1 Exercise Testing Study Guide 1 Tony Berardi1. Know the modifiable and non- modifiable risks for heart disease. How does exercise improve these? How else can individuals modify?- Modifiable would be their lipid level, weight, PA, smoking, obesity, glucose tolerance, and possible hypertension- Non-modifiable would be just age and family history- Exercise obviously helps with pretty much everything. Common sense- Other possible things are to stop smoking and eating better2. What are the sources of injury that can happen to the endothelium of the arteries? What is Nitric Oxide?- This deals with atherosclerosis, or the hardening of the arteries. Most cardiovascular diseases originate of this (plaque buildup). This process actually starts in childhood (it always happens), but certain acts can accelerate it. Smoking is the biggest factor. Others are high LDL, low HDL, obesity etc. Once the endothelium gets damaged, the process starts. Nitric Oxide is made in thebody and is a powerful vasodilator. It is what a nitroglycerine tablets contains for MI patient3. What are the ranges for all that shit?- Cholesterol- less than 200 is desirable- HDL- want more than 40. - LDL- less than 100 is ideal, The risk factor is above 130- Triglycerides- less than 150- Hematocrit- Men is 40-52%. Women is 36-48% This is the percentage of RBC. Fun fact is having a value greater that 55% (men) gets you banned from sporting events (no way to increase that high legally)- BMI- expressed in Kg/m2. You know this- Hemoglobin- Men 13.5-17 g/DL Women 11.5-15.5 g/DL- Fasting glucose- want less than 100. For OGTT you want below 140Tony Berardi1- HbA1C- between 5.7-6.4% is a sign of pre-diabetic. (higher in diabetic)- Blood pressure- normal is lower than 120/80. - Waist circumference- lower than 40 in for men. 35 for women 4. What are the blood tests to assess liver and kidney function?- A thing that makes it easy to remember is that to find out any abnormality of the kidney, look at the urine. The presence of certain substances (blood, protein) tells you that there is a problem at a certain part. Normally these things are filtered out, so if they are present, something is up. For the kidney, you have a blood urea test, or a creatinine test- For the liver you have a bilirubin test (this is a protein that is normal degraded in the liver. If you can’t break it down, that leads to jaundice. Not harmful, just yellow skin, which is weird). And SGOT or a SGPT test (transanimation)5. What is a PAR-Q test?- This is the standard paperwork they give to clients before any test. Bunch of basic health questions6. What are the components of the medical history and the informed consent?- The medical history is obvious, you want to find out everything medical related, if physical, family history ect. - Informed consent is just a paper telling the client of the risks, benefits, purpose, their responsibilities, and their freedom of consent. 7. What are the risks factors for CVD? What are the signs and symptoms? What is the risk stratification? There are 8 possible risk factors and these will determine are much of a risk the patient is for CVD.- Age: Greater than 45 for men. Greater than 55 for women- Family history: Father or brother had MI or CVD problems before 55. Mother, or sister before 65- Dyslipidemia: LDL greater than 130, OR HDL less that 40, OR total CHL above 200 (If you have and HDL of greater than 60, it is a NEGATIVE factor, so you can take off a positive factor)- Hypertension: Blood pressure of 140/90 or greaterTony Berardi1- Smoking: If you smoke, are around smoke, or quit within 6 months- Sedentary: Be active at least 3 day 30 min for last 3 months- Obesity: BMI of 30 or greater- Glucose levels: if your IFG is between 100-125 (126 and higher is diabetic) or OGTT of 140-199 Now you add up the factors they have, and using the number you can classify them as low or med risk- Low risk: If they have 1 or less risk factors- Medium risk: If they have 2 or more. So they can have all 8 and still be moderate- High risk: Irrelevant of the risk factors. If they display any of the CVD symptoms, or if they have a metabolic disease, a know CVD, pulmonary, or had an MI. Now the symptoms of CDV- Angina, Dyspenea, Ankle edema, Palpitation/tachycardia, syncope, intermittent claudications, unusual fatigue, heart murmur, or orthopenea.8. How do the factors play in for a MD being present for exercise and tests?- Low risk individuals don’t need a MD for moderate or vigorous exercise. Moderate risks don’t need a MD for moderate, but they do for vigorous. And High risk need a MD for everything- For the testing it is pretty much the same. Low risk can do submax and max, Moderate can do submax, but need a MD present for a max test. High risk needs a MD present for submax and max.9. How do you classify individuals as low, moderate, or high risk. Know the new guidelines presented this summer.- A low risk individual is when they have 1 or less risk factors from that list. A moderate risk group has 2 or more risk factor (so they can have all 8, and still only be moderate). These groups also have none of the symptoms of cardiovascular disease. A high risk individual either had a previous MI, or has a metabolic disease, or a pulmonary issue. Even if they just have any of the symptoms of cardiovascular disease, they are considered high risk. 10. How to calculate BMI:Tony Berardi1- The units for BMI are Kg/m^2, so you have to convert the weight in pounds to kilograms. This is done by dividing by 2.2. Then you have to get their height in inches to meters. Since there is no conversion factor for a British unit into a metric unit, you have to first convert inches to centimeters by multiplying by 2.54. Then convert centimeters to meters by dividing by 1000, and then finally squaring it. Then just divide the Kg by the m^2.11. Know EKG leads for chest, limb, precordial, extremity, unipolar, bipolar. - There are 12 leads in the ECG, and these are formed by placing 10 electrodes on the thorax region. These are broken down to 6 limb leads and 6 precordial. The rest are just different names for the same thing Chest leads are the same as precordial leads. So V1-V6 Limb leads are the other 6 leads. Lead 1,2,3, aVF, aVR, aVL Extremity leads are the same thing as the limb leads Unipolar leads are everything expect lead 1,2,3 Bipolar leads are lead 1,2,3,12. Be able to identify the
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