PET4551 SG Exam 2 28 05 2012 00 48 00 1 Know previous study guide 3 When should you stop a stress test Drop in SBP of 10 mmHg with increase in workload Onset of angina or angina like symptoms Failure of heart rate to increase Excessive rise in BP SBP 250 mmHg or DBP 15 mmHg Shortness of breath wheezing leg cramps claudication Noticeable change in heart rhythm Signs of poor perfusion light headiness confusion pallor pale nausea cold and clammy skin cyanosis Technical difficulties can t get BP or HR Subject s desire to stop ST segment elevation 1 0 mm that can mean ischemia or lack of BF Increasing nervous system symptoms dizziness or having a panic attack cardiorespiratory fitness 4 What are some field tests that we use to measure fixed distance tests fixed time tests 5 What are some of the advantages and disadvantages of submaximal testing Advantages o Inexpensive o Personnel require minimal amount of training test o Allow for mass testing o Test itself is shorter in duration compared to Max o Safer since it does not require maximal exertion o No physician needed if low risk o VO2 max can be estimated o Heart rate and BP are monitored o Useful in documenting changes due to intervention o Maximal HR BP RPP are not measured o VO2max not directly measured o Limited diagnostic value errors range from 10 20 o True max HR is not obtained for exercise prescription programs Disadvantages 6 submaximal testing Identify sources of errors that are involved in Errors in the measurement of workload or HR Age predicted max HR o Variability between individuals Variability in mechanical efficiency o Some people will require less O2 to perform a given Variability in submaximal HR at the same work rate on 7 What are the four assumptions we make when doing submaximal testing 1 A steady state HR is obtained for each exercise work work rate diferent days rate 2 A linear relationship exists between HR and work rate 3 The maximal HR for a given age is uniform 220 age bpm 4 Mechanical efficiency is similar for everyone this can differ among people as far as efficiency o Ex Short people on bench test need to expend more energy than someone taller to step up and down o 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 9 What is the Rating of Perceived Exertion Scale A valuable indicator for monitoring an individual s exercise tolerance cycle and bench step 10 Know general procedures for submaximal testing 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 MAP o HR 100 b min MAP 1 3 SBP DBP DBP o HR 100 b min MAP 1 2 SBP DBP DBP Direct measure of Mean Arterial Pressure MAP o MAP CO x TPR Pulse pressure SBP DBP Rate Pressure HR x SBP 100 12 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 HRrest Heart Rate Reserve Hrmax HRrest 13 Know how to calculate relative or absolute VO2 Relative VO2 mL kg min Absolute VO2 L min 14 Know the different ECG leads chest leads limb leads precordial extremity unipolar bipolar Frontal Extremity Limb Leads 6 o Bipolar I II III o Unipolar AVR AVL AVF aVr 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 plane o V1 V2 V3 V4 V5 V6 all Unipolar Lead V1 fourth intercostals space to R of sternum Lead V2 fourth intercostals space left of the sternum Lead V3 midway btwn leads V2 and V4 Lead V4 midclavicular line 5th intercostals space Lead V5 anterior axillary line same level as V4 Lead V6 midaxillary line same level as V4 Bipolar Leads are named because of the differences in electrical voltage between two unipolar extremities o Lead 1 LA RA aVL aVr o Lead 2 LL RA aVf aVr mm sec watts o Lead 3 LL LA aVf aVL o Lead I Lead III Lead II o aVr aVL aVf 0 Small box vertically amplitude 1 mm large box 5 mm Small box horizontally time 0 04 sec large box 0 2 sec 15 Know how to calculate heart rate Methods for HR o Small box method 1500 of small boxes o Large box method 300 of large boxes o 6 second method count number of peaks in a 6 second interval starting with 0 Small box vertically amplitude 1 mm large box 5 Small box horizontally time 0 04 sec large box 0 2 16 Know how to calculate work load in kgm min or Watts kg m min 6 12 17 Know equation for VO2max and cardiac output Fick Equation VO2 CO x a v O2 difference CO HR x SV 18 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 increases SBP increases as it is indirect measure of CO DBP indirect decreases or stays the same as it is an measure of TPR CO HR x SV o HR during exercise increases because HR 100 increases bc of decrease in parasympathetic activity HR 100 increases bc of increase in sympathetic activity Chatecolamine s are released by adrenal gland of kidney also help increase HR o SV increases during exercise because Frank 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 sites After Load Decreases resistance heart experiences on systemic side Treppe Effect intrinsic reflexive
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