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Chapter 6

Chapter 6. Medical Evaluation & Exercise Testing. Medical Evaluation & Exercise Testing. Limitations to exercise Rx Describe risk profile Facilitate goals Guideline 6.1. Diagnosis Symptoms Risk Factors Recent procedures, illness, etc. Medications, allergies. Other habits

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Chapter 6

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  1. Chapter 6 Medical Evaluation & Exercise Testing

  2. Medical Evaluation & Exercise Testing • Limitations to exercise Rx • Describe risk profile • Facilitate goals • Guideline 6.1

  3. Diagnosis Symptoms Risk Factors Recent procedures, illness, etc. Medications, allergies Other habits Exercise Hx Work Hx Psychosocial Hx Figure 6.1 – Medical Hx

  4. Body weight, height, BMI Pulse Rate, regularity Resting BP Lung sounds Heart sounds Artery Palpatation Lower extremities evaluation (edema, pulses, etc.) Blood Pooling Orthopedic problems Examination of chest and leg wounds Figure 6.2 – Physical Exam

  5. Graded Exercise Test • Tolerate physical activity • EKG assessment • Symptoms • Ischemia • BP & HR response

  6. Figure 6.3 - Exercise Testing • Absolute Contraindications • Acute MI within 2 days • Unstable Angina • Uncontrolled Heart Failure • Acute Pericarditis • Severe Aortic Stenosis • Acute Pulmonary Embolus

  7. Figure 6.3 (Cont.) • Relative Contraindications • Electrolyte Abnormalities • Left Main Stenosis • Moderate Valve Disease • Severe Atrial Hypertension • High Degree AV Block • Hypertrophic Cardiomyopathy

  8. CAD patients 60-100 times > risk 1 death per 2,500 tests Use of PAR-Q & You Emergency Equipment Physicians, RN’s, & Exercise Physiologist (ACLS) GXT Protocols Exercise Testing Safety & Personnel

  9. Exercise Test Protocols • Submaximal Exercise Testing (70% HR max) • Maximum Stress Test (85% HR max) • Bicycle, Treadmill, Walk Test

  10. Figure 6.5 • Terminating Exercise Testing • Max • Sub Max • Figure 6.7

  11. Symptom Rating Scales • RPE • Angina • Dyspnea • Claudication

  12. Exercise Echocardiography • Echo “Sonogram of the heart” • Rest vs. Exercise • Images must be obtained within 2 minutes (wall motion decreases after this time) • Myocardial contractility increases with exercise (ischemia causes hypokinesis, akinesis, or dyskinesis) • Sensitivity – 74 to 97%

  13. Exercise Nuclear Imaging • Thallium or Sestamibi prior to end of exercise • Images are obtained • Rest vs. exercise • Ischemia or past MI (scarring)

  14. Pharmacologic Stress Testing • Deconditioning, PVD, Orthopedic problems, Obesity, • Dobutamine Echo (synthetic catecholamine), Dipyridamole or Adenosine GXT (Vasodilators) • Little help for exercise Rx

  15. Sub Max Tests • 6 Minute walk • 12 Minute Walk • Patient Interview (Duke Activity) • Controlled Job Simulation

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