Term
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Definition
| Symptoms. (Angina, fatigue, etc...) |
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Term
| How long must you wait post cardiac event/ discharge from hospital to perform a max GET? |
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Definition
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Term
| There are two things that you MUST have on hand while performing a Max GET? |
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Definition
| A trained person, and a crash cart for rapid response. |
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Term
| What are the three major purposes for doing a GET? |
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Definition
| 1. Diagnostic/Prognostic (PTs don't use for Dx, though) 2. Therapeutic Assessment. 3. Functional Testing. |
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Term
| For what reason do PTs generally do GET? |
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Definition
| For therapeutic assessment |
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Term
| Are the sensitivity and specificity for GET good? |
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Definition
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Term
| What is the importance of recognizing false positives? |
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Definition
| A false positive would caus you prescribe less exercise than they're capable of, so we need to know what things cause them. |
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Term
| What are the causes for false positives on GXT? |
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Definition
| 1. Pre-existing abnormal ECG. 2. Cardiac Hypertrophy. 3. Coronary Spasm. 4. Drugs (Digoxin) 5. Anemia. 6. Cardiomyopathy. 7. Hypokalemia. 8. Vasoregulatory abnormalities. 9. Sudden intense exercise. 10. Mitral valve prolapse. 11. Conduction deficits. 12. Female gender 20-50yoa. |
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Term
| Why can cardiac hypertrophy cause false positives? |
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Definition
| It can cause inturruptions on ECG that make it look like CAD when it's not really present. |
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Term
| How does Coronary spasm cause false positives? |
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Definition
| can show up on EDG and make ST look depressed. |
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Term
| Why can digoxin cause false positives? |
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Definition
| makes it difficult to tell anything about the ST segment. |
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Term
| How does anemia cause false positives? |
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Definition
| B/c there's not enough O2 on the RBC there can be ischemia. They may develop chest pain, ST segment changes. They look like heart Sx but they're really anemia Sx. |
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Term
| What does hypokalemia do to ECG readout? |
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Definition
| Changes the QRST complex and makes it look weird. |
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Term
| Why will a mitral valve prolapse cause a false positive? |
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Definition
| It affects how the blood is delivered to heart muscle as well as the rest of the body. |
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Term
| What is the importance of a false negative on a GET? |
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Definition
| The test results tell you they don't have CAD when they do. This would lead you to prescribe exercise that the pt should be doing and could potentially be dangerous. |
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Term
| What are the seven major causes of false positives? |
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Definition
| 1. Failure to reach an adequate workload. 2. Insufficient number of leads to detect ECG changes. 3. Failure to use other information in test interpretation. 4. Single vessel disease. 5. Good collateral circulation. 6. Musculoskeletal limitations before cardiac abnormalities occur. 7. Technical or observer error. |
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Term
| How many leads do you need to adequately detect ECG changes? What happens if you don't have enough. |
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Definition
| 12. If you don't have enough you might not see where teh ST depression is. ie: if using 3 leads, you start w/ V5 and you can't see what's happening in V1-4. (so won't know if there's a LAD infarct. |
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Term
| What other information do you need to use in your GET interpretation? (3) |
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Definition
| 1. BP. 2. Dysrhythmias. 3. HR response. |
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Term
| Why could single vessel disease or good collateral circulation result in a false negative? What can you do to avoid this problem? |
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Definition
| If they have one of these, circulation may be sufficient to provide good test results, and mask the problem. There's nothing we can do about it, but it probably won't impact exercise prescription, either. |
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Term
| What are the Dx and prognostic uses of GET?(6) |
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Definition
| Dx CAD, Survival (Duke Score), Determine presence of ischemia, Cardiac Arrhythmias, Exercise induced problems (bronchoconstriction), Ventilatory Impairments, Assess Sx. |
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Term
| What does the Duke Score determine? What are the scores? |
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Definition
| Gives an idea of mortality. Low death risk = 5+. Intermediate risk = -10 - 5. High death risk = < -10. |
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Term
| What population is the Duke Score useful for? At what point does this score become obsolete? |
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Definition
| For pts w/ median age of 49. Not predictive for pts over 75yo. |
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Term
| How is the Duke Score calculated? |
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Definition
| Exercise Time (mins) - 5 x mmST depression - 4 x angina level. |
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Term
| What Sx does a GET assess? (4) |
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Definition
| 1. Chest pain. 2. Fatigue. 3. Exertional Dyspnea. 4. Claudication. |
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Term
| What are the functional testing applications of a GET? (4) |
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Definition
| 1. Pre-participation screening. 2. Exercise prescription. 3. Recommendations for return to work/vocational interests. 4. Assess outcome of CR and effects of training. |
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Term
| What are the therapeutic assessment uses for GET? (3) |
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Definition
| 1. Assess efficacy of Tx. 2. Optimize medical therapy w/ certain classes of drugs. 3. Follow progression of disease. |
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Term
| What are the absolute contraindications to GET? |
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Definition
Major cardiac problems ie: 1. Recent significant change in resting ECG suggesting:
2. MI or another acute cardiac event
3. Recent complicated MI
4. Unstable angina
5. Uncontrolled ventricular arrhythmia
6. Uncontrolled atrial arrhythmia that compromises cardiac function
7. 3* heart block: deficient blood supply
8. Acute CHF
9. Severe Aortic stenosis: not enough blood to body
10. Suspected or know dissecting aneurysm
11. Thrombophlebotic or pulmonary embolus
12. Acute infection
13. Significant emotional distress |
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Term
| What are some of the relative contraindications to GET? (10) |
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Definition
| 1. Resting DBP>120 or SBP>200. 2. Moderate valvular disease. 3. electrolyte imbalances. 4. Frequent PVCs, Vtach, etc... 5. Ventricular aneurysm. 6. Cardiomyopathy. 7. Uncontrolled metabolic disease. 8. Chronic infectious disease. 9. Advanced or complicated pregnancy. 10. Neurmuscular, musculoskeletal, or rheumatic disorders that are exacerbated by exercise. |
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