What, how much, and whom should I monitor and Stress Testing

Question 1

When can one not use the Max HR formulas for a patient?

Answer 1

When they’re on specific meds (Beta blockers for instance) that control HR.

Question 2

What is the best way to get someone’s maximum HR?

Answer 2

symptom-limited max exercise test

Question 3

What is a normal HR response to increasing METs?

Answer 3

Increase of 8-12 bpm/MET

Question 4

What is a normal BP response to increasing MET’s?

Answer 4

Rise approx. 8-12 mmHg/MET

Question 5

Is HR greater during static or dynamic work?

Is BP greater during static or dynamic work?

Answer 5

HR: dynamic
BP: static

Question 6

What is the maximum the diastolic BP should rise during exercise?

Answer 6

should rise <10 mmHg, but increase should be only during heavy resistance activity.

Question 7

What is Stage 1 Htn? What should you do if you find a pt with this?

Answer 7

140-159/90-99. Call MD to discuss patient before the patient’s next visit. Continue to monitor this visit. If symptoms, call MD depending on symptoms.

Question 8

What is Stage 2 Htn? What should you do if you find a pt with this?

Answer 8

160-179/100-109. Call MD this visit before treating patient.

Question 9

What is Stage 3 Htn? What should you do if you find a pt with this?

Answer 9

Call MD STAT and ask if they know that their patient BP is extremely elevated (and where they would like you to send the pt, office or ER)

Question 10

Explain a talk test.

Answer 10

During exercise, if pt. can…
sing = mild exercise
talk, not sing = moderate exercise
not sing nor talk = vigorous exercise

Question 11

How do you perform a ventilatory Response Index and what should be a normal response?

Answer 11

Pt counts to 15
Should take 7.5-8 seconds
Count # of breaths pt takes
Do pre and post exercise

Question 12

Compliance to an exercise program in the elderly beyond 1 year.

Answer 12

30%

Question 13

What are 3 essential components of the pre-stress test eval?

Answer 13

Pt hx
Cardiac Screening (BP, RR, HR, maybe auscultation, observation)
Informed Consent

Question 14

When do you terminate the stress test?

Answer 14

When they ask for it.

or when serious symptoms develop

Question 15

Absolute or Relative Contraindication to Exercise Testing:

1. Left main coronary stenosis
2. Ventricular aneurysm
3. Suspected or known dissecting aneurysm
4. High degree AV block
5. Symptomatic severe aortic stenosis
6. Uncontrolled metabolic disease
7. Severe arterial Htn at rest

Answer 15

1. R
2. R
3. A
4. R
5. A
6. R
7. R

Question 16

Absolute or Relative Contraindication to Exercise Testing:

1. Unstable angina
2. Chronic infectious disease
3. Mental or physical impairment leading to inability to exercise adequately.
4. Acute myocarditis or pericarditis
5. Tachydysrhythmia or bradydysrhythmia
6. Electrolyte abnormalities
7. Uncontrolled symptomatic heart failure

Answer 16

1. A
2. R
3. R
4. A
5. R
6. R
7. A

Question 17

Absolute or Relative Contraindication to Exercise Testing:

1. Acute PE or pulmonary infarction
2. Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
3. A recent significant change in ECG suggesting significant ischemia, recent MI, or other acute cardiac event
4. Neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
5. Acute systemic infection accompanied by fever, body aches, or swollen lymph glands.
6. Hypertophic cardiomyopathy and other forms of outflow tract obstruction
7. Moderate stenotic valvular heart disease

Answer 17

1. A
2. A
3. A
4. R
5. A
6. R
7. R

Question 18

Absolute or Relative Indication to Terminating Exercise Testing:

1. Drop in SBP of >10 mmHg from baseline BP despite an increase in workload when accompanied by other evidence of ischemia
2. Drop in systolic BP of >10 mmHg from baseline BP despite an increase in workload in the absence of other evidence of ischemia
3. Increasing chest pain
4. Hypertensive response (sBP of >250 mmHg and/or dBP of >115 mmHg
5. Fatigue, SOB, wheezing, leg cramps, or claudication
6. Sustained ventricular tachycardia
7. Subject’s desire to stop

Answer 18

1. A
2. R
3. R
4. R
5. R
6. A
7. A

Question 19

Absolute or Relative Indication to Terminating Exercise Testing:

1. Development of BBB or intraventricular conduction delay that cannot be distinguished from v-tach.
2. Sustained v-tach
3. ST elevation (+1.0 mm) in leads without diagnostic Q-waves
4. Arrythmias other than sustained v-tach
5. Signs of poor perfusion
6. ST or QRS changes such as excessive ST depression or marked axis shift
7. Moderately severe angina
8. Technical difficulties monitoring the ECG or systolic BP

Answer 19

1. R
2. A
3. A
4. R
5. A
6. R
7. A
8. A