What are the three most common types of exercise electrocardiography?
treadmill testing, cycle or arm-ergometry
What is a noninvasive procedure?
it does not require entrance into a body cavity, tissue, or blood vessel
When do you record the patient's blood pressure and ECG tracing?
Before starting and after each stage of exercise
What is the main responsibility of a healthcare professional during a stress test?
Provide for safety, prepare the patient prior to procedure, attach electrodes properly, instruct the patient to report symptoms, and monitor the patient (ECG and Blood Pressure)
What is CVD?
Coronary vascular disease is the narrowing of the coronary blood vessels causing a reduction in the blood flow to the heart. Usually due to atherosclerosis (plaque in the blood vessels from excess fat)
Why is exercise electrocardiography used?
it evaluates how the heart and blood vessels respond to physical activity
What is the myocardium?
the muscle of the heart
What is proof of CVD?
blood flow won't increase in response to the exercise
What is proof of myocardial ischemia?
the ST segment will be depressed on the ECG tracing
What is angina?
chest pain, the heart muscle is not receiving enough oxygen due to blockage
What are the common symptoms of exercise ECGs?
angina, weakness, shortness of breath, palpitations, and dizziness
What are the uses for exercise electrocardiography?
helps diagnose chest pain, determines functional capacity of the heart, screens for heart disease, helps set limitations, identifies cause of abnormal heart rhythms, and evaluates effectiveness of heart meds
What is a chemical stress test?
performed by administering meds that cause the heart rate to increase or the coronary blood vessels to dilate
What is a cardiologist?
a physician who specializes in the study of the heart
What is a radiologist?
a physician who specializes in the use of radioactive substances to diagnose and treat disease
What are common stressing chemicals?
adenosine, Persantine, dobutamine, or Lexiscan
What is a nuclear stress test?
a stress test which radionuclides (radioactive tracers) are administered to trace the path of blood through the heart
What is the function of a gamma camera?
to record the gamma radiation emitted by the radioactive tracers in a patient's blood
What does it mean to gate a study?
triggering the camera to record at specific points during the cardiac cycle
How do you minimize false positives caused by stress induced ischemia?
scan the patient 3-24hrs after stressing to provide a resting image series
How long can scan time take?
15mins to 1hr
What two factors affect testing procedures?
the female breast causes imaging defects
the patient's diet
What is an echocardiogram?
it uses sound to study the heart, its valves, and the major blood vessels around the heart
What is a stress echocardiogram?
a combination of an exercise stress test and chemical stress test with an echocardiogram to assess left ventricular wall motion
What is a sign for ischemia in an echocardiogram?
a change in left ventricular wall shape or contractility with exercise
What are the three phases of stress echocardiogram studies?
resting, immediate postexercise, and recovery scan
What is the percentage target before the patient can stop exercising on the treadmill?
85-100%
What is a chemical stress echocardiogram?
the heart is stressed by chemicals and not physical exercise
What are common instructions for a patient prior to having an exercise ECG study?
explain the procedure
no tobacco, alcohol, or caffeine 3 hrs prior
no eating 2 hrs prior
wear comfy clothes
check meds
the test takes 45mins to 3 hrs
What does a beta blocker do?
it treats hypertension
Why does the patient need an informed consent signed?
there is possible risk or complications that could occur
What are some ways to provide safety for the patient?
have a physician present, have a crash cart nearby, and the monitor the patient at all times
Describe hypertension?
high blood pressure
What is CHF?
Congestive heart failure is when the heart doesn't pump enough blood to the body tissues
What are health conditions which hinder a patient from doing exercise electrocardiography?
a change in resting ECG, abnormal heart rhythms, recent MI, inflammation of the heart, hypertension, CHF, and emotional stress
What is hyperventilation?
breathing at an increased rate and depth inspiration and expiration
What is a skin rasp?
a rough piece of material used to abrade the skin prior to electrode placement
Describe the Mason-Likar attachment method.
12-lead ECG placement with limb leads to upper chest and torso
Common protocols
2-3 minute stages
length of time
incline of treadmill
Bruce protocol
most common
uses 3min stages
Modified Bruce protocol
used in older people or others with limited exercise capabilities
uses 3min stages
Naughton protocol
for sicker patients
gradual increase in intensity
speed at 2mph
uses 2min stages
What is considered the THR?
the target heart rate is 220 minus the patient's age multiplied by 60-85%
THR= 220-PA x 60-85%
often referred to as submaximal exercise
What is maximal exercise?
THR= 220-PA
What is the RPP?
the rate pressure product (double product) is systolic blood pressure multiplied by the heart rate
SYS BP x HR = RPP
What two factors determine the workload of the heart?
heart rate and systolic blood pressure
After exercise electrocardiography, what are the instructions for the patient?
rest for several hours
avoid extreme temps
avoid stimulants for at least 3hrs
don't take showers or baths at least 2hrs
What is a false positive?
a diagnostic test that indicates disease is present but no disease is present in reality.