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Flashcards in Stress testing Deck (8)
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1
Q

What are the drugs of choice for cardiac stress testing

A

1st: vasodilators
dipyridamole (PDE inhibitor)
or adenosine

2nd: dobutamine

2
Q

Exercise stress test

A

Patient should reach 85% of max pulse rate (220 minus age)

Accompanied by ECG, Echo, or SPECT perfusion imaging.

3
Q

When is a drug induced stress test indicated?

A

LBBB, post-MI, and in patients who are immobile.

4
Q

When is exercise stress test indicated

A

To diagnose suspected CAD

In LATE-risk stratification after UA/NSTEMI has been managed, 48-72 hours after therapy.

Post PCI or thrombolytic treatment for MI to evaluate success/limitations

5
Q

Stress test contraindications

A

Acute MI, NSTEMI or UA.
NOT USED in early/immmediate risk stratification for UA/NSTEMI.

Fever, Pericarditis or myocarditis

Symptomatic Aortic stenosis

Aortic dissection

Uncontrolled hypertension

Decompensated heart failure

6
Q

Evaluations of ECG and physical exam parameters during stress test.

A

ECG - checking for any ST depression, elevations. 2mm ST depression is positive test.

Hemodynamic - maximum heart rate, blood pressure, any exertional DECREASE in blood pressure, or FAILURE to increase blood pressure during exercise.

Does ANGINA develop

Development of any other limiting symptoms, dyspnea.

7
Q

Evaluation of ECHO stress test

A

Assesing EJECTION FRACTION, and Wall Motion Score Index.

> 75% hyperdynamic

55-75% normal

40-55% mild reduction

<40% intermediate reduction.

<30% Severe reduction.

Wall motion score of 2 or higher indicates high risk for future cardiac events. (scale 1-5, 3=akinetic, 4=outward bulding, 5=overt aneurysm present in diastole)

8
Q

SPECT perfusion imaging evaluation

A

SPECT perfusion shows degree of myocardial perfusion during rest and at exercise.

Low uptake of tracer indicates poor perfusion.

Late gadolinium DTPA enhancement of infarcted myocardium – increased extravascular space in post-infarcted and scarred areas.

~90% sensitivity, ~85% specificity.

Evaluated by Summed Stress Score
Each segment is scored from 0 thru 0.5, normal to no uptake of the tracer.

Higher SSS indicates higher annual risk of ischemic event
0-3, normal
beyond 4, elevated risk
beyond 14, severe risk