1. Know previous study guide.3. When should you stop a stress test?Drop in SBP of > 10 mmHg with increase in workloadOnset of angina or angina-like symptomsFailure of heart rate to increaseExcessive rise in BP: SBP>250 mmHg or DBP > 15 mmHgShortness of breath, wheezing, leg cramps, claudicationNoticeable change in heart rhythmSigns of poor perfusion: light-headiness confusion, pallor (pale), nausea, cold and clammy skin, cyanosisTechnical difficulties (can’t get BP or HR)Subject’s desire to stopST segment elevation (+1.0 mm) – that can mean ischemia or lack of BFIncreasing nervous system symptoms (dizziness) or having a panic attack4. What are some field tests that we use to measure cardiorespiratory fitness?fixed distance tests, fixed time tests5. What are some of the advantages and disadvantages of submaximal testing?AdvantagesInexpensivePersonnel require minimal amount of trainingAllow for mass testingTest itself is shorter in duration (compared to Max test)Safer since it does not require maximal exertionNo physician needed if low riskVO2 max can be estimatedHeart rate and BP are monitoredUseful in documenting changes due to intervention programsDisadvantagesMaximal HR, BP, RPP are not measuredVO2max not directly measuredLimited diagnostic value errors range from 10-20%True max HR is not obtained for exercise prescription6. Identify sources of errors that are involved in submaximal testing.Errors in the measurement of workload or HRAge predicted max HRVariability between individualsVariability in mechanical efficiencySome people will require less O2 to perform a given work rateVariability in submaximal HR at the same work rate on diferent days7. What are the four assumptions we make when doing submaximal testing?1. A steady state HR is obtained for each exercise work rate.2. A linear relationship exists between HR and work rate.3. The maximal HR for a given age is uniform. (220 – age)4. Mechanical efficiency is similar for everyone. (this can differ among people as far as efficiency..Ex. Short people on bench test need to expend more energy than someone taller to step up and down.Another Ex. Less coordinated people expend more energy to do the same thing also).8. What is meant by steady state?Steady state = HR Doesn’t increase more than + or – 5 bpm9. What is the Rating of Perceived Exertion Scale?A valuable indicator for monitoring an individual’s exercise tolerance10. Know general procedures for submaximal testing cycle and bench step.Submax Test(page 123)Bench Step Test (page 113)11. Know systolic, diastolic, and mean arterial pressure. Know how to calculate MAP, PP, and RPP.Indirect Measure of MAPHR < 100 b/minMAP = (1/3(SBP-DBP)) + DBPHR > 100 b/minMAP = (1/2(SBP-DBP)) +DBPDirect measure of Mean Arterial Pressure (MAP)MAP = CO x TPRPulse pressure: (SBP – DBP)Rate Pressure = (HR x SBP)/10012. Know how to calculate the heart rate reserve from the Karvonen Formula. Be able to calculate intensity or target heart rate.Target HR = [(HRmax – HRrest)%] + HRrestHeart Rate Reserve= Hrmax-HRrest13. Know how to calculate relative or absolute VO2.Relative VO2: mL/kg/minAbsolute VO2: L/min14. Know the different ECG leads chest leads, limb leads, precordial, extremity, unipolar, bipolar.Frontal / Extremity/ Limb Leads (6)Bipolar: I, II, IIIUnipolar: AVR, AVL, AVFaVr=augmented voltage right arm, aVL=left arm and aVf=left side foot (not actually placed on the foot though)Chest/ Precordial Leads (6)- measure the horizontal planeV1, V2, V3, V4, V5, V6 (all Unipolar)Lead V1 fourth intercostals space to R of sternumLead V2 fourth intercostals space left of the sternumLead V3 midway btwn leads V2 and V4Lead V4 midclavicular line 5th intercostals spaceLead V5 anterior axillary line same level as V4Lead V6 midaxillary line same level as V4Bipolar Leads are named because of the differences in electrical voltage between two unipolar extremitiesLead 1 = LA –RA (aVL – aVr)Lead 2 = LL – RA (aVf – aVr)Lead 3 = LL – LA (aVf – aVL)Lead I + Lead III = Lead IIaVr + aVL + aVf = 0Small box vertically (amplitude) = 1 mm, large box = 5 mmSmall box horizontally (time) = 0.04 sec, large box = 0.2 sec15. Know how to calculate heart rate.Methods for HRSmall box method: 1500/# of small boxesLarge box method: 300/# of large boxes6-second method: count number of peaks in a 6 second interval starting with 0Small box vertically (amplitude) = 1 mm, large box = 5 mmSmall box horizontally (time) = 0.04 sec, large box = 0.2 sec16. Know how to calculate work load in kgm/min or watts.Watts = ((kg)(m)/min)/6.1217. Know equation for VO2max and cardiac output.Fick Equation: VO2 = CO x (a-v)O2 differenceCO= HR x SV18. Why does heart rate increase when one goes from the supine position to standing?HR is lowest in supine position. This is because blood pools in the chest and SV is highest. HR when standing is highest because blood pools in the legs and SV decreases due to gravity. CO stays the same in upright and supine positions due to the changes in HR and SV.19. What happens to systolic BP, diastolic BP, heart rate, RPP, PP, and MAP when you start exercising?SBP increases, DBP stays the same or decreases, HR increases to 100 because of a decrease in PNS activity, HR increases beyond 100 because of an increase in SNS activity, Catecholamine’s bind to beta-receptors at the SA node of the heart, making it fire more often. RPP increases, PP increases, MAP increases because CO increases more than TPR drops, CO increases, SV increases up to 40-50% VO2 max due to an increase in plasma, VO2 increasesSBP increases as it is indirect measure of CO; DBP decreases or stays the same as it is an indirect measure of TPRCO = HR x SVHR during exercise increases becauseHR <100 increases bc of decrease in parasympathetic activityHR > 100 increases bc of increase in sympathetic activityChatecolamine’s are released by adrenal gland of kidney also help increase HRSV increases during exercise becauseFrank Starling’s Mechanism: increase in venous return increase in end diastolic volume and increase in pre-load (stretching on ventricles) results in a greater volume of blood in the hearts chambers causing a more powerful stretch. This stretch triggers optimal binding of myosin to actin, which provides a more powerful contraction.Contractility: More calcium is released from the sarcoplasmic reticulum, which allows for more myosin to actin, which results in a more powerful contraction due to an increase in binding
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