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57 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What needs to be addressed in Box 1?
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Positive tests for Ischemia either by EKG or with symptoms. Must also state %MPHR and Functional Capacity in METs. If neither must say negative by EKG and symptoms
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What needs to be state in Box 2?
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Hemodynamics-the response of HR and BP very brief
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What is stated in Box 3?
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ECG's both ST segment (where it developed 1mm depression and where it progresses up to peak and how it reacts in recover) as well as Arrythmias during exercise
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What is stated in Box 4?
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Symptoms of Ischemia, basically any chest discomfort including where it started and how it progressed. How long it took to resolve in recovery
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What is normal response of Heart rate?
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Linear Increase during GXT, gradual return in recovery
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What is the influence on Beta blockers?
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Attenuates (lessens) HR and BP-causing a blunted response. It blocks the sympathetic drive. Important to note in Box 2.
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What are abnormal responses to HR?
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Chronotropic Incompetence-"flat" response, Inability for HR to increase with exercise appropriately-poor prognosis (increased incidence and mortality)
Delayed HR recovery-less than 12bpm decrease in first minute of recovery (powerful predictor of mortality) |
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Normal response of BP during GXT?
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Increased SBP and no change/decrease in DBP during GXT, gradual return in recovery
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Abnormal Responses of BP in GXT?
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Inotropic Incompetence (inability to increase appropriately)
Hypotensive Response-Significant drop in SBP, imparticular with ischemic indicators Hypertensive response-greater than 250/115 |
Note if Inotropic Incompetence you should first check again, than consider this idea. It is rare
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What is RPP?
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Rate Pressure Product=HRxSBP its an index of MVO2. Index of myocardial Demand.
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What is Ischemic DP?
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HRxSBP when ischemic first develops, giving an index of MVO2 where ischemic is developed.
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What are the Characteristics in ST depression?
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Degree, Shape, Leads it develops in, How far into exercise it develops, and how it recovers after.
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What is the rule for Degree of ST depression in EKG?
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Higher the amplitude more significant the ST depression. 1mm or more is considered ST depression. Anything above 2 mm is considered relative indication to stop but is never stopped on ST depression alone.
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What is the rule for the number of leads in ischemia?
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More leads=more significant
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What are the three different possibilities for ischemia evolution in recovery?
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Arising, (none in exercise, first observed in exercise) Persisting ( seen in exercise and is stable in recovery) Evolving (Seen in exercise and gets worst in recovery)
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Which leads are indications for which walls in ischemia?
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Cannot tell where ischemia is based on leads, only that it is in the heart
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If ST depression at rest can you still run an exercise test to see Ischemia?
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No even if the ST depression gets worse in exercise you cannot use the test as an indicator. You must use an Echo or Nuclear test
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What are some EKG problems that could give false ST depression readings?
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LBB (indicated on left chest leads)
LVH (causes tall R waves in V5,6) Digitalis (on almost all leads) WPW as well as NSSTTWchanges |
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What is an ectopy?
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Arrythymia outside normal rhythm
May or may not be clinically significant |
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How may an Arrythymia change during exercise?
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They may be provoked worsened or suppressed
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When is Rate Related BBB serious?
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When you cant distinguish from something more serious
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What Heart Block may indicate a need for a Pacemaker soon?
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3rd degree
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When are Ventricular arrhythmias associated with CAD?
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When they are either complex or frequent
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Do Supraventricular Arrythmias have significance for CAD?
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They do not appear too
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What is the purpose of doing Echo or Nuclear testing?
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To increase Specificity and Sensitivity
(accuracy) Can locate and quantify extent of myocardia ischemia |
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What are the three types of Wall Motion Abnormalities?
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Hypokinesis (less movement)
Dyskinesis (abnormal movement) Akinesis (no movement) |
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What are the two abnormalities which cause problems in an Echo?
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Ischemia -normal at rest abnomal at exercise (Wall motion abnornmality)
Infarct-WMA all the time...always abnormal |
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When is an echo normal?
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When it is both normal at rest and exercise
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Compared to rest where is exercise in a nuclear image?
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Exercise test is above the resting image
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When is a Nuclear image normal?
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When it is a nice full orange image in both rest and exercise.
Fully Perfused at rest and exercise |
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What are the two examples of an abnormal nuclear image?
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Ischemia-Perfusion induced by exercise (loses the nice full orange image)
Infarct-Fixed Perfusion defects all the time, which would suggest the prior infarct |
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When should a pharmacological stress test be ran?
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Used when the subjects may be unable to undergo stress testing because of deconditioning, PVD, orthopedic problems, neurological deficits, and other limitations
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Drugs used to vasodilate in Pharmacological Stress Test
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Persantine/Adenosine/Lexiscan.....Used in Nuclear scans. Allows More blood to enter all areas except where Ischemia is.
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Drugs used to increase force of contractions?
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Dobutamine, increases Myocardial deman which will provoke the ischemia.....used in both Nuclear and Echo testing.
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What is the accuracy of a normal stress test and one with imaging?
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75 with stress test alone, 90 with imaging
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How is Bayes Analysis determined?
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Determined by pretest likelyhood, which uses age, gender, and symptoms
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Accuracy of medical tests based on what?
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Bayes Analysis
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What are the different outcomes of tests and what do they mean?
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True Positive-Test is positive and the person has CAD
True Negative-Test is negative and person does not have CAD False Positive-Test is positive, person does not have CAD False Negative-Test is negative, person does has CAD |
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What is sensitivity?
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Ability to detect disease when its there
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What is Specifity?
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Ability to Rule out disease when there is none
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What is the calculation of Sensitivity?
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(True Positive)/(True posivitive + False Negatives)=percent with CAD and a positive test. So it is all the people combined with CAD divided by the amount the tests were able to locate
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What is the calculation of Specifity?
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(True Negative)/(True Negative+False Positive)=percent without disease and negative tests. So it is all the people without CAD divided by the number that the tests were found not to have it.
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What are the percentages of sensitivity between a Stress Test, Echo, and Nuclear?
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Stress test-68%
Echo test-74-97% Nuclear-90% |
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What are the percentages of specifity between a Stress Test, Echo, and Nuclear?
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Stress test-77%
Echo test-64-94% Nuclear-93% |
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In VO2 testing what are the 3 main pieces of equipment?
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Pneumotach, O2 analyzer, and CO2 analyzer
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What does a Pneumotach Record?
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Total Volume of Expired Air (Minute Ventilation) (Ve)
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What does an O2 analyzer record?
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The percentage of O2 in total volume
Total VolumexPercentage of O2 analyzer=VO2 Volume O2 inspired- Volume expired= Volume O2 comsumed |
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What does a CO2 analyzer record?
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The percentage of CO2 in total volume
VCO2=total volume x concentration CO2 CO2-CO2 inspired=Volume CO2 produced |
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What problem arrives from the mouthpiece in VO2 testing?
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Person cannot vocally communicate must rely on yes and no answers that can be answered through gestures. Also need to keep a closer monitor on other indications including HR, EKG, r value
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What is the importance of the r value?
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r value of VO2 test is the calculation of VCO2/VO2 at rest and during early stages of exercise r value is less than 1. As exercise increases and O2 demand increases the amount of O2 expired is decreased and the amount of CO2 produced is increased causing r value to go above 1. This is an indicator the person is getting close to max.
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When is a VO2 test used?
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On Pulmonary and Heart Failure patients
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Why does a VO2 test help a cardiac patient?
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VO2 can be an index of Left Ventricular Function
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What is the Calculation of VO2?
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VO2=(HRxSV)x(a-VO2)
^ ^ peripheralcomponent Central Component |
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Why does a VO2 test help a pulmonary patient?
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Unlike normal people, pulmonary patients are limited by breathing. In pulmonary tests they use electrical cycle.
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What group has the sickest hearts?
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The Heart Failure Patients---Eventually may get heart transplant
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Which leads are most sensitive?
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V5, V6
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Where is ST depression most commonly seen?
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AVF, V5, V6
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