UBC RCE Compiled Notes II Flashcards
What is rate of MI in EST? Death?
5/10 000, 1/10 000
What is normal increase in SBP per MET?
10% increase per MET
Criteria for Hypotensive Response?
-Decrease in SBP below resting BP
-SBP goes down by 10 or more points after initial increase
What is Heart rate reserve?
Age predicted max HR - Resting HR
**How to write an exercise prescription: 50-70%
-THR = ((Max HR - Resting HR) x 0.5) + RHR = Lower end
What is calculation for Chronotropic Index?
(Max HR - Baseline) / (Age predicted - Baseline)
< 80%
Definition of abnormal HR recovery?
Not going down 12 point in first minute of recovery
What is more predictive of CAD: CP or ST changes on EST?
CP
What are the absolute CI’s to EST? (9)
-Symptomatic Severe AS
-ACS in last 48h
-High risk unstable Angina
-Decompensated HF
-Myopericarditis
-PE
-Aortic Dissection
-Unable to walk
-Arrhyhtmia with HD compromise
Name all absolute indications to stop an EST?
-Moderate-Severe Chest Pain
-Pallor/Cyanosis
-CNS symptoms/Ataxia
-ST elevation in leads without Q waves
-Unstable Ventricular Arrhythmias
-Hypotensive response with signs of ischemia
-Patient request to stop
-Cannot safely monitor the patient
Describe the BRUCE protocol
Begins at a workload of 4 METS and increases the workload every 3 minutes by 3 MET increments
What is the prognostic significance of LBBB developing during Exercise? How about RBBB?
-LBBB: Predicts higher risk of death and major cardiac events
-RBBB: Associated with CAD, especially LAD disease
What happens to the following with EST?
-P wave
-PR segment
-QRS
-Q wave
-T wave
-U wave
-QT interval
-P wave: Magnitude increases
-PR segment: Shortens
-QRS: Increases in amplitude
-Q waves: Increase
-T wave: Decreases in amplitude
-U wave: No changes with exercise
-QT interval: Absolute QT decreases
What is equivocal STD?
> 1mm upsloping STD
Is it normal to have normalization of Early Repol with exercise?
Yes
Why is having Complete Heart Block a contraindication to EST?
Risk of precipitating VT
What is the most important prognostic variable on EST?
Exercise Duration: 1 MET greater exercise capacity is associated with a 12% reduction in risk of death
4 CI’s to using Persantine/Adenosine? Updated as per CP guidelines
-SBP < 90mmhg
-SBP > 200mmhg
-Mod-severe asthma with active wheezing
-Brady < 45bpm without a pacemaker
-2nd or 3rd degree AV block without a pacemaker
-Dypirimadole recent use
-Methylxanthine use in last 12 hours
-ACS in last 48 hours
When assessing Viability, what has the highest sensitivity for predicting Viability?
Improvement with Low dose Dobutamine
When assessing Viability, what has the highest specificity for predicting Viability?
Biphasic response (Wall motion better at low dose, worse at high dose)
What is viability determined by on DSE?
Improvement of at least one grade in 2 or more segments
5 high risk criteria on DSE?
2 on CCS statement, preferred for exam:
-2 or more inducible WMA’s
-WMA at low ischemic threshold (Dobutamine < 10mg/kg/min, or HR < 120 bpm)
Others in case they ask more:
-Peak LVEF < 45% AND Extensive ischemia
-Baseline LVEF < 35 % AND Extensive ischemia
-Transient Ischemic DIlatation
Describe the following Adenosine receptors (1, 2A, 2B, 3)
1- SA and AV nodal blockade
2A- Coronary Vasodilation
2B- Bronchoconstriction and Peripheral Vasodilation
3- Mast cell degranulation
What is unique about Regadenoson?
Selective 2A receptor agonist
6 High risk criteria on MPI?
-Large perfusion deficits (>10%)
-Increase lung or RV uptake
-Multiple Coronary territories
-TID
-LVEF < 45% at peak stress of LV decrease from baseline with ischemia
-Resting LVEF < 35% due to non coronary cause