Final Exam

absolute reasons for stopping a GXT test

-Angia increasing from 3 to 4 on a 4 point angina scale -Patient feels dizzy and their EKG has sawtooth like appearance with no p waves and heart rate of 150bpm -you are unable to hear the patient's korotkoff sounds and cannot get their blood pressure -patient who is experiencing shortness of breath and who's SBP drops by 16 mmHg after increasing from stage 1 to stage 2 of the Bruce protocol.

atrial flutter

-P waves occur 3-4 times per QRS complex -RR interval is constant from beat to beat

1st degree AV block

-PR interval is > 0.20 seconds

2nd degree AV block

-PR interval is progressively lengthening, and eventually a QRS complex is dropped

Absolute contraindications to exercise testing

-Patient had myocardial infarction 36 hours ago -Patient with a third degree AV blockand low blood pressure -Patient who regularly has spontaneous angina at rest -Patient who feels lightheaded/dizzy and SOB with mild activity, has chest pain, and when you listened to their heart sounds you hear lub-whistle-dup

3rd degree AV block

-no association between P waves and QRS complex

atrial fibrillation

-no discernable P waves -bag of worms isoelectric line -RR interval is variable

ventricular fibrillation

-no discernable p waves -no discernable QRS complex -bag of worms -is really bad

relative contraindications to exercise testing

-patient who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease -patient who recently started experiencing angina when they exercise -patient who had a stroke 10 days ago -patient who comes to your office with a resting blood pressure of 220/92 -patient with severe anemia

relative reasons for stopping a GXT

-patient's SaO2% drops to 79% -patient is at a high heart rate and their QRS complexes are now very wide; it is hard to tell if they have a bundle branch block or something else -patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol -2.0 mm of ST depression 0.08 seconds after the J point in a patient who has a history of stable angina -patient has severe pain in their calves due to peripheral vascular disease and they are also wheezing and experiencing dyspnea -patient has had several beats that had no P wave and long, unusual QRS complexes; these complexes do not all look the same. These unusual beats are increasing in frequency and, at one point you observed three in a row.

multifocal PVCs

-premature -QRS > 0.12 -no p wave precedes bizarre QRS complex -different shapes

unifocal PVCs

-premature -QRS > 0.12 -no p wave precedes bizarre QRS complex -same shape

PACs (premature atrial contractions

-premature -normal QRS -p-wave may look different but is present

The normal duration of the QRS interval is ----to ---- seconds and if it is longer than usual it could suggest the person has ----

0.08-.12seconds, a bundle branch block

Based on pre-2017 guidelines a systolic blood pressure of __________ mmHg would be classified as pre-hypertensive (more than one acceptable answer)

130 (range of 120-140)

What is a typical maximal exercise stroke volume in a trained subject? (use ml)

150

What is a typical resting TPR (in dyn/s.cm5) for an adult human with an average cardiac output and average blood pressure?

1500

What is a typical maximal exercise cardiac output in an untrained subject? (use L)

25

Which of the following is an appropriate value for maximal exercise TPR in (dyn/s.cm5) a young, untrained, healthy subject with a normal blood pressure response to exercise?

300

What is a typical maximal exercise cardiac output in a trained subject? (use L)

35

feel a pulse with regular rhythm of varying strength pulses

3rd degree AV block

What is a typical value for cardiac output in a healthy adult human (in L)?

5

What is a typical resting stroke volume in an untrained subject? (use ml)

75

What is a typical value for stroke volume in a healthy adult human (in mL)?

75

A systolic blood pressure of __________ mmHg would be suggestive of hypotension

90

Left ventricular hypertrophy

A large, deep S wave in V1 and a large, tall R wave in V5 Asymmetric, inverted T waves in V5 or V6 Left axis deviation with a slightly widened QRS complex

If your subject's PR interval is longer than normal, select the part of the conduction system that is most likely to be causing this problem?

AV node

Which of the following is NOT an absolute contraindication for exercise testing (you should not start an exercise test)?

All of these ARE contraindications to stress testing: 3rd degree AV block accompanied by low blood pressure patient with heart failure who presents with severe bilateral ankle edema and shortness of breath at rest and when lying down chest pain that occurs at random times inflammation of the pericardium

Which of the following is are NOT true about cardiac output?

At rest it is approximately 70 ml/beat these are true: In elite endurance athletes it may reach 40-50 L/min at maximal exercise During maximal exercise ins untrained subjects, 20-30 L/min would be typical

Match the following

D: 20 vols%, arterial O2 content E: Venous Content, 15 vols% F: 40 mmHg, PO2 in systemic tissues G: PO2 in systemic arteries, 100 H: position of curve during exercise, position of curve with high concentration of H+ I: position of curve at rest, position of curve with low concentration of H+

The figure below depicts an action potential from an atrial muscle cell. Phase X of this figure would likely occur during what part of the EKG?

P wave

Which of the following would be most suggestive of some type of SVT (supraventricular tachycardia)?

RR interval 0.44 seconds every beat PR interval 0.12 seconds every beat QRS interval 0.08 seconds every beat P before each QRS complexe QRS after each P wave

Which of the following would be most suggestive of a bundle branch block?

RR interval 0.75 seconds every beat PR interval 0.16 seconds every beat QRS interval 0.14 seconds every beat P before each QRS QRS after each P wave

If graph i depicts the changes in cardiac output (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what would be appropriate values for points a and b on the y axis in an elite male endurance athlete?

a = 5 b = 42.1

If graph ii depicts the changes in stroke volume (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what would be appropriate values for points a and b on the y axis in a healthy untrained female subject?

a = 65 b = 119

If graph i depicts the changes in a-vO2 difference (y axis) between rest and maximal intensity cycling exercise, what factors could be causing this change?

a decrease in active muscle pO2

Fill in the letters cycling vs. arm crank

a: arm crank SBP b: cycling SBP c: d: e: f:

fill in the letters cycling vs. isometric knee extension

a: cycling SBP b: knee extension SBP c: knee extension MAP d: cycling MAP

Which of the following is NOT a sign/symptom suggestive of cardiac, pulmonary, or metabolic disease?

all of these ARE signs/symptoms suggestive of cardiac, pulmonary, or metabolic disease unexplained severe pain in the calves during mild activity sudden shortness of breath when lying down unexplained loss of consciousness mitral regurgitation (lub-swish-dup) chest pain on exertion

what causes an increase in A-VO2 difference

an increase in hemoglobin concentration during this type of activity a decrease in blood pH redistribution of blood flow away from inactive tissues and towards active tissues (especially muscle)

What causes the change in increase heart rate from rest to maximal exercise?

an increase in sympathetic stimulation of the SA node a decrease in acetylcholine release at the SA node more neurotransmitter binding with beta-1-adrenergic receptors

Palpitations would most likely be associated with which of the following:

arrhythmias

There are many possible causes of chest pain. Which of the following chest pain examples would be most suggestive coronary artery disease?

burning sensation below the sternum during exercise

MAP would likely be lowest for which of the following exercises?

cycling at 200 Watts (90% of max)

Pulse pressure would likely be highest for which of the following exercises?

cycling at 200 Watts (90% of max)

In some arrhythmias we may not observe all EKG waveforms in their normal order of PQRST. Which of the following is/are NOT true?

in a bundle branch block there may be QRS complexes with no P wave before them TRUE: In atrial flutter some P waves are not followed by QRS complexes In Atrial fibrillation there are QRS complexes that are not preceeded by P waves In PVCs there are QRS complexes with no P wave before them

The QT interval:

is heart rate dependent includes both ventricular depolarization and repolarization is longer when HR decreases is shorter when HR increases

ST segment depression

ischemia

If graph v depicts the changes in TPR (y axis) between rest and maximal intensity cycling exercise, how would this change influence the blood pressure response to exercise?

it is why DBP decreases slightly in young healthy subjects during this type of activity

What contributes to a gradual decline in TPR?

local metabolic factors acting on arteriolar smooth muscle in the active muscles

What does the 4th Korotkoff sound sound like?

muffled

Which of the following conditions would be least likely to cause the mean electrical axis to shift to the left?

pregnancy lying down left ventricular hypertrophy inferior wall or right ventricular infarction

Which of the following would be most likely to cause the mean electrical axis to shift to the right?

right ventricular hypertrophy

Our body is a little like Goldilocks; it wants everything just right. Which of the following is/are true about hypertension, normotension, and hypotension?

severe hypotension may be a more immediate threat to a patient's life than hypertension 40-50% of all US adults have hypertension a blood pressure of 80 over 40 could cause syncope hypertension increases the risk of having a stroke

____________________________________ is a symptom suggested of cardiovascular or pulmonary disease associated with loss of conciousness due to reduced blood flow to the brain

syncope

Which of the following is/are possible sign(s) that a patient may have heart failure?

three of these answers think it is these three: bilateral ankle edema shortness of breath when lying down orthopnea NOT a sigh: Intermittent claudications

If graph ii depicts the changes in stroke volume (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what factors could be contributing to why this variable plateaus in most subjects during acute exercise?

ventricular filling time decreases at high intensities

Which of the following is/are NOT true about limb lead II?

we would expect the QRS to be mostly negative if the subject had left ventricular hypertophy TRUE: It is usually mostly upright in subjects with a normal mean electrical axis