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NUMT 2020 Midterm > Stress testing > Flashcards

Stress testing Flashcards

1
Q

Rest oxygen demand and blood flow

A
  • low oxygen demand
  • adequate blood flow
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2
Q

Stress oxygen demand and blood flow

A
  • Increased oxygen demand and blood flow
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3
Q

Excercise stress testing meds to discontinue

A

Beta blockers: 72 hrs
Calcium channel blockers: 48 hrs
Long-acting nitrates: 12 hrs
Off caffeine: 24 hrs (varies by department)

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4
Q

Treadmill protocols

A

Bruce
Modified Bruce
Naughton

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5
Q

Reasons to terminate exercise

A

 Chest Pain
 ECG Changes
 T wave inversion
 ST segment depression >3 mm or elevation
 Fatigue
 HR & BP product target
 METs
 SOB
 Syncope
 Target HR achieved

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6
Q

Exercise contraindications

A

✔ Acute myocardial infarction (MI) (<2 days old)
✔ Unstable angina (chest pain at rest or worsening symptoms)
✔ Severe symptomatic aortic stenosis (risk of sudden collapse)
✔ Uncontrolled arrhythmias with hemodynamic instability
✔ Decompensated heart failure (fluid overload, respiratory distress)
✔ Acute myocarditis or pericarditis (risk of worsening inflammation)
✔ Severe pulmonary hypertension (right heart failure risk)
✔ Acute aortic dissection (risk of rupture and death)
✔ Active thromboembolic disease (e.g., pulmonary embolism, DVT

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7
Q

Exercise relative contraindications

A

⚠ Moderate valvular heart disease (e.g., moderate aortic stenosis or mitral stenosis)
⚠ Resting hypertension (>200/110 mmHg) (risk of hypertensive crisis)
⚠ Tachyarrhythmias or bradyarrhythmias (risk of instability)
⚠ High-degree AV block (e.g., Mobitz II, complete heart block)
⚠ Hypertrophic cardiomyopathy (HCM) with obstruction (risk of sudden cardiac death)
⚠ Severe electrolyte imbalances (e.g., hypokalemia, hypomagnesemia)
⚠ Recent stroke or TIA (<3 months) (risk of neurologic complications)
⚠ Uncontrolled diabetes with hyperglycemia (risk of metabolic crisis)
⚠ Physical disability limiting exercise (e.g., severe arthritis, neuromuscular disease)

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8
Q

What are the different pharmacological stress agents

A

Dipyridamole (Persantine)
Adenosine (Adenoscan)
Regadenoson (Lexiscan)
Coronary reserve
Dobutamine
Inotropic
Chronotropic

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9
Q

Advantages of pharmacologic stress tests

A

 Standardized test
 Pt’s unable to reach target HR:
- LBBB
- Pacemakers
- Respiratory conditions
- Limited HR response
 Pt’s physically unable to stress

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10
Q

Pharmacologic stress disadvantages

A

No functional cardiac
information
Increased level of side effects

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11
Q

Pharmacologic contraindications

A
  • allergies to dipyridamole and aminophylline
  • Reactive airway diseases like asthma and COPD
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12
Q

Pharmacologic relative contraindications

A

 Recent MI < 72hrs
 Hypotension
 Systolic pressure < 90mmHg
 Refractive CHF
 Unstable angina

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13
Q

Pharmacologic stress preparations

A
  • NPO:4hrs
  • No methylxanthines: 24hrs
  • Caffeine/theophylline/nicotine
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14
Q

Persantine characteristics

A

 Coronary vasodilator
 Acts indirectly via adenosine
 Increases coronary blood flow
 HR increases ~13 bpm
 T1/2 in serum ~30-60 min
 Coronary peak ~6-8 min
 Side effects:
 Most common - chest pain & headaches

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15
Q

Persantine Dose

A

0.57 mg/kg, max 60mg

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16
Q

Infusion time persantine

A

continuous over 4 min

17
Q

What is monitored during persantine?

18
Q

RP injected how long after persantine?

19
Q

Persantine antidote

A
  • aminophylline
  • 50-100mg increments
20
Q

Adenosine additional prep

A
  • discontinue dipyridamole 12-24 hrs
21
Q

Adenosine additional contraindications

A
  • 2nd and 3rd degree heart block
  • sinus node disease
22
Q

Adenosine characteristics

A

Coronary vasodilator
Acts directly
Increases coronary blood flow
T1/2 in serum <10 sec
Coronary peak ~55 sec
Increased side effects

23
Q

Adenosine dose

A

0.14 mg/kg/min

24
Q

Adenosine infusion time

A
  • continuous over 6min
25
Q

When is rp injected after adenosine admin

26
Q

regadenosin characteristics

A

Coronary vasodilator
A2A specific agonist
Increases coronary blood flow
T1/2 in serum ~30-60 min
Coronary peak ~33 sec
HR increases ~13 bpm
Less frequent side effects
Reactive airway disease

27
Q

Regadenosin dose

28
Q

Injection of regodenosin

A

20 sec bolus

29
Q

When is RP injectedafter regadenosin

30
Q

Regadenosin antidote

A

aminophylline

31
Q

Dobutamine indications

A

 Similar to vasodilators
 Side effect tolerance
Can be used when contraindications to coronary
vasodilators
Reactive airway
Allergies
Caffeine

32
Q

Dobutamine characteristics

A

Synthetic catecholamine
 Alpha and beta adrenergic receptors
 Directly assesses oxygen demand
 Invokes ischemia
 T1/2 in serum: ~2 min
 Coronary peak: ~10 min
 75% pts experience side effects

33
Q

Dobutamine infusion stages

A

3 min stages
5 μg/kg/min
10 μg/kg/min
20 μg/kg/min
30 μg/kg/min
40 μg/kg/min

34
Q

Dobutamine procedure

A

Monitor: BP, HR, ECG
Inject RP @ 1 min after max tolerable dose reached
Continue infusion for 1 min
Antidote: atropine

NUMT 2020 Midterm (11 decks)

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