06 18 2012 PET 4551 Exercise Testing and Prescription Study Guide Exam 3 JUST BECAUSE SOMETHING IS NOT RED DOESN T MEAN IT ISN T IMPORTANT 1 Previous Study guides WHAT YOU NEED TO KNOW FORM OTHER STUDY GUIDES WHAT I WROTE IN EXAM 1 STUDY GUIDE Review numbers 1 you should know 3 9 11 12 16 21 22 23 26 left right atrial enlargement ventricular hypertrophy WHAT I WROTE IN EXAM 2 STUDY GUIDE Review numbers 2 4 11 12 13 you should know 14 19 23 25 be able to identify 30 32 36 37 39 42 AND test yourself with the ARYTHMIAS I attached at the bottom 2 Metabolic Equations For this you want to master how to find kcal the amount of time it takes grade She likes to test you on those But review the other ones too Make sure you use the right equation Read the question as to which it is asking you to use THIS WEBSITE WILL HELP EXPLAIN http blue utb edu mbailey handouts pdf MetCalnew pdf 3 Know terms for isometric eccentric concentric isokinetic isotonic muscular strength muscular endurance and flexibility Know the physiological mechanisms of how strength increases over time Isometric keep the muscle at the same length throughout the whole contraction Examples pushing against a wall or the handgrip test Eccentric the lengthening of the muscle lasts about 3 4 seconds Example the downward motion of a bicep curl when using free weights Concentric the shortening of the muscle lasts about 2 3 seconds Example the upward motion or curl of the arm of a bicep curl when using free weights Isokinetic when you are using the same velocity Example Biodex very expensive so not used often Example when you use free weights or a bench press the tension won t change Isotonic when you have the same tension Muscular strength maximum force you can produce 1 RM Muscular Endurance ability for your muscles to lift at submaximal effort for an extended duration Until fatigue Flexibility ability of your joints to move through a full range of motion All you need to know about strength increasing is the order of which hypertrophy when the muscle increases in size occurs Increase number of motor units recruited Synchronization of those motor neurons Increase in firing rate Note Only after a few weeks does hypertrophy start and lean body mass Know conduction blocks First Degree Second degree Mobitz Type I aka increases Wenckebach block and Mobitz Type II and Third Degree Heart Block SHE LIKES TO ASK ABOUT ALL THREE CONDUCTION BLOCKS SO KNOW THEM Conduction block any obstruction or delay of the flow of electricity along the normal pathways of electrical conduction Sinus node block Indistinguishable from sinus arrest AV block block around the AV node Bundle branch block block in the ventricular bundle branches The AV block comes in three varieties First Degree Second Degree and Third Degree First Degree AV Block prolonged delay in conduction at the AV node The wave of depolarization spreads normally from the sinus node through the atria but upon reaching the AV node is held up for longer than the usual one tenth of a second Results in the PR interval being prolonged The diagnosis of first degree AV block requires only that the PR interval be longer than 0 2 seconds Normal to find in normal hearts but can also be an early sign of degenerative disease of the conduction system or a transient manifestation of myocarditis or drug toxicity Impulse gets through to the ventricle Second Degree AV block not every atrial impulse through AV node into the ventricles THERE ARE TWO TYPES Wenckebach block Type I Mobitz The difference is the PR interval gets more delayed with every beat because there is a variable block Eventually one signal doesn t not make it through so you will have a dropped beat P wave with no QRS and after the cycle will repeat Since it is in the AV node it will probably not progress to third degree block meaning it is benign usually Block within the AV gets longer and longer delay until one does not go thru usually every 3th or 4th one Mobitz Type Type II block below AV node progressive lengthening of the PR interval does not occur EKG shows normal PR interval and QRS complex then there will be a dropped beat There is no QRS complex no progressive lengthening of PR interval Mobitz type II often mandates insertion of a pacemaker Third Degree Block no atrial impulses make it through to activate the ventricles Ventricle respond by generating an escape beat at a rate of 30 to 45 beats per minute Atrial beat is normal around 60 to 100 beats per minute Ventricles are wide because of the ventricle origin Note that PVC s are seen since the ventricle pacemaker is firing This is almost always from a degenerative conduction problem or from an MI The patient needs a pacemaker to correct conduction Another example Know what the right and left bundle branch blocks look like Know characteristics Bundle blocks occur in the left and right bundle branches so they affect conduction of the signal to the left and right ventricles respectively This results in the QRS complex to be wide or have a weird shape Right Bundle Branch Block conduction through the right side of the heart across after the left side has depolarized This causes o QRS complex greater than 0 12 seconds will be wider V1 and V2 will have RSR pattern o Lateral left leads I aVl V5 and V6 will have deep S waves altered shape Left Bundle Branch Block o QRS complex greater than 0 12 wider o Lateral left leads I aVl V5 and V6 will have marked prolongation in the R waves which will have a brad or notched top Leads over right ventricle will have a deep wave o Left axis deviation may also occur very wide QRS complexes NOTE Repolarization is also affected So you might have ST depression and T wave inversion LEFT BUNDLE BRANCH is bad this is the location where the ventricle pumps blood to the whole body The block sometimes only occurs when the heart hits a certain rate AKA CRITICAL RATE 6 Know all of the arrhythmias including the two pre excitation conditions and the stages of a myocardial infarction Know how to diagnose a Myocardial Infarction What tests do we do Pre excitation Syndrome when conduction is generated more quickly Wolf Parkinson White Syndrome o Bypass AV node called Bundle of Kent so signal can get to the ventricles o PR interval less that 0 12 sec because of the faster signal o QRS complex widened and sloped wave called the delta wave early rising of faster the QRS complex NOTE There are two pathways so PSVT is more common in people who have wolf parkingsons white Lown
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