Compulsory Questions

Question 1

What are the absolute contraindications to exercise

Answer 1

1) Unstable Angina
2) Unstable or acute heart failure
3) Unstable diabetes
4) New or uncontrolled arrhythmias
5) Resting or uncontrolled tachycardia >100bpm
6) Resting SBP >180mmHg, Diastolic >100mmHg
7) Symptomatic hypotension

Question 2

What are the main reasons for referring a client back to their primary care team?

Answer 2

1) Deteriorating exercise performance/functional capacity despite apparent compliance with program
2) Worsening of angina or development of unstable angina despite compliance with medication
3) Worsening of other symptoms e.g suspected arrhythmias, excessive breathlessness despite medication compliance
4) Any further cardiac event
5) Uncontrolled tachycardia >100bpm
6) SBP >180mmHg, DBP >100mmHg,
7) Symptomatic hypotension

Question 3

What is the purpose of risk stratification? What is the main criterion that will increase a persons risk?

Answer 3

Risk stratification identifies the risk of a patient have a further cardiac event of incident during an exercise session

1) Extensive myocardial damage
2) Poor LV lumping capacity
3) Residual Ischaemia
4) Ventricular arrhythmias on exercise

Question 4

What action would you take with someone that is experiencing chest pain during exercise? And how would you action change if you suspected an MI?

Answer 4

1) Stop activity, sit down and rest
2) In no immediate relief take GTN spray/tablets
3) Repeat at 5-min intervals up to a max of 2 doses
4) If no relief dial 999
5) If symptoms relieved, rest for 5 mins then rewarm resuming exercise

Question 5

What are the characteristics that make angina unstable?

Answer 5

1) New onset angina - considered unstable for 1 months
2) Angina at rest - no pattern
3) Increases in angina indicating a change in previous pattern
- Increased frequency
- Increased severity
- Occurrence at lower levels of exertion

Question 6

How do you recognise that someone is experiencing angina?

Answer 6

1) Tightness in chest - burning or dull sensation
2) Pain or heavy feeling in left arm - both might be affected
3) Pain/discomfort in throat, abdomen, back
4) Breathlessness on exertion which may occur independently of other symptoms
5) Fatigue

Question 7

What is the possible signs and symptoms of MI?

Answer 7

Intense pain possibly radiating to throat or down both arms. Described as ‘band like’ ‘crushing’ ‘squeezing’.
To:
Relatively mild discomfort - similar to indigestion
- Discomfort in the arm (s) and possibly throat.
- Discomfort in the back of abdomen

Additionally:
Breathlessness
Nausea/vomiting
Pale, cold, clammy skin 
Agitation and fear of impending doom 
Weakness and sometimes collapse