV function (EF <30%)
4. Complex ventricular arrhythmias at rest or appearing or increasing with exercise
5. Exertional hypotension (≥15 mm Hg decrease in systolic pressure during exercise)
6. PVCs appearing or increasing with exercise

A. American College of Physicians (ACP)
B. American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

Answer 37

1. B
2. A
3. A
4. B
5. A
6. A

Question 38

HIGH RISK

Match the following items:
7. Decrease in systolic blood pressure of >15 mm Hg during exercise or failure to rise consistent with exercise workloads
8.MI complicated by CHF, cardiogenic shock, and/or complex-ventricular arrhythmias
9. Recent MI (<6 months) complicated by serious ventricular arrhythmias
10. Patients with severe CAD and marked (>2 mm) exercise induced ST-segment depression
11. Exercise-induced ST-segment depression >2 mm
12. Survivor of cardiac arrest

A. American College of Physicians (ACP)
B. American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

Answer 38

7. B
8. B
9. A
10. B
11. A
12. A and B