ABSOLUTE indications for terminating exercise test

description of ST ELEVATION IN LEADS WITHOUT DIAGNOSTIC Q WAVES

( elevation of 1mm or more in leads other than V1 and AVR) ST depression designates evolving MI and exercise must be discontinued, its likely that the patient is demonstrating symptoms/signs of ischemia/infarct

how would you identify INCREASING NERVOUS SYSTEM SYMPTOMS?

- monitor patient for progressive loss of muscle coordination - stable gait (signs of ataxia) - dizziness - feeling faint

description of TECHNICAL DIFFICULTIES MONITORING THE EKG/SBP

Goal of test is to identify ECG and SBP response indicative to ischemia - if unable to monitor either, the test is ineffective and dangerous to conduct as ischemia can be missed

level 3 of angina is typically accompanied by what?

ST depression

description of SUSTAINED VENTRICULAR TACHYCARDIA

a fast chaotic rhythm that doesn't allow the heart to maintain cardiac output , this rhythms precedes unconsciousness, v fib and arrest

DROP IN SYSTOLIC BP > 10mmHg - absolute or relative?

absolute

INCREASED NERVOUS SYSTEM SYMPTOMS - absolute or relative?

absolute

MODERATELY SEVERE ANGINA (3 on scale) - absolute or relative?

absolute

SIGNS OF POOR PERFUSION - absolute or relative?

absolute

ST ELEVATION IN LEADS WITHOUT DIAGNOSTIC Q WAVES - absolute or relative?

absolute

SUBJECTS DESIRE TO STOP - absolute or relative?

absolute

SUSTAINED VENTRICULAR TACHYCARDIA - absolute or relative?

absolute

TECHNICAL DIFFICULTIES MONITORING THE EKG/SBP - absolute or relative

absolute

description of MODERATELY SEVERE ANGINA (3-4 on scale)

angina is a sign of ischemia and continued exercise could cause INFARCTION

how would you identify MODERATELY SEVERE ANGINA?

angina rating scale: 1 - mild, barely noticeable 2 - moderately, bothersome 3 - MODERATELY SEVERE, VERY UNCOMFORTABLE ***** 4 - MOST SEVERE OR MOST INTENSE PAIN EVER EXPERIENCED ******

description of DROP IN SYSTOLIC BP > 10mmHg WITH AN INCREASE IN WORK ACCOMPANIED BY OTHER EVIDENCE OF ISCHEMIA OR IF SYSTOLIC BP DECREASES BELOW THE VALUE OBTAINED IN THE SAME POSITION PRIOR TO TESTING ACCOMPANIED BY OTHER EVIDENCE OF ISCHEMIA

as the heart delivers more blood/oxygen to the exercising muscles, the systolic BP increases with workload a drop in systolic BP with increase in workload can be indicative of pump failure but will be accompanied by symptoms of ischemia or inadequate cardiac output

how would you identify DROP IN SYSTOLIC BP during test?

confirm BP reading and if there's a DROP noted - examine EKG for signs of ischemia/infarct ST depression/ST elevation - check pt for signs of ischemia/pump failure (dyspnea, dizziness, syncope, hypotension, angina chest pain, limiting fatigue)

how would you identify SUBJECTS DESIRE TO STOP?

if the patient is credible and insistent in their desire to stop, we do so

how would you identify TECHNICAL DIFFICULTIES MONITORING THE EKG/SBP?

if your'e unable to monitor the ECG or SBP, the test must be terminated

description of INCREASED NERVOUS SYSTEM SYMPTOMS

increasing nervous system symptoms are indicative of the body's inability to continue exercise (neurologic or other systems have been challenged) and there is a risk of falling or worsening of the condition

description of SUBJECTS DESIRE TO STOP

its important to believe their desire to stop is credible and they understand stopping the test early will make it non diagnostic (sometimes they just need encouragement) - if credible and insistent requests are ignored, continuation of test violates patients rights and increases chance of injury if patient tries to exit the treadmill

how would you identify ST ELEVATION IN LEADS WITHOUT DIAGNOSTIC Q WAVES?

monitor the EKG for ST elevation

how would you identify SIGNS OF POOR PERFUSION?

monitor the patient for - excessive dyspnea - pallor (white clammy skin, can be cold to the touch) - cyanosis (blue nailbeds/lips) - marked fatigue

how would you identify SUSTAINED VENTRICULAR TACHYCARDIA?

monitor the stress EKG for sustained V tach

What are Absolute Indications for Terminating Exercise Testing?

patient makes the physician aware and he/she will instruct you to stop the test

description of SIGNS OF POOR PERFUSION

signs of poor perfusion speak cardiorespiratory failure (inability to adequately oxygenate or deliver oxygenated blood)

ataxia definition

without coordination, loses muscle control in arms and legs, may lead to a lack of balance, coordination and walking, can affect the fingers/hand/arms/legs/body/speech/eye movements