Exercise Testing Study Guide 1 Tony Berardi 1 Know the modifiable and non modifiable risks for heart disease How does exercise improve these Modifiable would be their lipid level weight PA smoking obesity glucose tolerance and possible How else can individuals modify hypertension Non modifiable would be just age and family history Other possible things are to stop smoking and eating better Exercise obviously helps with pretty much everything Common sense 2 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 the body and is a powerful vasodilator It is what a nitroglycerine tablets contains for MI patient 3 What are the ranges for all that shit Cholesterol less than 200 is desirable HDL want more than 40 Hematocrit Men is 40 52 Women is 36 48 LDL less than 100 is ideal The risk factor is above 130 Triglycerides less than 150 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 Fasting glucose want less than 100 For OGTT you want below 140 Hemoglobin Men 13 5 17 g DL Women 11 5 15 5 g DL HbA1C between 5 7 6 4 is a sign of pre diabetic higher in diabetic Waist circumference lower than 40 in for men 35 for women Blood pressure normal is lower than 120 80 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 questions 6 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 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 Hypertension Blood pressure of 140 90 or greater 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 summer 9 How do you classify individuals as low moderate or high risk Know the new guidelines presented this 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 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 waves Know the leads and be able to determine the transition zone The EKG records the electrical activity in the heart as it moves there the different chambers The P wave represents atrial depolarization or contraction This …
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