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Flashcards in Chapter 11 Deck (28):
1

Exercise Electrocardiography

Performed to determine cardiac problems not captured by the ECG.
Also known as exercise tolerance test, a treadmill stress test, a cardiac stress test, a stress ECG, or an exercise treadmill test.
Procedure is performed with a cardiologist. Pt is carefully monitored.

2

Exercise electrocardiography procedure

Pt is asked to walk on the treadmill. ECG is continuously monitored. Pt is asked to increase the level of exertion of eves ice as the test progresses. We monitor the ECG, BP, heart rate, skin temperature, oxygen level, and physical appearance.

3

How is the monitoring of exercise electrocardiography measured?

Using a ergometer

4

What is done after each exercise stage?

Take the blood pressure and a 12 lead ECG recorded

5

What must the pt report during an exercise electrocardiography?

Chest pain, dizziness, SOB, or any other sx's

6

What do MAs do for an exercise ECG?

Providing pt instructions an monitoring the pt during the procedure by taking BP, other measurement, observing for pain, discomfort, fatigue, or difficulty breathing, applying and removing electrodes. Be ready for emergencies.

7

Why is exercise ECG used?

To evaluate how the heart and blood vessels respond to physical activity. Usually when there is suspicion for cardiac problems, most commonly coronary vascular disease. To asses pt's BP maintenance during exercise. Determination of pt's risk of a MI. Functioning of the heart after a cardiac surgery or after a MI. Evaluates effectiveness of heart medications

8

What is coronary artery disease (CAD)?

Due to atherosclerosis which occurs when plaque forms in the blood vessels from an accumulation of excess fat.

9

Reasoning behind using exercise ECG

When the heart is exercised, it requires additional blood to provide oxygen to the myocardium. The exercise increases the myocardial oxygen demand. If the pt's arteries are obstructed or narrowed due to CVD, blood flow to the heart will not increase in response to the exercise. The additional workload may change the ECG tracing.

10

Changes in the ECG seen during exercise stress test

ST segment depression which indicate a myocardial ischemia. ST segment depression may be caused by digitalis medications as well

11

What sx's may the pt get when performing exercise ECG?

chest pain (angina), weakness, SOB, palpitations, or dizziness.

12

Variations of exercise ECG?

Chemical stress test and Pharmacologic stress test.

13

What is chemical stress test?

Invasive procedure. Similar to exercise stress test, exercise and monitoring portion are the same; however during a chemical stress test, the pt is injected IV with thallium or other nuclear isotopes such as Cardiolite 1 to 2 minutes before the end of the exercise period.

14

What is Thallium and Cardiolite?

They are radiopaque substances, they do not let xray penetrate so they can be traced by an X-ray machine. As the chemical flows the cardiologist can monitor its flow into the heart using a camera or scanner.

15

How long is the monitoring during chemical stress test?

20 minutes

16

How to perform a chemical stress test?

Pt lies on table whit both arms above the head and the scanner above them. The heart is viewed immediately after the test as well as 3 to 4 hours later, when the pt has rested. The san is then interpreted by the cardiologist.

17

Reading a scan from a chemical stress test

The chemicals flow more easily through non-diseased arteries. The purpose of the procedure is to determine if exercise causes a decrease in blood flow to any area of the heart.

18

What is pharmacologic stress test?

Variation of exercise electrocardiography. Similar except instead of actual exercise the pt is given medication to induce cardiovascular stress similar to exercise. IV is injected over time to stimulate the heart. Pt is also injected with imaging agent such as thallium and one of the cardioactive drugs.

19

What medications are used in pharmacologic stress test?

adenosine, dipyridamole (Persantine), dobutamine, or regadenoson (Lexiscan).

20

Why would it be necessary to use chemical stress testing?

Cardiologist the pictures to determine if blood flow to the heart improves with rest.

21

Preparing the pt before exercise ECG

Describe the procedure
Verify that the medical hx is complete
Explain the procedure, including the reason for the test.
Possible complications, and safety measures that will be followed during procedure
Explain "informed consent", and ask the pt to sign consent form
Inform pt that on the day of the test they should wear comfortable clothing. Female pts should not wear an underwire bra. Restrain form use of tobacco, caffeine, or alcohol for at least 3 hours prior to test. The pt should eat a light meal 2 hours prior to the test.
Check with physician's orders agains the pt medication list to provide information as to what medications the pt should not take the day of the test.
Go over all instructions and information with the pt. Encourage questions; make sure the pt fully understands the procedure.
Provide a detailed list of instructions, making sure that your facility telephone number and your name appear on the list. Encourage pts to call if they have any questions prior to test day.

22

Instructions for exercise ECG day of test.

Verify is working properly
Gather supplies-electrodes, alcohol, gauze sponges, razor, adhesive tape, blood pressure cuff, and so on.
Crash cart is ready and fully supplied
Verity physician's orderes, medical hx should be completed, and informed consent signed.
Bring the pt into the room
Verify with the pt that he/she has complied with all instructions
Instruct pt to change into gown with opening to the front
Assist pt to lie down on the table
Prep pts skin and apply electrodes as indicated by the protocol
Connect cables, apply the BP cuff, and chef the eCG tracing for artifacts
Obtain pt's BP in all required positions
Demonstrate the treadmill
Explain test protocol : speed should increase every 3 minutes
Pt should report any SOB, faintness, tingling sensations, numbness, or extreme fatigue immediately
Explain again that the test will be completed when the target heart rate is reached or when pt cannot continue
Start test.
At the 2 1/2 minute mark of each phase, take the pt's BP and enter data in computer.
When test is done help pt to a chair.

23

When should the BP and ECG tracings be obtained during the test?

Supine, sitting, sitting post 30 minute hyperventilation, standing

24

What is the target heart rate during an exercise ECG

(220-age) x 0.85

25

Preparing the pt before exercise ECG

Describe the procedure
Verify that the medical hx is complete
Explain the procedure, including the reason for the test.
Possible complications, and safety measures that will be followed during procedure
Explain "informed consent", and ask the pt to sign consent form
Inform pt that on the day of the test they should wear comfortable clothing. Female pts should not wear an underwire bra. Restrain form use of tobacco, caffeine, or alcohol for at least 3 hours prior to test. The pt should eat a light meal 2 hours prior to the test.
Check with physician's orders agains the pt medication list to provide information as to what medications the pt should not take the day of the test.
Go over all instructions and information with the pt. Encourage questions; make sure the pt fully understands the procedure.
Provide a detailed list of instructions, making sure that your facility telephone number and your name appear on the list. Encourage pts to call if they have any questions prior to test day.

26

Instructions for exercise ECG day of test.

Verify is working properly
Gather supplies-electrodes, alcohol, gauze sponges, razor, adhesive tape, blood pressure cuff, and so on.
Crash cart is ready and fully supplied
Verity physician's orderes, medical hx should be completed, and informed consent signed.
Bring the pt into the room
Verify with the pt that he/she has complied with all instructions
Instruct pt to change into gown with opening to the front
Assist pt to lie down on the table
Prep pts skin and apply electrodes as indicated by the protocol
Connect cables, apply the BP cuff, and chef the eCG tracing for artifacts
Obtain pt's BP in all required positions
Demonstrate the treadmill
Explain test protocol : speed should increase every 3 minutes
Pt should report any SOB, faintness, tingling sensations, numbness, or extreme fatigue immediately
Explain again that the test will be completed when the target heart rate is reached or when pt cannot continue
Start test.
At the 2 1/2 minute mark of each phase, take the pt's BP and enter data in computer.
When test is done help pt to a chair.

27

When should the BP and ECG tracings be obtained during the test?

Supine, sitting, sitting post 30 minute hyperventilation, standing

28

What is the target heart rate during an exercise ECG

(220-age) x 0.85