PET3932 – SECTION 02CUMULATIVE (FINAL) STUDY GUIDECh 1, 4, 5, & 6 (Exam 1 Material) – Benefits & risks associated with physical activity, Health-related physical fitness testing and interpretation, Clinical exercise testing, & Interpretation of clinical exercisetest resultsHandouts: History of Framingham Heart Study (link), Risk Assessment Tool (link), PA Compendium, Case Study 1 Clinical Exercise Testing (p.114) “Standard graded exercise tests (GXT) are used clinically to assess a patient’s ability to tolerate increasing intensities of aerobic exercise. Electrocardiographic (ECG), hemodynamic, and symptomatic responses are monitored during the GXT for manifestations of myocardial ischemia, hemodynamic/electrical instability, or other exertion-related signs or symptoms. Ventilator expired gas analysis may also be performed during the GXT, particularly in patients with congestive heart failure (CHF), suspected/confirmed pulmonary limitations, and/or unexplained Dyspnea upon exertion.” Assessment/Diagnosis of CAD/CHD (Looking for underlying Coronary Artery Disease) *this is what will be further discussed throughout this study guide. Risk factors Signs & symptoms Resting ECG (Electrocardiogram) Cardiac biomarkers measured to evaluate heart function (myocardial infarctions, etc.) Exercise ECG (including those done in the ER) Exercise nuclear imaging (perfusion, nuclear, thallium, cardiolite) Pharmacological how do they react to dobutamine, dipyridamole, & adenosine Echocardiography an ultrasound examination of the heart CT scan (electron beam computed tomography) Coronary angiography uses dyes & x-rays to show the inside of the coronary arteries. Autopsy Classification of CAD risk factors Primary non-modifiable (these are factors that cannot be changed) Advancing age Male gender Family Hx Primary modifiable (these are factors that can be changed) Dyslipidemia Hypertension Tobacco smoking Diabetes mellitus Overweight or obesity Sedentary lifestyle Atherogenic lifestyle promotes the formation of fat in arteries Emerging risk factors (lipids) lipid changes that happen over time Lipoprotein (α) Lipoprotein remnants Small LDL (low-density lipoprotein) particles HDL subspecies Apolipoproteins B & A-1 TC/HDL ratio (Total Cholesterol/High-Density Lipoprotein ratio) Emerging risk factors (non-lipids) other changes that happen over time Homocysteine (amino acid – LDL, clot) (metabolic syndrome) Thrombogenic & hemostatic factors Inflammatory markers (C-reactive protein) Impaired glucose tolerance Subclinical atherosclerosis & plaque burden Risk Assessment tool for estimating your 10-year risk of having a heart attack (handout): http://cvdrisk.nhlbi.nih.gov/calculator.asp Takes into account your age, gender, total cholesterol, HDL cholesterol, whether you smoke, systolic blood pressure, and if you’re taking medication for high blood pressure. Total cholesterol: the sum of all the cholesterol in your blood (the higher your total cholesterol, the greater your risk for heart disease).- Lower risk: < 200 mg/dL- Borderline-high risk: 200 – 239 mg/dL- More than twice the risk as someone below 200 mg/dL: ≥ 240 mg/dL HDL cholesterol: “good” cholesterol; high density lipoproteins (HDL) carry cholesterol in theblood from other parts of the body back to the liver; helps keep cholesterol from building upin the walls of the arteries; the higher your HDL, the better.- Major risk factor: < 40 mg/dL- Lower risk factor: 40 – 59 mg/dL- Protective against heart disease: ≥ 60 mg/dL Framingham Heart Study (handout): http://www.framinghamheartstudy.org/about-fhs/history.php “CVD is the leading cause of death & serious illness in the U.S.” This study was a big deal b/c, for the first time, it tracked a large group of people for a long period of time in order to identify the common factors or characteristics that contribute to CVD (participants had not suffered heart attacks, strokes, or CVD symptoms yet). After 3 generations of studies, extensive physical examinations, and lifestyle interviews, they found: The major CVD risk factors: high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity. The effects of related factors: blood triglyceride and HDL cholesterol levels, age, gender, and psychosocial issues. Major signs or symptoms suggestive of cardiovascular, pulmonary or metabolic disease Angina (symptom of hard/soft/silent ischemia) SOB at rest or with mild exertion Dizziness or syncope Orthopnea or paroxysmal nocturnal dyspnea Ankle edema Palpitations or tachycardia Intermittent claudication Known heart murmur Unusual fatigue or SOB with usual activities Prizmental (random heat problems – coronary spasms) Claudication → sign of diabetes ECG reading (p.148 *see images) P wave: electrical impulse going through atria (superior aspect of heart) Atrial depolarization (atria – pacemaker of the heart) QRS complex: electrical impulse going though the ventricles Ventrical depolarization T wave Ventrical repolarization – electrical recovery (repolarization) of the ventricles ST-segment depression: (p.149) Most common manifestation of exercise-induced myocardial ischemia “Horizontal or downsloping ST-segment depression is more indicative of myocardial ischemia than is upsloping depression.” ST-segment elevation: early repolarization (p.148) Evidence of transmural ischemia (acute MI) Will come back down as an inverted T wave Significant Q wave Old MI Q wave width: >40 msec Q wave height: > ¼ of R wave EKG – important pointers when performing test Magnitude: amount (1 ml, 2 ml, etc.) – the greater the amount, the worse it is Slope (ST-segment depression): upsloping (best)→horizontal→ downsloping (worst) Number of leads used Duration of EKG EKG – severity of ischemia ≥ 1 mL horizontal or downsloping ST depression is positive for ischemia If you see 2 mL → stop testing Use 2-lead to check for arrhythmia → arrhythmia can result in ischemia RPP: Rate Pressure Product “double product” RPP = Heart Rate [HR] x Systolic Blood Pressure [SBP] Signs of an acute MI Symptomology (myocardial
View Full Document