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CPFT/RPFT Review > Exercise Testing > Flashcards

Exercise Testing Flashcards

1
Q

Indications for exercise testing

A
  1. Chief c/o DOE
  2. Determine ventilators limitations to work
  3. Determine cardiac limitations to work
  4. Determine maximum workloads for developing an exercise plan or adjusting daily activities
  5. For disability purposes
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2
Q

Normal BMI

A

19 - 25

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3
Q

Steady-state method

A

Primarily used for pulmonary patients
1. Patient exercised at sub-maximal level for 5-8 minutes
2. Workload is 50-75% of max HR (220-age)
3. Once target reached, timer begins
4. Measurements made during final 1-2 minutes of test

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4
Q

Multistage method

A

Used to determine max tolerable workload
Primarily used for cardiac patients
1. Workloads are increased at predetermined levels and measurements are made at the end of each stage
2. Stages change every 1-6 minutes (most common= Q3min)
3. A steady state of ventilation and gas exchange is not achieved

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5
Q

Typical workload setting

A

10-15 watts/min to reach 100-150 watts in 10 minutes

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6
Q

Workload intensity

A

<50 watts = Low
50-100 watts = Medium
100-200 watts = High
>200 watts = Too high for stress testing

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7
Q

To determine treadmill incline

A

Slope = Rise/Run
Example: 3 inch rise / 30 inch run = 10% slope

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8
Q

Define: workload

A

The amount of energy being generated by the patient during testing
Normally measured in kilopond-meters (kpm)

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9
Q

Define: power

A

The amount of work per minute (kpm/min)
Normally measured in watts

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10
Q

Define metabolic equivalents (METS)

A

Unit of measure to determine oxygen consumption per kg of body weight
1 MET = 3.5 mL O2/min/kg (normal value at rest)

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11
Q

To calculate energy expenditure at a given workload

A

(VO2 / weight in kg) / 3.5 = METS performed

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12
Q

Define: anaerobic threshold (AT)

A

The level of exercise or oxygen consumption at which anaerobic metabolism will begin to supplement aerobic metabolism

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13
Q

Changes at AT

A
  1. Blood lactate levels will increase and metabolic acidosis will occur
  2. Exhaled minute ventilation will continue to increase, primarily by increasing RR instead of Vt
  3. RER/RQ will increase above 1.0
  4. VCO2 will rise above VO2
  5. HR remains stable
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14
Q

RER can increase outside of exercise by…

A

Eating a large meal or hypoventilation

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15
Q

Define: O2 max

A

A point where work continues to increase but VO2 does not
Usually higher when treadmill is used vs cycle ergometer, unless the patient supports part of their weight on the handrails

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16
Q

Stress testing without gas analysis

A
  1. Typically uses a ramp or multistage protocol
  2. Patient is exercised until max HR is achieved or adverse symptoms develop
  3. HR & BP monitored throughout testing
  4. Patient should be able to speak in short sentences during testing
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17
Q

Stress testing with gas analysis

A
  1. Typically uses a steady-state method
  2. Patient exercises at sub-maximal level for 5-8 minutes
  3. ECG, HR, BP and ventilation are monitored
  4. Exhaled gas is collected
    A. Near the end of each stage
    B. In the final 1-2 minutes after 4-6 minutes of constant workload
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18
Q

Gas analysis measurements

A
  1. Total exhaled volume
  2. Gas temperature
  3. Time of collection
  4. RR
  5. Fraction of mixed expired O2 (FEO2)
  6. Fraction of mixed expired CO2 (FECO2)
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19
Q

Gas analysis calculations

A
  1. MV
  2. Vt
  3. RR
  4. O2 consumption
  5. CO2 production
  6. RER
  7. Ventilatory equivalent for O2 (VE/VO2)
  8. Ventilatory equivalent for CO2 (VE/VCO2)
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20
Q

Stress testing with gas analysis and ABG

A

Indicated for patients with primarily pulmonary problems
ABGs are performed at the same time as gas analysis

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21
Q

Additional measurements made with ABGs during stress testing

A
  1. Physiologic dead space
  2. Alveolar ventilation
  3. VD/Vt ratio
  4. CO
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22
Q

Bruce protocol

A

Common cardiac stress testing protocol
Workload is increased every 3 minutes
“Modified” Bruce protocol is slower and often used for pulmonary stress testing

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23
Q

Estimating HR on ECG

A

Measure distance between two R waves:
300 / # large boxes (normal = 3-5 boxes)
1500 / # small boxes

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24
Q

1st degree heart block

A

PR interval > 0.2 (5 small squares)
Treatment = atropine

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25
2nd degree heart block
Normal P waves but some QRS waves are missing Treatment = atropine or pacemaker
26
3rd degree heart block
P waves and QRS waves are entirely unlinked (P rate 60, QRS rate 40) Treatment = pacemaker
27
Cardiac ischemia on ECG
Depressed or inverted T wave
28
Cardiac injury on ECG
Elevated ST segment
29
Cardiac infarction on ECG
Large, downward Q waves Doesn’t revert after acute MI with infarction
30
Normal response to stress testing
1. HR increases linearly 2. High HR with minimal exertion and no ECG changes = deconditioning 3. ST segment changes should be closely monitored - consider stopping testing 4. PVCs are common - more than 10/min (1 per screen) may mean ischemia 5. Increased systolic (may double) and diastolic (10-20pts) BP is normal A. If systolic doesn’t increase or diastolic falls rapidly stop the test (CO is not increasing appropriately) 6. RR, Vt and MV increase 7. VCO2 and VO2 will increase together to maintain RER near 0.8 8. pH increases initially then decreases once AT is reached 9. VD/VT will decrease due to increased pulmonary perfusion 10. PAP remains constant as pulmonary vessels dilate A. Increased PAP indicates ventilatory limitation due to lung or vascular disease
31
ATPS vs BTPS
On the exam, calculate for ATPS then choose the answer that’s slightly higher for BTPS
32
Normal minute ventilation
Normal = 5-10L/min at rest Exercise = 100-200 L/min
33
Estimated maximum minute ventilation
FEV1 x 35 Normal subjects should be able to reach at least 70% of their max MV If max MV is reached, this indicates primary ventilatory limitation to exercise
34
Normal oxygen consumption/uptake (VO2)
0.25 L/min at rest Up to 4L/min with exercise Best indication of workload
35
Alveolar MV
(VT - VD) x f
36
Estimated VD
1mL/lb body weight
37
Normal carbon dioxide production (VCO2)
0.2L/min at rest Up to 4L/min with exercise Indicates metabolic status FECO2 x MV = VCO2
38
Respiratory Exchange Ratio (RER)
The ratio of VO2 to VCO2 at the mouth RER = VCO2 / VO2
39
Ventilatory Equivalent for Oxygen (VE/VO2)
Relationship of MV to O2 consumption
40
Calculation for MV
MV = (total vol x 60) / time in sec
41
Normal VE/VO2
20-30 at rest and low to moderate workloads A high VE/VO2 at rest is caused by hyperventilation An increase in VE out of proportion to VO2 results from pulmonary disease
42
Ventilatory equivalent for CO2 (VE/VCO2)
The relationship of VE to CO2 produced
43
Normal VE/VCO2
25-35
44
SpO2
Should remain fairly constant during exercise Decreased SpO2 indicates Ventilatory limitation due to diffuse pulmonary fibrosis Stop testing if SpO2 is <85%
45
O2 Pulse
(VO2 / HR) x 1000 Volume of O2 consumed per heartbeat Low O2 pulse that doesn’t increase appropriately with high HR indicates cardiac disease and low SV When VO2 plateaus at the end of the test (AT), the O2 pulse will decrease with increased HR
46
Normal O2 pulse
2.5-4 at rest 10-15 with exercise
47
Normal P(A-a)O2
At rest: 10-20 on RA, less than 100 on 100% FIO2 With exercise: 20-30 Increased P(A-a)O2 plus decreased PaO2 may be caused by R->L shunt, V/Q mismatch, or diffusion defect
48
PaCO2 / ETCO2
A.K.A. VD / VT ratio Reflects the amount of wasted ventilation (ventilation w/o perfusion) At moderate workloads PaCO2 is constant and ETCO2 rises At AT, metabolic acidosis occurs and MV increases, so PaCO2 decreases
49
Normal VD/VT
0.2-0.4 at rest, lower with exercise
50
Mean Arterial Pressure (MAP)
MAP = ((2 x diastolic) + systolic) / 3
51
Normal CVP
2-6 mmHg Monitors the systemic venous return and right heart function
52
Normal PAP
25/8 mmHg Monitors blood moving into the lungs
53
Troubleshooting PAP
PAP remains constant during CPET because of dilation of pulmonary vessels The balloon must be deflated when drawing a mixed venous blood sample
54
Normal PCWP
8mmHg Monitors blood moving into the left heart The balloon must be inflated to measure
55
Cardiopulmonary pressures
CVP = right heart PAP = lungs PCWP = left heart
56
Normal cardiac output (QT)
4-8 L/min Cardiac index (CI) is QT / BSA. Normal CI is 2.5-4 L/min
57
Normal systemic vascular resistance (SVR)
<1600 dynes
58
Normal pulmonary vascular resistance
<200 dynes
59
Limitations to exercise
Ventilatory Cardiac Deconditioning Poor effort
60
Events that indicate ventilatory limitation
At low to moderate workload: -Max MV -Ve/VO2 > 30 -Decreased SpO2 -Respiratory acidosis -Increased PAP -Increased RER -Normal ECG and HR
61
Events that indicate cardiac limitation
At low to moderate workload: -Significant ECG changes -Systolic BP doesn’t rise -Diastolic BP falls -O2 pulse decreases -VT, RR and MV < 70% of MVV
62
Indications of deconditioning
At low to moderate workload: -Increased HR -Normal ECG -VT, RR and MV < 70% of MVV
63
Indications of poor effort
At low to moderate workload: -ECG, HR & SpO2 are normal -AT not achieved -VT, RR and MV < 70% of MVV
64
FVL during CPET
Normal - IRV & ERV will decrease to allow increased VT Chronic lung disease - only IRV will decrease to allow increased VT

CPFT/RPFT Review (6 decks)

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