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SPDX > stress testing > Flashcards

stress testing Flashcards

1
Q

was first described in
1772 by the English physician
William Heberden

A

Angina

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2
Q

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

A

1772

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3
Q

Angina was first described in
1772 by the English physician
___

A

William Heberden

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4
Q

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

A

ST segment changes

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5
Q

stress testing is used to detect what disease?

A

coronary artery disease or CAD

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6
Q

___ST depression first noted during angina (Bousfield)

A

1918

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7
Q

a graphic recording of the electrical activity of the heart

A

ECG

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8
Q

REPRESENT VENTRICULAR DEPOLARIZATION

A

QRS complex

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9
Q

REPRESENTS VENTRICULAR REPOLARIZATION

A

t wave

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10
Q

REPRESENTS TOTAL TIME REQUIRED FOR VENTRICULAR DEPOLARIZATION AND REPOLARIZATION

A

QT interval

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11
Q

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

A

1876

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12
Q

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

A

goldberger

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13
Q

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

A

einthoven

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14
Q

CORRECT ABOUT 6 CHEST LEADS

A

I,III,IV
‌I-V1, III- V4, IV-V6

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15
Q

QRS COMPLEX

A

E no answer

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16
Q

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

A

1928

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17
Q

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

A

1929

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18
Q

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

A

1932

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19
Q

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

A

1938

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20
Q

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

A

1940

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21
Q

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

A

1941

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22
Q

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

A

1942

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23
Q

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

A

1950

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24
Q

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

A

1952

25
Q

Cycle tests used to predict fitness (Astrand)

A

1954

26
Q

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

A

1956

27
Q

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

A

1969

28
Q

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

A

Bayes Theorem (1970s and 1980s)

29
Q

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

A

stress testing

30
Q

3 type of stress testing

A

exercise
pharmacologic
nuclear

31
Q

exercise stress testing are

A

treadmill and bicycle

32
Q

pharmacologic st are

A

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

33
Q

shows how your heart works during physical activity.

A

exrcise st

34
Q

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

A

exercise st

35
Q

indications of st

only have 3 - DDG

A

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

36
Q

risk for ST
we have 3 as well - LAH

A

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

37
Q

Contraindications

A

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

38
Q

Safety Precautions and Equipment

A

́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.

39
Q

Pre –Test Preparation

A

́ 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.

40
Q

Preparation for Exercise Testing

A

́ 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.

41
Q

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

A

Treadmill Test
́

42
Q

Exercise Protocols

A

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.

43
Q

Various Protocols FOR TREADMILL

A

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

44
Q

another protocol aside the treadmill protocol

A

Bicycle ergometer

45
Q

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

A

Bruce protocol

46
Q

Termination of Exercise Testing

A

́ 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

47
Q

Positive test

A

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

48
Q

Negative test

A

Target heart rate is not achieved

49
Q

Limitations of Treadmill Stress Test

A

́ Sensitivity- 68%
́ Specificity- 77 %

50
Q

2 ways in Pharmacological Stress Test

A
  1. Vasodilators
  2. B2 agonist
51
Q

example of vasodilators

A

Adenosine and Dipyridamole

52
Q

example of b2 agonist

A

Dobutamine

53
Q

INDICATIONS OF PHARMACOLOGICAL
STRESS TESTING

A

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

54
Q

how Nuclear Stress Test is conducted

A

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

55
Q

what is used in nulear testing

A

radiotracer

56
Q

example of radiotracer

A

Tc-99 sestamibi or thallium

57
Q

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

A

gamma
camera

58
Q

how many days is the nuclear testing done

A

2 separate days

59
Q
A

SPDX (5 decks)

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