STRESS Flashcards by Loui Mojica

first
described in 1772 by
the English physician
William Heberden

Angina

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Angina was first
described in 1772 by
the English physician

William heberden

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Angina was first
described in__________ by
the English physician
William Heberden.

1772

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The “______________” of
modern stress testing was
the recognition of the
importance of ST segment
changes to predict the
presence of coronary
artery disease (CAD)

cornerstone

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is the flat, isoelectric section of the
ECG between the end of the S wave (the J point) and
the beginning of the T wave.

ST segment

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represents the interval between ventricular
depolarization and repolarization.
.

ELECTROCARDIOGRAM (ECG )

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occurs when the J point is displaced below
baseline.

ST depression

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≥1 mm ST-segment depression 60 to 80 ms from I point - positive stress test

Horizontal

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≥1 mm
ST-segment depression 60 to 80 ms from I point
- positive stress test

Downsloping

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≥1 mm
ST-segment depression 60 to 80 ms from I point
- nonspecific stress test

Upsloping

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ST depression first noted during angina

Bousfield 1918

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ST changes during exercise (sit ups) are associated with
chest pain & decreased cardiac blood flow

Feil and siegel 1928

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________________, first “standard” exercise protocol
(Master)

Master’s Step test 1929

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ST depression is present in only 75% of patients with angina
during exercise (similar to percentages today)

Goldhammer & Scherf 1932

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First to use maximal exercise testing to test for CAD

Missal 1938

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Continuous EKG monitoring, depression > 1.0 mm is
clinically significant

Riseman et al. 1940

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EKG changes after exercise can be useful to detect
CAD

Master and jaffe 1941

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The Harvard Step Test used to assess fitness from
HR during recovery

Johnson et al. 1942

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Maximal exercise (stair climbing) was more sensitive
(88%) to detect CAD than submaximal exercise (39%)

Master test and wood et al. 1950

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used with set criteria to screen for
CAD (Yu et al.) ST depression > 1.0 mm
Change in T wave (upright - inverted)
Increase T wave amplitude & Q-T duration

Treadmill testing 1952

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Cycle tests used to predict fitness

Astrad 1954

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established the guidelines used today: treadmill,
with EKG, during exercise

Bruce 1956

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Refined interpretation of ST changes (V5 or CM5 most
sensitive leads)

Blackburn et al. 1969

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the father of the treadmill exercise
stress test, died on February 12, 2004
when he was 87 years of age.

Dr. Robert A. Bruce

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Dr. Robert A. Bruce the father of the treadmill exercise stress test, died on ______________ when he was 87 years of age.

February 12, 2004

Dr. Robert A. Bruce the father of the treadmill exercise stress test, died on February 12, 2004 when he was________ years of age.

87 yrs old

used improvements in both EKG's and treadmills to perfect his new procedure.

Dr. Bruce

His first studies, published in 1949, analyzed minute-to-minute changes in respiratory and circulatory function of normal adults who took a single-stage treadmill test. He then published a paper describing a multistage test in 1963

Dr. Bruce

Named after 18th-century British mathematician Thomas Bayes, is a mathematical formula for determining conditional probability

Bayes theorem

Conditional probability is the likelihood of an outcome occurring, based on a previous outcome having occurred in similar circumstances

Bayes theorem

Stated The probability of a “true” positive stress test depends on the pre-test risk of the patient

Bayes theorem

Test used in Medicine to measure heart’s ability to respond to external stress in a controlled clinical environment

STRESS TESTING

A stress test is a very commonly performed test to learn:

a) How heart pumps blood. b) Whether heart is receiving blood supply. c) How perform physical activity (riding a treadmill or stationary bike) compared with other people your age and sex. d) If your symptoms (chest discomfort, shortness of breath, feeling like your heart is racing or even dizziness) can be reproduced while performing physical activity.

Stress test makes it easier to identify and evaluate certain heart issues, such as:

1. Issue muscle or valves 2. Blood supply to heart 3. Electric stability of heart during exercise

Healthcare providers assess your response to the increased workload by measuring:

1. Blood pressure. 2. Heart rate. 3. Oxygen levels. 4. Electrical activity in your heart. 5. How hard your heart is working compared with others your age and sex

used when there are problems interpreting the EKG

Exercise stress test with imaging

Used of treadmill or bike

Regular exercise stress test

Example of exercise stress test with imaging

-with echocardiogram --with nuclear imaging

for the person who cannot safely exercise to the level needed

Chemical stress test

This is the most common and basic heart stress test

Exercise stress test

Shows how your heart works during physical activity

Exercise stress test

It usually involves walking on a treadmill or riding a stationary bike

Exercise stress test

is done when an exercise stress test is not possible due to physical limitations like back trouble, joint disease, prior stroke, dizziness or shortness of breath.

Pharmacological stress test

uses a medication that increases your heart load in the place of exercise.

Chemical or pharmacological stress test

INDICATIONS OF PHARMACOLOGICAL STRESS TESTING

- Patients inability to exercise adequately. - The chosen test cannot be performed readily with exercise.

also called a myocardial perfusion scan, is a type of nuclear medicine procedure.

Nuclear stress test

Usually done on two separate days.

Nuclear stress test

Scans are acquired with a gamma camera to capture images of the blood flow

Nuclear stress test

A nuclear stress test, also called

Myocardial perfusion scan

(Tc-99 sestamibi or thallium) is injected

Radiotracer

Radiotracer example

Thallium

You may need this test to detect heart problems like:

• Congenital heart disease. • Congestive heart failure. • Coronary artery disease. • Heart valve disease. • Hypertrophic cardiomyopathy. • People with high-risk occupations (like pilots or professional athletes) may also need stress tests.

Indications of Exercise Testing

• Diagnose coronary artery disease. • Diagnose heart rhythm problems (arrhythmias). • Guide treatment of heart disorders.

Possible Risks

• Low blood pressure • Abnormal heart rhythms (arrhythmias). • Heart attack (myocardial infarction).

Contraindications

• Acute M.I • High risk of unstable angina • Uncontrolled cardiac arrthymias • Symptomatic severe aortic stenosis ́Pulmonary infarction • Acute myocarditis • Acute aortic dissection

Safety Precautions and Equipment: should have Front and side rails for subjects to steady themselves.

Treadmill

Safety Precautions and Equipment: should be readily available to the staff only

Emergency stop button

Pre –Test Preparation

• Any history of light headedness, fainting while exercising should be asked. • The physician should also ask about family history and general medical history, making note of any considerations that may increase the risk of sudden death. • A brief physical examination should always be performed prior to testing to rule out significant outflow obstruction.

Preparation for Exercise Testing

• The subject should be instructed not to eat or smoke at least 2 hours prior to the test. • Unusual physical exertion should be avoided before testing. • Specific questioning should determine which drugs are being taken. • Because of a greater potential for cardiac events with the sudden cessation of -blockers , they should not be automatically stopped prior to testing.

It usually involves walking on a treadmill at increasing levels of difficulty, while electrocardiogram, heart rate, and blood pressure are monitored.

Treasmill test

In general, ____ to ______minutes of continuous progressive exercise during which the myocardial oxygen demand is elevated to the patient's maximal level is optimal for diagnostic and prognostic purposes.

6 to 12 mins

The Bruce multistage maximal treadmill protocol has ____-minute periods to allow achievement of a steady state before work-load is increased for next stage.

3 mins

was designed by cardiologist Robert A. Bruce in 1963 as a non-invasive test to assess patients with suspected heart disease.

Bruce protocol treadmill test

Bruce protocol In this capacity, is perhaps more widely known as

stress test or exercise tolerance test

Termination of Exercise Testing

• Moderate to severe chest pain • Severe shortness of breath • Abnormally high or low blood pressure • An abnormal heart rhythm • Dizziness • Fatigue • Certain changes in your electrocardiogram

Termination of Exercise Testing: A flat or down sloping depression of the ST segment > 0.1 mV below baseline

Positive test

Termination of Exercise Testing: Target heart rate is not achieved .

Negative test

Limitations of Treadmill Stress Test • Sensitivity- • Specificity- 77 %

68%

Limitations of Treadmill Stress Test • Sensitivity- 68% • Specificity-

77 %

Responsibilities of a Cardiology Technologist during Exercise Stress Tests

• Ensure the patient has signed all relevant forms, followed preparation guidelines, and that their medical history was provided. • Ensure the patient exercises for as long as possible in order to get a complete and accurate reading. • Make sure the patient knows that they should speak up if they experience any chest or arm pains, dizziness or other unusual symptoms. • Monitor the ECG continuously and be prepared to stop the test immediately if any anything warning signs appear.

STRESS Flashcards

(70 cards)