509 - Lec 4 - Exercise Testing

Front 1

What does symptoms limited tests help to determine onset of?

Back 1

angina
dyspnea

Front 2

what does exercise testing evaluate?

Back 2

physiological response to increasing demands

Front 3

why lie person down after exercise testing?

Back 3

increase blood return, increasing preload, challenges heart to pump the more blood out

Front 4

What % of HR does submax go to?

Back 4

85%

Front 5

Maximal goes to what end point?

Back 5

predicted max HR,
symptom limited

Front 6

How long does max continuous test last in normals?

Back 6

12-16min

Front 7

graded or non-graded test most commonly used?

Back 7

graded

Front 8

NY Heart Association CHF Class
4 / 3 / 2 / 1

Back 8

4fatigue/discomfort with minimal ANY activity
3 limited
2 slight limit
1 no limit

Front 9

Risk stratification, risk vs exercise intensity (low mod high)
MD supervised testing of:

Back 9

low - not needed
mod - max test
high - submax and max

Front 10

Risk stratification, risk vs exercise intensity (low mod high)
get med exam & GXT before:

Back 10

low - not needed
mod - vigorous exercise
high - mod and vig exercise

Front 11

what are safety recommmendations for testing:
(5)

Back 11

have emergency procedures
select appropriate exercise
perform pre-ex assessment/testing
determine variables to be monitored
perform post-ex eval and monitoring

Front 12

what is the single most non-invasive procedure? (for CAD)

Back 12

clinical exercise testing
(sensitivity 66-70%, specificity 84%)

Front 13

What variables are often monitored? (6)

Back 13

ECG, HR, BP, signs/symptoms, RPE, gas exchange

Front 14

How early may a patient with MI be candidate for low level sub max test?

Back 14

as early as 4 days post-event

Front 15

how early may a patietn with MI be candidate for max test?

Back 15

14 days (if apporpriate)

Front 16

what is the most definitive procedure upon which to base aerobic exercise recommendatiosn?

Back 16

max symptom limited test

Front 17

what does max symptom limited test allow for identification of?

Back 17

magnitude and threshold of (HR & RPP at onset) of:
angina, ischemia, dysrhythmias, BP abnormalities

Front 18

what position are patients placed in after test?

Back 18

supine

Front 19

how long should monitoring continue for after test?

Back 19

5-6 min post exercise,
or until signs/sx have resolved

Front 20

absolute indicators for stopping testing:

Back 20

drop in SBP >10mmHg
moderate/severe angina (lvl3)
nervous system symptoms (ataxia, dizziness, near syncope)
cyanosis/perfusion
tech. difficulties
subject desire to stop
sustained ventricular tachycardia
ST elevation in leads not V1 or avR

Front 21

relative indicators to stop max testing

Back 21

ST or QRS changes
arhythmias other than sustained V tach
fatigue, SOB, wheezing, cramps, claudication
bundle branch block or conduction problem that can't be distinguished from V-tach
increasing chest pain
hypertensive response (SBP>250mmHg, DBP >115mmHg)

Front 22

how many MET's will be endpoint for max test for sub-acute pt?

Back 22

5-7 mets

Front 23

how mcuh ST depression or elevation change will stop max test? (for subacute patient)

Back 23

>1 mm

Front 24

what HR will stop max test? for subacute patient

Back 24

70-75% predicted MHR, or 120-130

Front 25

how much RPE will stop max test for subacute patient?

Back 25

15

Front 26

how do resisted and isometric exercise affect HR compared to each other?

Back 26

resisted, greater inc
isometric, minimal inc

Front 27

what is normla HR response to exercise?

Back 27

linear increase proportional to workload & duration

Front 28

what is abnormal HR response to exercise?

Back 28

excessive increase for workload,
blunted increase
chronotropic incompetence

Front 29

What are normal EKG response to exercise?

Back 29

no change in rhythm
ST segment remains isoelectric (no sig up/down shift)

Front 30

what are abnormal EKG responses to exercise

Back 30

chagne in rhythm
ST up/down move
T wave inversion
new onset BBB

Front 31

What are normal BP responses to isotonic exercise? (5)

Back 31

7-10mm/MET increase

Front 32

What are normal BP response to resisted exercises?

Back 32

increase SBP proportional to max voluntary contraction

Front 33

What are normal BP response to isometric exercise?

Back 33

significant increase in SBP and DBP proportional to max voluntary contraction

Front 34

What is normal BP response to valsalva maneuver?

Back 34

initial increase, than transient decrease, than final increase

Front 35

How much does DBP change with normal response to exercise?

Back 35

+5 to 8 mmHg

Front 36

What are abnormal BP responses to exercise?

Back 36

hypertensive (SBP>10mmHg/MET)
blunted response <7
flat response
or hypotensive response

Front 37

what can cause hypertensive response?

Back 37

increased catecholamiens
increased resistance due to PVD
abnormal centrally mediated vasomotor/ tone

Front 38

what can cause blunted flat SBP response?

Back 38

meds
insufficient CO
chronotropic competence
rapidly decreasing TPR

Front 39

what is hypertensive response indicate risk of?

Back 39

resting hypertension

Front 40

what is blunted BP response indicate risk of?

Back 40

if unable to reach SBP of 130mmHg, risk for SUDDEN DEATH!

Front 41

What may cause hypotensive BP response to exercise?

Back 41

severe multi-vessel CAD
poor LV function (acute!)
severe AS or HCM

Front 42

what does hypotensive BP response indicate?

Back 42

strong correlation with pathological cardiac conditions

Front 43

what is hypotensive BP response?

Back 43

intiial increase with low workload, then drop with further load

Front 44

What is normal respiratory response to exercise?

Back 44

linear increase in VE proportional to worklad (first Vt goes up, then Fb/RR)

Front 45

What is abnormal respiratory response to exercise?

Back 45

excessive increase
subjective dyspnea

Front 46

unfinished

Back 46

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