EP Exam Chapter 5

The standard minimum criterion for a positive exercise test is upsloping ST-segment depression. 1.0 mm (0.1 mV) of horizontal or downsloping ST segment at the J point extending for 60-80 ms. 2.0 mm (0.2 mV) of horizontal or downsloping ST segment at the J point extending for 60-80 ms. ST-segment elevation in the presence of left bundle branch block.

1.0 mm (0.1 mV) of horizontal or downsloping ST segment at the J point extending for 60-80 ms.

The normal heart rate response to incremental exercise is to increase with increasing workloads at the rate of approximately ________ bpm per 1 MET. 5 10 15 20

10

How soon post event a symptom-limited stress testing of low- and intermediate-risk patients with NSTE-ACS patients can be conducted? 2 d 12-24 hr 2 wk Never

12-24 hr

Because of regional muscle fatigue during cycle ergometry, what percentage of maximal oxygen consumption when compared to treadmill testing can be expected? 20%-30% lower 5%-10% lower 10%-20% higher 20%-30% higher

5%-10% lower

When performing a symptom-limited maximal exercise test, the selected exercise testing protocol should result in a total exercise duration of 6-8 min. 8-14 min. 15-20 min. 6-12 min.

6-12 min.

At what point is depression of the J point measured on the electrocardiogram? 80 ms 120 ms 1 s 0.5 s

80 ms

Which of the following is the definition of "predictive value"? The percentage of patients tested with known CVD who demonstrate significant ST-segment (i.e., positive) changes The percentage of patients without CVD who demonstrate nonsignificant (i.e., negative) ST-segment changes A measure of how accurately a test result (positive or negative) correctly identifies the presence or absence of CVD in tested patients Conditional probability

A measure of how accurately a test result (positive or negative) correctly identifies the presence or absence of CVD in tested patients

Which of the following is an absolute contraindication for symptom-limited maximal exercise testing? Tachyarrhythmias with uncontrolled ventricular rates Recent stroke or transient ischemia attack Active endocarditis Resting hypertension with systolic >200 mm Hg or diastolic >110 mm Hg

Active endocarditis

What may be one of the single best prognostic markers in all individuals regardless of health status? Aerobic capacity Muscular strength Muscular endurance Body mass index

Aerobic capacity

Which of the following are typically not monitored during a graded exercise test? Electrocardiogram Hemodynamic responses Symptoms Blood gases

Blood gases

Which of the following is the most commonly used treadmill test protocol? Naughton protocol Rockport Walking Test Ramp protocol Bruce protocol

Bruce protocol

At what interval should heart rate be monitored during a symptom-limited maximal exercise test? During the last 45 s of each stage Continuously but recorded during the last 5-10 s of each minute At the beginning of each stage At any time during a stage

Continuously but recorded during the last 5-10 s of each minute

Which of the following is an abnormal electrocardiographic response to exercise? Changes in P wave morphology Superimposition of the P and T waves of successive beats Depression of the ST segment Increases in septal Q wave amplitude

Depression of the ST segment

At what interval should blood pressure be monitored during a symptom-limited maximal exercise test? During the last 30-60 s of each stage During the last 5 s of each stage At the beginning of each stage At any time during a stage

During the last 30-60 s of each stage

Although important in some patient populations, which of the following is the least likely to be measured or monitored? Heart rate Blood pressure Expired gases Electrocardiogram

Expired gases

Which of the following is not a hemodynamic response to clinical exercise testing? Heart rate Systolic blood pressure Diastolic blood pressure Gas exchange and ventilatory responses

Gas exchange and ventilatory responses

Which of the following is not a cognitive skill a nonphysician allied health care professional must possess to administer clinical exercise tests? Knowledge of appropriate indications for exercise testing Knowledge of basic cardiovascular and exercise physiology including hemodynamic response to exercise Knowledge of endpoints of exercise testing and indications to terminate exercise testing Knowledge of antidepressants

Knowledge of antidepressants

Which of the following electrocardiogram changes are known to affect test interpretation of ischemic heart disease? A single unifocal premature ventricular contraction Three premature atrial contractions in 1 min Left atrial hypertrophy Left ventricular hypertrophy

Left ventricular hypertrophy

Which of the following is a relative contraindication for symptom-limited maximal exercise testing? Symptomatic severe aortic stenosis Recent stroke or transient ischemia attack Acute aortic dissection Ongoing unstable angina

Recent stroke or transient ischemia attack

The rate pressure product is calculated by DBP × HR. SBP × HR. SBP × DBP. SBP × DBP × HR.

SBP × HR.

In patients with left bundle-branch block, ventricular hypertrophy, and preexcitation syndrome ST-segment abnormalities that develop during exercise are uninterpretable with respect to evidence of myocardial ischemia heart rate is often uninterpretable because of the electrical interference ST-segment abnormalities can only be interpreted as positive during exercise myocardial ischemia can only be interpreted in the "indicative" leads

ST-segment abnormalities that develop during exercise are uninterpretable with respect to evidence of myocardial ischemia

At what interval should signs and symptoms be monitored during a symptom-limited maximal exercise test? During the last 45 s of each stage At the beginning of each stage At any time during a stage Signs and symptoms should be monitored continuously and recorded as observed.

Signs and symptoms should be monitored continuously and recorded as observed.

The normal electrocardiographic response to exercise includes which of the following? Decreases in septal Q wave amplitude Slight decreases in R wave amplitude Decreases in T wave amplitude Widening of the QRS duration

Slight decreases in R wave amplitude

What is the most common exercise testing mode in the United States? Cycle ergometer Treadmill Arm ergometer Elliptical

Treadmill

Which of the following statements is false regarding the ST segment on a resting electrocardiogram? Horizontal or downsloping ST-segment depression 1 mm (0.1 mV) at 80 ms after the J point is a strong indicator of myocardial ischemia. When ST-segment elevation is present in the upright resting ECG, only ST-segment depression below the isoelectric line during exercise is considered for ischemia. 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. ST-segment depression at a low workload or low rate-pressure product is associated with worse prognosis and increased likelihood for multivessel disease.

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.

An adverse prognosis in the postmyocardial infarction patient includes an ischemic ST-segment depression at a low level of exercise. a functional capacity of >5 METs. an increased left ventricular systolic function. a hypertensive blood pressure response to exercise.

an ischemic ST-segment depression at a low level of exercise.

Exercise ECG sensitivity for the detection of ischemic heart disease has traditionally been based on angiographic evidence of a coronary artery stenosis <50% in at least one vessel. 100% in at least one vessel. 70% in at least one vessel. between 50% and 100% in at least two vessels.

between 50% and 100% in at least two vessels.

All of the following are known to influence clinical exercise test data with the exception of orthopedic limitations. elevated levels of physical fitness. pulmonary disease. neurologic disorders.

elevated levels of physical fitness.

True or False? An absolute decrease in arterial oxygen saturation (SpO2) 2% is considered abnormal.

false

What is the pretest likelihood that a male aged 40 yr with typical angina pectoris has atherosclerotic cardiovascular disease? Very low Low Intermediate High

high

Exercise-induced myocardial ischemia may cause left ventricular dysfunction, exercise intolerance, and a ___________ blood pressure response. hypotensive hypertensive normotensive normal

hypotensive

A delayed decrease in heart rate during active postexercise recovery (e.g., at least 12 beats · min-1 decrease after the first minute in recovery or 22 beats · min-1 decrease after the second minute in recovery) is a powerful predictor of overall mortality. ventricular incompetence. being physically fit. gender bias.

overall mortality.

The normal blood pressure response to dynamic upright exercise consists of a progressive increase in diastolic blood pressure. systolic blood pressure. mean arterial pressure. pulse pressure.

systolic blood pressure.

The magnitude of ischemia caused by a coronary lesion generally is proportional to the degree of ST-segment depression on the electrocardiogram. just one electrocardiogram lead. a short duration of ST-segment depression on the electrocardiogram in recovery. the nonobstructive atherosclerotic plaque.

the degree of ST-segment depression on the electrocardiogram.

In patients on vasodilators, calcium channel blockers, angiotensin-converting enzyme inhibitors, and - and -adrenergic blockers, the blood pressure response to exercise is variably attenuated and cannot be accurately predicted in the absence of clinical test data. always increased in these types of patients. always decreased during graded exercise testing. typically normal if the patient is either on the medication or off of it.

variably attenuated and cannot be accurately predicted in the absence of clinical test data.

What is the pretest likelihood that a female aged 35 yr with nonanginal chest pain has atherosclerotic cardiovascular disease? Very low Intermediate High Very high

very low

Interindividual variability for predicting maximal heart rate from age is ~5 beats · min-1. ~10 beats · min-1. ~12 beats · min-1. ~20 beats · min-1.

~10 beats · min-1.