Stress Testing in Cardiac Population Flashcards
Before doing and exercise test what information do me need from EHR or physician?
Medical history Results from physical exam: BP, cholesterol levels, lipoprotein levels, blood components PFT Previous GXT or EKG Body comp
What information is essential for conduction GXT?
Medical history
Risk factor appraisal
Determine level of supervision: physician present
Absolute vs. relative contraindications for GXT
Mode and extent of GXT
What are absolute and relative contraindications for GXT?
Absolute contraindications: indication of MI, moderate to severe angina, >20 mmHg drop in SBP, onset of arrhythmia, severe SOB, diaphoresis, dizziness, blurred vision, confusion, subject requests to stop
Relative contraindications: increasing chest pain, EKG changes from baseline, wheezing, leg cramping, abnormal SBP or DBP, moderate SOB
what are components of a GXT?
EKG (HR, ischemia, arrhythmias)
VO2 max vs. peak (gas exchange)
BP
RPE/Angina/Dyspnea
Symptoms
Protocol (TM, cycle, arm ergometer, nustep, recumbent cycle, pharm)
Exercise capacity (workload and time–> norms)
What are the three types of stress tests in cardiac patients?
Diagnostic (no meds) for CAD: symptom limited endpoint
Functional (with meds): identify cardiovascular response to exercise, low level GXT prior to discharge, stop at 4-6 METS or 75% APHRmax, comfortable walking speed
Therapeutic (with/out meds): optimize medical management, endpoint may be a MET level= work of ADLS
What is the NY heart association classification?
Class 1: disease w/o limitations
Class 2: disease w/ slight limitations (physical activity results in fatigue, dyspnea, etc)
Class 3: disease w/ marked limitations (OK at rest, less than ordinary activities cause symptoms)
Class 4: disease but inability to perform physical activity w/o discomfort (symptoms at rest, activity exacerbates symptoms)
What are effects of medications on patients with CHF and exercise performance?
Digoxin: diffuse ST effects, may increase performance
Diuretics: may decrease BP
Vasodilators: Increase HR, decrease BP, increase performance
ACE inhibitors: decrease BP, increase performance
Antiarrhythmic: may increase HR but little effect on performance
What are special considerations with GXT in CHF?
Ventilation/perfusion inequalities cause increased dead space and hyperventilation/dyspnea
Increased risk of dysrhythmias
What are objectives of stress tests in MI?
Quantitatively and accurately assess: chronotropic capacity and HR recovery, aerobic capacity, myocardial aerobic capacity (RPP), exertional symptoms, changes in electrical function
What is low level exercise testing in MI?
below 5 METS or significantly below peak, gradually increase stages
Get hemodynamic measures after each stage
Get functional capacity
Make patient more confident that they can return to activity
What are PT essentials for GXT in MI?
Have pt keep NTG with them during exercise.
Angina = reportable symptom
Always know what meds pt is taking: action, dosage
Monitor post-exercise recovery for 10 minutes: get to 100bpm before you let them go home. Also need to be asymptomatic
What are indicators of an adverse prognosis in people with MI?
Ischemic ST depression at low level of exercise
Functional capacity
What are special considerations for GXT in MI?
Patients who have PAD or DM2
Select equipment adjusted by 1 MET increments
Minimum frequency of training in 3 nonconsecutive day/week
Safety education
What safety education should in do in MI patients?
Monitor signs and symptoms
Medications
ADLs/Return to work
Sexual activity (positions, monitor sx even during sex)
What are the cardiac markers (onset, peak, return to normal)?
CK: 3-4 hours, 33 hours, 3 days
Troponins: 3-12 hours, 18-24 hours, up to 10 days
Myoglobin: 1-4 hours, 3-15 hours
LDH: 12-24 hours, 72 hours, 5-14 days
