Final Exam
Normal QRS width
0.08-0.10 seconds or 2 to 2.5 mm
Normal PR interval
0.12-0.20 seconds or 3 to 5 mm
One small box on EKG paper represents:
1 mm or 0.04 seconds or 40 milliseconds
Identify five modifications of the exercise prescription to encourage return to work.
1. Emphasize exercises that use muscle groups involved in work tasks 2. Use exercises to mimic movement patterns in work tasks 3. Balance resistance vs. aerobic training relative to work tasks 4. If environmental stress occurs at work, educate the patient about appropriate precautions including avoidance if need be 5. Monitor the physiologic response to a simulated work environment
Describe the FITT recommendation for inpatient cardiac rehabilitation.
1. Frequency: Mobilization: two to four times per day for the first 3 d of the hospital stay. 2. Intensity: Seated or standing resting heart rate (HRrest) +20 beats ∙ min−1 for patients with an MI and +30 beats ∙ min−1 for patients recovering from heart surgery; with an upper limit ≤120 beats ∙ min−1 that corresponds to an RPE ≤13 on a scale of 6-20 (6). 3. Time: Begin with intermittent walking bouts lasting 3-5 min as tolerated with exercise bouts of progressively increasing duration. The rest period may be a slower walk (or complete rest at the patient's discretion) that is shorter than the duration of the exercise bout. Attempt to achieve a 2:1 exercise/rest ratio. 4. Type: Walking. Progression: When continuous exercise duration reaches 10-15 min, increase intensity as tolerated within the recommended RPE and HR limits.
Identify five factors to be considered in assessing a patient's work environment as return to work is contemplated.
1. Muscle groups used at work 2. Work demands that primarily involve muscular strength and endurance 3. Primary movements performed doing work 4. Periods of high metabolic demands versus periods of low metabolic demands 5. Environmental factors
Identify five clinical contraindications to participation in inpatient or outpatient CR.
1. Unstable angina 2. Uncontrolled hypertension 3. Drop of >22 mmHg 4. Uncontrolled diabetes 5. Uncontrolled arrhythmias
The normal heart rate response to incremental exercise is to increase with increasing workloads at the rate of approximately _____ bpm per 1 MET
10
Number of electrodes in a 12 lead EKG
10 Electrodes
Interindividual variability for predicting maximal heart rate from age is
10 beats * min-1
How many cardiac rehabilitation sessions should be monitored with continuous ECG monitoring in patients with known CVD who are at a moderate-to-high risk for cardiac complications?
12 to 18 sessions
How soon post event a symptom-limited stress testing of low- and intermediate-risk patients with NSTE-ACS patients can be conducted?
12-24 hours
What is the standard calibration?
25 mm/seconds ; 10 mm/mV
Duration of exercise bouts during inpatient cardiac rehabilitation should allow for rests as necessary but strive for an exercise/rest ratio of
2:1.
Number of electrodes in limb leads for 12 Lead EKG? Name the electrodes
4 electrodes: RA, LA, RL, LL
Because of regional muscle fatigue during cycle ergometry, what percentage of maximal oxygen consumptoin when compared to treadmill testing can be expected?
5%-10% lower
Number of chest leads in 12 lead EKG?
6
Number of limb leads in 12 lead EKG?
6
Number of electrodes in chest leads for 12 Lead EKG? Name the electrodes
6 electrodes: V1, V2, V3, V4, V5, V6
When performing a symptom-limited maximal exercise test, the selected exercise testing protocol should result in a total exercise duration of
6-12 minutes
Following a surgery involving median sternotomy, how long should upper body movements that exert tension on the sternal wound be avoided?
8 to 12 weeks
At what point is depression of the J point measured on the electrocardiogram
80 ms
The standard minimum criterion for a positive exercise test is
>1.0 mm (0.1 mV) of horizontal or downscoping ST segment at the J point extending for 60 to 80 ms
Exercise ECG sensitivity for the detection of ischemic heart disease has traditionally been based on angiographic evidence of a coronary artery stenosis
>70% in at lesast one vessel
Which of the following is an absolute contraindication for symptom-limited maximal exercise testing?
Active endocarditis
Which of the statements below is true regarding inpatient cardiac rehabilition programs?
Activities and programs during the early recovery period will dependent on the size of the myocardial infarction and the occurrence of any complications
What may be one of the single best prognostic markers in all inidviduals regardless of health status?
Aerobic capacity
Amlodipine ______________
All of the above
An adverse prognosis in the postmmyocardial infraction patient includes
An ischemic ST-segment depression at a low level of exercise
Amiodarone is a type of _____ drug
Antiarrhythmic
Which of the following are typically not monitored during a graded exercise test?
Blood Gases
Which of the following lowers cholesterol?
Both A and B (Lipitor & Lovastatin)
Which of the following is the most commonly used treadmill test protocol?
Bruce Protocol
At what interval should heart rate be monitored during a symptom-limited maximal exercise test?
Continuously be recored during the last 5-10 seconds of each minute
Which drug is an example of an anticoagulant?
Coumadin
Which of the following is an abnormal electrocardiographic response to exercise?
Depression of the ST segment
In the outpatient cardiac rehabilitation program, before each session begins, which of the following parameters is not routinely assessed?
Dietary analysis
At what interval should blood pressure be monitored during a symptom-limited maximal exercise test?
During the last 30-60 s of each stage
Define EKG. What is the purpose of EKG?
Electrocardiogram(EKG) records the electrical signals in your heart. It's a common test used to detect heart problems and monitor the heart's status in many situations.
Although important in some patient populations, which of the following is the least likely to be measured or monitored?
Expired gases
Describe the FITT recommendation for individuals with cardiac transplant
F- 3-5 d*wk-1 I- Use RPE of 11-14 on a 6-20 scale T- Progressively increase from 15 to 20 minutes T- Treadmill or free walking
Describe the FITT recommendation for individuals with asthma.
F- Frequency: At least 3-5 d*wk-1 I-Intensity: Approximately at the ventilatory anaerobic threshold T- Time: at least 20-30 min*d-1 T- Type: Aerobic activities using large muscle groups such as walking, running, or cycling
Describe the FITT recommendation for individuals with COPD
F- Frequency: At least 3-5 d*wk-1 I-Intensity: For patients with COPD, vigorous (60%-80% of peak work rates) and light (30%-<40% of peak work rates) intensities have been recommended T- Time: Individuals with moderate or severe COPD may be able to exercise only at a specified intensity for a few minutes at the start of the training program T- Type: Walking and/or cycling
Describe the FITT recommendation for individuals suffering a cerebral vascular accident.
F- Frequency: Fitness has been shown to improve with twice weekly exercise sessions I-Intensity: The programs should begin at a conservative intensity and be slowly progressed depending on how the individuals report they are feeling T- Time: It is recommended that a program for more frail individuals last between 20-30 minutes T- Type: Exercises should include aerobic, strengthening, stretching, coordination and balance activities
Describe the FITT recommendation for individuals with lower extremity, symptomatic peripheral arterial disease.
F- Frequency: Weight-bearing aerobic exercise 3-5 d ∙ wk−1; resistance exercise at least 2 d ∙ wk−1. I-Intensity: Moderate intensity (i.e., 40%-<60% VO2R) that allows the patient to walk until he or she reaches a pain score of 3 T- Time: 30-60 min ∙ d−1 Type: Weight-bearing aerobic exercise, such as walking, and non-weight-bearing exercise, such as arm and leg ergometry
True or False? A dyspnea rating between 3 and 6 on the Borg CR10 Scale corresponds with 40% to 50% of VO2peak, respectively.
False
True or False? A target heart rate of HRrest + 30 beats · min-1 is an appropriate mechanism to gauge intensity for the patient who has just undergone cardiac transplantation and is in an outpatient cardiac rehabilitation program.
False
True or False? An absolute decrease in arterial oxygen saturation (SpO2) >2% is considered abnormal
False
True or False? Patients must have a graded exercise test prior to beginning outpatient cardiac rehabilitation in order for an exercise prescription to be formulated.
False
True or False? Patients with cardiac disease should be discouraged from exercising at home postdischarge and encouraged to exercise only while monitored in outpatient cardiac rehabilitation programs.
False
True or False? Patients with cardiac disease should not perform resistance training because of the extreme effects of those activities on heart rate and blood pressure responses.
False
True or False? The major symptom of peripheral artery disease is permanent claudication.
False
Long PR interval represents ________
First degree atrioventricular heart block
Describe the FITT recommendation for individuals with heart failure.
Frequency - Be active on most days of the week but at least three to four days. Work up to five days a week. Intensity - Exercise at a moderate level. Use the "talk test" to help you monitor. Time - Exercise 30-60 minutes per day. Type - Do rhythmic exercises using the large muscle groups. Try brisk walking, cycling, and swimming.
Describe the FITT recommendation for individuals with cardiovascular disease participating in outpatient cardiac rehabilitation.
Frequency: Exercise should be performed at least 3 d but preferably on most days of the week Intensity: Exercise intensity may be prescribed using one or more of the following methods: -Based on results from the baseline exercise test, 40%-80% of exercise capacity using the HR reserve (HRR), oxygen uptake reserve (VO2R), or peak oxygen uptake (VO2peak) methods Time: The goal for the duration of the aerobic conditioning phase is generally 20-60 min per session. After a cardiac-related event, patients may begin with as little as 5-10 min of aerobic conditioning with a gradual increase in aerobic exercise time of 1-5 min per session Type: The aerobic exercise portion of the session should include rhythmic, large muscle group activities with an emphasis on increased caloric expenditure
Which of the following is not a hemodynamic response to clinical exercise testing?
Gas exchange and ventilatory responses
Before beginning formal physical activity in the inpatient setting, a qualified health care provider should assess the patient for which of the following?
Heart and lung sounds
What is the pretest likelihood that a male aged 40 yr with typical angina pectoris has atherosclerotic cardiovascular disease?
High
In patients with diagnosed exercise-induced asthma, which of the following is not considered and environmental "trigger" to be avoided?
Humid air
Exercise-induced myocardial ischemia may cause left ventricular dysfunction, exercise intolerance, and a _______ blood pressure response
Hypotensive
12 views of the heart
I- Lateral II- Inferior III- Inferior aVR- x aVL- Lateral aVF- Inferior V1- Septal V2- Septal V3- Anterior V4- Anterior V5- Lateral V6 Lateral
Who would be a likely candidate for implantation of an implantable cardioverter defibrillator?
ICDs are used for high-rate ventricular tachycardia or ventricular fibrillation in patients who are at risk for these conditions as a result of previous cardiac arrest, cardiomyopathy, heart failure, or ineffective drug therapy for abnormal heart rhythms.
Which of the following is not a cognitive skill a nonphysician allied health care professional must possess to administer clinical tests?
Knowledge of antidepressants
The figure below represents ___________
Left Axis deviation (If the QRS is upright in lead I (positive) and downward in lead aVF (negative), then the axis is between 0 and -90 degrees. )
The figure below represents ___________
Left Bunde Branch Block (Dominant S wave in V1 with broad, notched ('M'-shaped) R wave in V6)
The figure below represents ___________
Left Ventricular Hypertrophy (ST depression and T wave inversion in the lateral leads)
Which of the following electrocardiogram changes are known to affect test interpretation of ischemic heart disease
Left ventricular hypertrophy
Which of the following is NOT a dieuretic?
Lipitor
Which drug is an example of an antihypertensive or ACE inhibitor?
Lisinopril
Which of the following is an angiotensin receptor blocker?
Losartan
Which of the following is an example of a beta blocker?
Metoprolol
A delayed decrease in heart rate during active post exercising recovery is a powerful predictor of
Overall mortality
Which of hte following is an anti platelet?
Pentoxifyline
Which of the following is a relative contraindication for symptom-limited maximal exercise testing?
Recent stroke or transient ischemia attack
Define ischemia
Reduced blood flow
The figure below represents ___________
Right Axis deviation (If the QRS is predominantly negative in lead I and positive in lead aVF, then the axis is rightward (right axis deviation).
The figure below represents ___________
Right Bundle Branch Block ( "bunny ear" pattern in the anterior precordial leads (leads V1-V3)
The rate pressure product is calculated by
SBP x HR
Define dysnpea
Shortness of breath
At what interval should signs and symptoms be monitored during a symptom-limited maximal exercise test
Signs and symptoms should be monitored continuously and recorded as observed
The normal electrocardiographic response to exercise includes which of the following?
Slight decreases in R wave amplitude
Blood Flow through the body and heart
Superior vena cava-> Right atrium -> Tricuspid valve -> Right ventricule -> Pulmonary valves -> Pulmonary arteries -> Pulmonary veins -> Left atrium -> Bicuspid valve -> Left ventricle -> aortic valves -> aorta -> body tissues
Identify the key symptom of chronic obstructive pulmonary disease (COPD) and what this symptom may lead to.
Symptoms: • Shortness of breath, especially during physical activities • Wheezing • Chest tightness • Having to clear your throat first thing in the morning, due to excess mucus in your lungs • A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish • Blueness of the lips or fingernail beds (cyanosis) • Frequent respiratory infections • Lack of energy • Unintended weight loss (in later stages) • Swelling in ankles, feet or legs Lead to: • Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections. • Heart problems. For reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack. Quitting smoking may reduce this risk. • Lung cancer. People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk. • High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension). • Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression.
The normal blood pressure response to dynamic upright exercise consists of a progressive increase in
Systolic blood pressure
What are recommendations for progressing the duration of the aerobic conditioning phase for patients with cardiovascular disease in an outpatient rehabilitation?
The goal is to complete 20-60 min total of aerobic conditioning. Patients may begin with 5-10 min and gradually progress 1-5 min per session (or 10%-20% per week). However, there is no set format for rate of progression.
What is a 12 lead EKG?
The standard 12-lead electrocardiogram is a representation of the heart's electrical activity recorded from electrodes on the body surface. 12 views of the heart.
On EKG paper, the horizontal axis measures
Time
What is the most common exercise testing mode in the United States?
Treadmill
True or False? A cold environment may aggravate the symptoms of intermittent claudication.
True
True or False? For outpatient cardiac rehabilitation, intensity of exercise can be recommended based on an RPE of 12-16 (based on a 6-20 scale).
True
True or False? If a patient has an implanted cardiac defibrillator (ICD), heart rate intensity should be maintained at least 10-15 beats · min-1 below the programmed HR threshold for defibrillation.
True
True or False? Rate-responsive pacemakers are programmed to alter heart rate matching the level of physical activity.
True
Which of the following is false regarding the ST segment on a resting electrocardiogram?
Upsloping ST-segment depression >1 mm (0.1 mV) at 80 ms after the J point may represent myocardial ischemia, especially in the presence of angina
Describe the electrode placement for each of the leads:
V1- 4th intercostal right of the sternal border V2- 4th intercostal left of the sternal border V3- Midpoint line between V2 and V4 V4- Midclavicular line of 5th intercostal V5- Anterior axillary line on horizontal through V4 V6- Midaxillary line on a horizontal through V4 and V5
Nitrogylcerin is a _______ and ________ blood vessels
Vasodilator; opens
What is the pretest likelihood that a female aged 35 yr with nonanginal chest pain has atherosclerotic disease?
Very Low
Which of the following is not an example of a second degree atrioventricular heart block?
Wolf Parkinson White
All of the following are known to influence clinical exercise test data with the exception of
elevated levels of physical fitness
It is recommended that the upper limits of exercise intensity during inpatient cardiac rehabilitation may be measured on any of the following except
post-MI: HRrest + 30 beats · min-1.
The magnitude of ischemia cased by a coronary lesion generally is proportional to
the degree of ST-segement depression on the electrocardiogram
In patients on vasodilators, calcium channel blockers, angiotensin-converting enzyme inhibitors, and a- and b- adrenergic blockers, and the blood pressure response to exercise is
variably attenuated and cannot be accurately predicted in the absence of clinical test data
