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STRESS Flashcards

1
Q

first
described in 1772 by
the English physician
William Heberden

A

Angina

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2
Q

Angina was first
described in 1772 by
the English physician

A

William heberden

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3
Q

Angina was first
described in__________ by
the English physician
William Heberden.

A

1772

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4
Q

The “______________” of
modern stress testing was
the recognition of the
importance of ST segment
changes to predict the
presence of coronary
artery disease (CAD)

A

cornerstone

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5
Q

is the flat, isoelectric section of the
ECG between the end of the S wave (the J point) and
the beginning of the T wave.

A

ST segment

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6
Q

represents the interval between ventricular
depolarization and repolarization.
.

A

ELECTROCARDIOGRAM (ECG )

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7
Q

occurs when the J point is displaced below
baseline.

A

ST depression

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8
Q

≥1 mm ST-segment depression 60 to 80 ms from I point - positive stress test

A

Horizontal

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9
Q

≥1 mm
ST-segment depression 60 to 80 ms from I point
- positive stress test

A

Downsloping

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10
Q

≥1 mm
ST-segment depression 60 to 80 ms from I point
- nonspecific stress test

A

Upsloping

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11
Q

ST depression first noted during angina

A

Bousfield 1918

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12
Q

ST changes during exercise (sit ups) are associated with
chest pain & decreased cardiac blood flow

A

Feil and siegel 1928

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13
Q

________________, first “standard” exercise protocol
(Master)

A

Master’s Step test 1929

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14
Q

ST depression is present in only 75% of patients with angina
during exercise (similar to percentages today)

A

Goldhammer & Scherf 1932

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15
Q

First to use maximal exercise testing to test for CAD

A

Missal 1938

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16
Q

Continuous EKG monitoring, depression > 1.0 mm is
clinically significant

A

Riseman et al. 1940

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17
Q

EKG changes after exercise can be useful to detect
CAD

A

Master and jaffe 1941

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18
Q

The Harvard Step Test used to assess fitness from
HR during recovery

A

Johnson et al. 1942

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19
Q

Maximal exercise (stair climbing) was more sensitive
(88%) to detect CAD than submaximal exercise (39%)

A

Master test and wood et al. 1950

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20
Q

used with set criteria to screen for
CAD (Yu et al.) ST depression > 1.0 mm
Change in T wave (upright - inverted)
Increase T wave amplitude & Q-T duration

A

Treadmill testing 1952

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21
Q

Cycle tests used to predict fitness

A

Astrad 1954

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22
Q

established the guidelines used today: treadmill,
with EKG, during exercise

A

Bruce 1956

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23
Q

Refined interpretation of ST changes (V5 or CM5 most
sensitive leads)

A

Blackburn et al. 1969

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24
Q

the father of the treadmill exercise
stress test, died on February 12, 2004
when he was 87 years of age.

A

Dr. Robert A. Bruce

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25
Q

Dr. Robert A. Bruce the father of the treadmill exercise
stress test, died on ______________
when he was 87 years of age.

A

February 12, 2004

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26
Q

Dr. Robert A. Bruce the father of the treadmill exercise
stress test, died on February 12, 2004
when he was________ years of age.

A

87 yrs old

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27
Q

used improvements in both
EKG’s and treadmills to perfect his
new procedure.

A

Dr. Bruce

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28
Q

His first studies, published in 1949,
analyzed minute-to-minute changes in
respiratory and circulatory function of
normal adults who took a single-stage
treadmill test. He then published a
paper describing a multistage test in
1963

A

Dr. Bruce

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29
Q

Named after 18th-century British mathematician Thomas
Bayes, is a mathematical formula for determining conditional
probability

A

Bayes theorem

30
Q

Conditional probability is the likelihood of an outcome
occurring, based on a previous outcome having occurred in
similar circumstances

A

Bayes theorem

31
Q

Stated The probability of a “true” positive stress test depends
on the pre-test risk of the patient

A

Bayes theorem

32
Q

Test used in Medicine to measure heart’s ability
to respond to external stress in a controlled
clinical environment

A

STRESS TESTING

33
Q

A stress test is a very commonly performed test
to learn:

A

a) How heart pumps blood.
b) Whether heart is receiving blood supply.
c) How perform physical activity (riding a
treadmill or stationary bike) compared with
other people your age and sex.
d) If your symptoms (chest discomfort, shortness of breath, feeling like your heart is racing or
even dizziness) can be reproduced while
performing physical activity.

34
Q

Stress test makes it easier to identify and
evaluate certain heart issues, such as:

A
  1. Issue muscle or valves
  2. Blood supply to heart
  3. Electric stability of heart during exercise
35
Q

Healthcare providers assess your response to
the increased workload by measuring:

A
  1. Blood pressure.
  2. Heart rate.
  3. Oxygen levels.
  4. Electrical activity in your heart.
  5. How hard your heart is working compared with
    others your age and sex
36
Q

used when there are problems interpreting the EKG

A

Exercise stress test with imaging

37
Q

Used of treadmill or bike

A

Regular exercise stress test

38
Q

Example of exercise stress test with imaging

A

-with echocardiogram
–with nuclear imaging

39
Q

for the person who cannot safely exercise to the level needed

A

Chemical stress test

40
Q

This is the most
common and basic
heart stress test

A

Exercise stress test

41
Q

Shows how your heart
works during physical
activity

A

Exercise stress test

42
Q

It usually involves
walking on a treadmill
or riding a stationary
bike

A

Exercise stress test

43
Q

is
done when an exercise stress
test is not possible due to
physical limitations like back
trouble, joint disease, prior
stroke, dizziness or shortness of
breath.

A

Pharmacological stress test

44
Q

uses a medication
that increases your heart load in
the place of exercise.

A

Chemical or pharmacological stress test

45
Q

INDICATIONS OF PHARMACOLOGICAL STRESS
TESTING

A
  • Patients inability to exercise adequately.
  • The chosen test cannot be performed
    readily with exercise.
46
Q

also called
a myocardial perfusion scan, is a
type of nuclear medicine
procedure.

A

Nuclear stress test

47
Q

Usually done on two separate
days.

A

Nuclear stress test

48
Q

Scans are acquired with a
gamma camera to capture
images of the blood flow

A

Nuclear stress test

49
Q

A nuclear stress test, also called

A

Myocardial perfusion scan

50
Q

(Tc-99 sestamibi or
thallium) is injected

A

Radiotracer

51
Q

Radiotracer example

A

Thallium

52
Q

You may need this test to detect heart problems like:

A

• Congenital heart disease.
• Congestive heart failure.
• Coronary artery disease.
• Heart valve disease.
• Hypertrophic cardiomyopathy.
• People with high-risk occupations (like pilots or
professional athletes) may also need stress tests.

53
Q

Indications of Exercise Testing

A

• Diagnose coronary artery disease.
• Diagnose heart rhythm problems (arrhythmias).
• Guide treatment of heart disorders.

54
Q

Possible Risks

A

• Low blood pressure
• Abnormal heart rhythms (arrhythmias).
• Heart attack (myocardial infarction).

55
Q

Contraindications

A

• Acute M.I
• High risk of unstable angina
• Uncontrolled cardiac arrthymias
• Symptomatic severe aortic stenosis ́Pulmonary
infarction
• Acute myocarditis
• Acute aortic dissection

56
Q

Safety Precautions and Equipment: should have Front and side rails for
subjects to steady themselves.

A

Treadmill

57
Q

Safety Precautions and Equipment: should be readily
available to the staff only

A

Emergency stop button

58
Q

Pre –Test Preparation

A

• Any history of light headedness, fainting while
exercising should be asked.
• The physician should also ask about family history
and general medical history, making note of any
considerations that may increase the risk of sudden
death.
• A brief physical examination should always be
performed prior to testing to rule out significant
outflow obstruction.

59
Q

Preparation for Exercise Testing

A

• The subject should be instructed not to eat or smoke at
least 2 hours prior to the test.
• Unusual physical exertion should be avoided before
testing.
• Specific questioning should determine which drugs are
being taken.
• Because of a greater potential for cardiac events with the sudden cessation of -blockers , they should not be
automatically stopped prior to testing.

60
Q

It usually involves walking on a treadmill at increasing
levels of difficulty, while electrocardiogram, heart rate,
and blood pressure are monitored.

A

Treasmill test

61
Q

In general, ____ to ______minutes of continuous progressive
exercise during which the myocardial oxygen demand is
elevated to the patient’s maximal level is optimal for
diagnostic and prognostic purposes.

A

6 to 12 mins

62
Q

The Bruce multistage maximal treadmill protocol has ____-minute
periods to allow achievement of a steady state before work-load is
increased for next stage.

A

3 mins

63
Q

was designed by cardiologist
Robert A. Bruce in 1963 as a non-invasive test to assess patients
with suspected heart disease.

A

Bruce protocol treadmill test

64
Q

Bruce protocol In this capacity, is perhaps more widely known as

A

stress test or
exercise tolerance test

65
Q

Termination of Exercise Testing

A

• Moderate to severe chest pain
• Severe shortness of breath
• Abnormally high or low blood pressure
• An abnormal heart rhythm
• Dizziness
• Fatigue
• Certain changes in your electrocardiogram

66
Q

Termination of Exercise Testing: A flat or down sloping depression of the ST segment >
0.1 mV below baseline

A

Positive test

67
Q

Termination of Exercise Testing: Target heart rate is not achieved .

A

Negative test

68
Q

Limitations of Treadmill Stress Test
• Sensitivity-
• Specificity- 77 %

A

68%

69
Q

Limitations of Treadmill Stress Test
• Sensitivity- 68%
• Specificity-

A

77 %

70
Q

Responsibilities of a Cardiology
Technologist during Exercise Stress
Tests

A

• Ensure the patient has signed all relevant forms, followed preparation
guidelines, and that their medical history was provided.
• Ensure the patient exercises for as long as possible in order to get a
complete and accurate reading.
• Make sure the patient knows that they should speak up if they
experience any chest or arm pains, dizziness or other unusual
symptoms.
• Monitor the ECG continuously and be prepared to stop the test
immediately if any anything warning signs appear.

Spdx (4 decks)

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