stress testing

Question 1

was first described in
1772 by the English physician
William Heberden

Answer 1

Angina

Question 2

Angina was first described in
___ by the English physician
William Heberden

Answer 2

1772

Question 3

Angina was first described in
1772 by the English physician
___

Answer 3

William Heberden

Question 4

The “cornerstone” of modern stress testing
was the recognition of the importance of
____ to predict the
presence of coronary artery disease
(CAD)

Answer 4

ST segment changes

Question 5

stress testing is used to detect what disease?

Answer 5

coronary artery disease or CAD

Question 6

___ST depression first noted during angina (Bousfield)

Answer 6

1918

Question 7

a graphic recording of the electrical activity of the heart

Answer 7

ECG

Question 8

REPRESENT VENTRICULAR DEPOLARIZATION

Answer 8

QRS complex

Question 9

REPRESENTS VENTRICULAR REPOLARIZATION

Answer 9

t wave

Question 10

REPRESENTS TOTAL TIME REQUIRED FOR VENTRICULAR DEPOLARIZATION AND REPOLARIZATION

Answer 10

QT interval

Question 11

YEAR WHEN IRISH SCIENTIST MAREY ANALYZES THE ELECTRIC PATTERN OF A FROGS HEART

Answer 11

1876

Question 12

HE INCREASED WILSON’S UNIPOLAR LEAD VOLTAGE BY 50% AND MADE AUGMENTED LEADS

Answer 12

goldberger

Question 13

THE NOBLE PRIZE FOR PHYSIOLOGY WAS GIVEN TO HIM FOR HIS WORK ON EKG

Answer 13

einthoven

Question 14

CORRECT ABOUT 6 CHEST LEADS

Answer 14

I,III,IV
‌I-V1, III- V4, IV-V6

Question 15

QRS COMPLEX

Answer 15

E no answer

Question 16

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

Answer 16

1928

Question 17

Master’s Step test, first “standard” exercise protocol (Master)

Answer 17

1929

Question 18

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

Answer 18

1932

Question 19

First to use maximal exercise testing to test for CAD (Missal)

Answer 19

1938

Question 20

Continuous EKG monitoring, depression > 1.0 mm is clinically
significant (Riseman et al.)

Answer 20

1940

Question 21

EKG changes after exercise can be useful to detect CAD (Master
& Jaffe)

Answer 21

1941

Question 22

The Harvard Step Test used to assess fitness from HR during
recovery (Johnson et al.)

Answer 22

1942

Question 23

Maximal exercise (stair climbing) was more sensitive (88%) to
detect CAD than submaximal exercise (39%) (Master’s test) (Wood et al

Answer 23

1950

Question 24

Treadmill testing used with set criteria to screen for CAD (Yu et al.)
ST depression > 1.0 mm

Answer 24

1952

Question 25

Cycle tests used to predict fitness (Astrand)

Answer 25

1954

Question 26

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

Answer 26

1956

Question 27

Refined interpretation of ST changes (V5 or CM5 most sensitive leads) (Blackburn et al.)

Answer 27

1969

Question 28

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

Answer 28

Bayes Theorem (1970s and 1980s)

Question 29

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

Answer 29

stress testing

Question 30

3 type of stress testing

Answer 30

exercise pharmacologic nuclear

Question 31

exercise stress testing are

Answer 31

treadmill and bicycle

Question 32

pharmacologic st are

Answer 32

A. Regadenoson B. Dobutamine C. Persantine D. Adenosine

Question 33

shows how your heart works during physical activity.

Answer 33

exrcise st

Question 34

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

Answer 34

exercise st

Question 35

indications of st only have 3 - DDG

Answer 35

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

Question 36

risk for ST we have 3 as well - LAH

Answer 36

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

Question 37

Contraindications

Answer 37

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

Question 38

Safety Precautions and Equipment

Answer 38

́The treadmill should have Front and side rails for subjects to steady themselves. ́ An emergency stop button should be readily available to the staff only.

Question 39

Pre –Test Preparation

Answer 39

́ 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.

Question 40

Preparation for Exercise Testing

Answer 40

́ 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.

Question 41

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

Answer 41

Treadmill Test ́

Question 42

Exercise Protocols

Answer 42

In general, 6 to 12 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. ́ The protocol should include a suitable recovery or cool-down period.

Question 43

Various Protocols FOR TREADMILL

Answer 43

a. Bruce b. Cornell c. Balke ware d. Acip e. mAcip f. Naughton g. Weber

Question 44

another protocol aside the treadmill protocol

Answer 44

Bicycle ergometer

Question 45

The ___ multistage maximal treadmill protocol has 3-minute periods to allow achievement of a steady state before work-load is increased for next stage

Answer 45

Bruce protocol

Question 46

Termination of Exercise Testing

Answer 46

́ 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

Question 47

Positive test

Answer 47

A flat or down sloping depression of the ST segment > 0.1 mV below baseline

Question 48

Negative test

Answer 48

Target heart rate is not achieved

Question 49

Limitations of Treadmill Stress Test

Answer 49

́ Sensitivity- 68% ́ Specificity- 77 %

Question 50

2 ways in Pharmacological Stress Test

Answer 50

1. Vasodilators 2. B2 agonist

Question 51

example of vasodilators

Answer 51

Adenosine and Dipyridamole

Question 52

example of b2 agonist

Answer 52

Dobutamine

Question 53

INDICATIONS OF PHARMACOLOGICAL STRESS TESTING

Answer 53

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

Question 54

how Nuclear Stress Test is conducted

Answer 54

A radiotracer (Tc-99 sestamibi or thallium) is injected

Question 55

what is used in nulear testing

Answer 55

radiotracer

Question 56

example of radiotracer

Answer 56

Tc-99 sestamibi or thallium

Question 57

nuclear testing, Scans are acquired with a ___ to capture images of the blood flow.

Answer 57

gamma camera

Question 58

how many days is the nuclear testing done

Answer 58

2 separate days