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57 Cards in this Set

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FICK EQUATION
VO2max = Q x (aO2- vO2)

- arterial oxygen content - the venous oxygen content times cardiac output
WHAT DETERMINES A GOOD VO2MAX TEST?
- a plateau occurs when a person is +/- 10 of maximal heart rate
- > 8mM of blood lactate concentration
- RER > 1.15 - If it isn't over one they aren't working hard enough
- fatigue
RESPIRATORY EXCHANGE RATIO (RER)
- CO2 production/ O2 production
- a normal RER is between .7 and 1
- If it is greater than 1 there is alot of CO2 produced. This CO2 is produced from the bicarbonate buffer reaction
HCO3 + H+ = H2CO3 = H2O + CO2
PURPOSE OF CARDIOVASCULAR STRESS TESTING
- measures the stress on heart without having to go to VO2max. You should only go to 85% of max heart rate.
- evaluates the heart's electrical activity in relation to the clinical situation at hand
PROTOCOL SELECTION FOR CARDIOVASCULAR STRESS TESTING
- Naughton or Balke-Ware are suited for older or deconditioned individuals and patients with chronic disease because it increases in smaller increments

- Bruce Protocol or Ellestad are beeter for younger or physically active individuals because it increases in larger increments

- ramp protocol is when work rate increases in a constant and continuous manner

- each protocol should be individualize so that the treadmill speed and increments in grade are based on the subject's capability. Know the patient's age and reason for obtaining EKG
BRUCE PROTOCOL
- graded exercise test because it becomes more difficult with each stage
- the speed and grade (by 10) increases in 3 minute stages
- treadmill starts at a walking pace
- place electrodes on subject and get a resting heart rate and blood pressure
- Heart rate responses are obtained each minute
- Blood pressure and perceived exertion are taken at each stage
- Stop test at 85% max heart rate or when the subject can't go any further
- Bring treadmill back to slow walking pace for cool down
- Estimate VO2 by plugging the treadmill time into the equation. It must be in seconds.
ELECTRODE PREPARATION
- clean skins with alcohol where the electrodes go
- break skin (New Prep)
- put metal portion of electrode on area of skin
ELECTRODE PLACEMENT
- 12 standard leads are used in recording voltages from heart
- chest leads (V1, V2, V3, V4, V5, V6)
- Extremity leads are left arm, right arm, left leg, and right leg
BIPOLAR
- 3 leads
- Bipolar- measures the difference in electrical activity between two extremities (triangle)
- Left and Right Arm- on infraclavicular fossa, anterior surface of the thorax between the superior margin of the pectoralis major and the medial border of the anterior deltoid
- Left Leg- lower left anterior surface of the external oblique just above the iliac crest at the level of the umbilicus on the outer 1/3 of the anterior surface of the abdomen
ELECTRICAL CONDUCTION
- conductivity of the heart is measured by the use of electrodes. The electrodes act as cameras recording the activity of the heart at different angles
- SA node goes to AV node in the right atria. The electrical conduction then goes to the bundle of His which separates in left and right bundle branches. It then goes to the purkinje fibers and radiates up from the apex of the heart
P WAVES
- P wave- atrial depolarization
- 0.09 sec to 0.11 sec (horizontally). Anything greater is suggestive or left atrial hypertrophy
- up to 0.25mV (vertical). Anything greater is suggestive of Righ Atrial Hypertrophy
HOW TO MEASURE HEART RATE USING EKG PAPER
- Each 1 mm box equals 0.04 sec. 25 small boxes equals 1 seconds. 1500/ # sm boxes
- Each 5 x 5 box is .2 sec. 5 boxes equal 1 second. 300/ # lg boxes
- measure the distance from P to P or R to R
QRS COMPLEX
- ventricular depolarization
- up to 0.09 sec on the horizontal. Anything longer is suggestive of Bundle branch block. A partial block is between 0.1 and 0.12, greater than 0.12 shows a complete block
T WAVE
- ventricular repolarization
PR INTERVAL
- corresponds to atrioventricular conduction
- 0.12 to 0.22 sec (horizontal). Anything longer can be atrioventricular block
ST SEGMENT
- shift up or down from baseline is very important pathophysiologically
- the shift vertically is suggestive of myocardial infarction. Does not matter horizontally
QT INTERVAL
- corresponds to the duration of the ventricular action potential
- Has to decrease when heart rate increases because the heart has to totally relax before it starts again
- 0.35 to 0.40 seconds (horizontal). Decreases with faster heart rate.
NORMAL SINUS RHYTHM
- between 60 and 100 bpm
SINUS TACHYCARDIA
- greater than 100 bpm
SINUS BRADYCARDIA
- less than 60 bpm
MOBITZ I
- second degree AV block
- PR continues to increase in length
- leads to ventricular depolarization in the QRS complex
MOBITZ II
- second degree AV block
- PR is normal and constant
- ventricular depolarization (QRS) fails
NODAL RHYTHM
- AV node acts as the pace maker
- electrical activity goes in opposite direction so p wave is inverted
- PR interval is shortened
- P wave hidden during QRS
- P wave after QRS
MYOCARDIAL INFARCTION
- ST segment is depressed or elevated from baseline
- Q wave is significant because it is greater than 0.04 seconds and at least 1/3 the distance from the R wave
PURPOSE OF PULMONARY FUNCTION TESTING
- measures the air volume that can be moved in and out of hte longs
- determines how fast air can be moved in and out of the lungs
- Determines lung compliance to stiffness
- responses to respiratory therapy
FORCE VITAL CAPACITY (FVC)
- maximal volume expired after maximal inspiration
- liters
FORCED EXPIRED VOLUME IN ONE SECOND (FEV1)
- volume of air that can be forcefully expired during the first second following a maximal inspiration
- liters
FEV1/FVC (FEV1%)
- the percentage of the total FVC that was expelled during the first second of forced exhalation
FORCED EXPIRATORY FLOW BETWEEN 25% AND 75% (FEF25-75%)
- the amount of air expelled from the lungs during the middle half of the forced vital capacity test
- indicator of obstructive disease
- L/sec
PEAK EXPIRATORY FLOW (PEF)
- maximal flow rate achieved by the subject beginning after full inspiration and starting and ending with maximal expiration
- L/sec
MAXIMAL VOLUNTARY VENTILATION (MVV)
- reflects the status of the respiratory muscles since you are attempting to determine the subjects ability to move air in and out as quickly as possible.
- poor test performance suggests pulmonary problems
- L/sec or L/min
NORMATIVE VALUES
- based on height and weight, age, gender, race
NORMAL PFT
- >85% of predicted values
MILD DISEASE
- between 65-85% of predicted values
MODERATE DISEASE
- between 50-65% of predicted values
SEVERE DISEASES
- <50% of predicted values
OBSTRUCTIVE DISEASE
- compliance is normal but elasticity is reduced causing problems with exhalation
- FVC is smal because air volume is expelled more slowly
- Reduced FEV1 and FEV%
- The first 25% and last 25% of FEF is dependent on subject's effort. Therefore the middle 50% is a good indicator
- PEF is a sensitve test because it measures maximal flow which will be low because of reduced air flow
- emphysema
RESTRICTIVE DISEASE
- compliance is reduced which causes problems with inhalation
- FVC will be small(even more smaller then in obstructive disease) because of mechanical limitations even after bronchioles are dilated. Also uses slow vital capacity test to reduce airway collapse during max exhalation
- FEV1 will be low but FEV1% may still be in normal range
- bronchitis
COMPONENTS OF EXERCISE PRESCRIPTION
- Frequency(days)
- Intensty (HRreserve, VO2reserve)
- Time (minutes)
- Mode (treadmill, cycle)
KARVONEN'S FORMULA
HR reserve = [(max-rest)%]+rest
VO2 RESERVE FORMULA
VO2 reserve = [(VO2max-3.5)%]+3.5
ABSOLUTE VO2
- divide relative VO2 by 1000mL
- multiply by weight in kg
METS
- divide relative VO2 by 3.5 ml/kg/min
KCAL
- multiply absolute VO2 by 5 kcals or the r value plus 4
- multiply by number of minutes
RUNNING OR WALKING METABOLIC EQUATIONS
- speed = 1 mph = 26.8 m/min
- When walking and the grade is equal to zero than the vertical component is taken out
- 1 kg = 2.2 pounds
LEG CYCLING METABOLIC EQUATION
- kp = kg
- work rate = kgm/min
- 1 watt = 6kgm/min
- 1 rev = 6m
- To get minutes in bottom use revolutions in numerator
- make sure you add 7
ARM ERGOMETER METABOLIC EQUATION
- work rate = kgm/min
- 1 revolution = 2.4 m not 6 m
STEPPING EQUATION
- step frequency = number of steps per minute. If a metronome number is given divide those bpm by 4 to get steps per minute
- height has to be in meters so 1 inch = 0.0254m
VO2MAX FOR ENDURANCE TRAINED ATHLETES
60-80mL/kg/min
VO2MAX FOR CONDITIONED INDIVIDUALS
45-55mL/kg/min
VO2MAX FOR SEDENTARY YOUNG PEOPLE
40-45 mL/kg/min (Can be 20-50 depending on level of activity)
VO2MAX OF A MIDDLE AGED INDIVIDUAL
30-35 mL/kg/min
VO2MAX FOR A POST MYOCARDIAL INFARCTION INDIVIDUAL
20-25 mL/kg/min
VO2MAX FOR A INDIVIDUAL WITH SEVERE PULMONARY DISEASE
< 20 mL/kg/min
UNIPOLAR LEADS
- Unipolar- diferences in electrical activity at one location relative to zero
- augmented leads
- avR (right arm), avL (left arm), avI (left leg)
PRECORDIAL LEADS
- V1- 4th intercostal space, right of sternum
- V2- 4th intercostal space to the left of the sternum
- V3- halfway between V2 and V4
- V4- left midclavicular axillary line in the 5th intercostal space
- V5- left anterior axillary line in the 5th intercostal space
- V6- left midaxillary line in the 5th intercostal space
EKG LEADS
- 12 standard EKG leads are used in recording voltages from the heart
- 6 extremity limb leads
- 6 chest precordial leads