11' Describe the changes in a normal electrocardiogram during an exercise test if abnormal responses

1

• 11. Describe the changes in a normal
  electrocardiogram during an exercise test if
  abnormal responses are present.

2
Principles of Exercise Testing

• Why conduct clinical exercise testing?
• Therapeutic application
• Diagnostic application
• Prognostic application
• Exercise testing is successful in
• Evaluating coronary artery disease and pulmonary
  symptoms.
• Evaluate the effects of cardiopulmonary
  procedures.
• Evaluate whether additional tests are required.
• Serve as basis for exercise prescription.

3
Value of Exercise Testing

• Sensitivity (confirming condition)
• True positive test
• False positive test
• True negative test
• False negative test
• Specificity (ruling out condition)
• Predictive accuracy (how accurately a test
  identifies the condition).

4
Health ScreeningRisk Stratification Before
Exercise

• Health risk necessary when working with the
  general population, particularly at-risk subsets
  of the population.
• Avoid individuals with contraindications.
• Identify those in need of specific testing before
  the start of an exercise program.
• Identify individuals who should only exercise
  under medical supervision.
• Use validated instruments for risk assessment.

5
ACSM Risk Classification

• Low risk
• Asymptomatic men lt45 years, women lt55 years, with
  maximum one risk factor for CAD.
• Moderate risk
• Men 45 years, women 55 years, with 2 or more
  risk factors for CAD.
• High risk
• Those with signs and symptoms of cardiovascular
  and/or pulmonary disease.
• There may also exist absolute or relative
  contraindications to exercise.

6
Selecting a Graded Exercise Protocol

• Matching the exercise mode and exercise protocol
  to the patient.
• Physical demands of the test and physical
  limitations of the test must be considered.
• Treadmill tests are preferred over cycling
  protocols or arm ergometry.
• Task-specific tests may need to be devised.

7
Types of Exercise Protocols

• Continuous vs. discontinuous.
• Duration of each stage.
• Ramp loading.
• Treadmill protocols for non-trained individuals.
• Bruce protocol (and modified Bruce protocol)
• Balke protocol (and modified Balke protocol)
• Pepper protocol
• Leg and arm ergometer protocols.

8
Exercise Electrocardiography

• ECG yields essential information about the
  activity of the myocardium during exercise.

9
Typical ECG Reading
10
(No Transcript)
11
Einthoven Triangle
12
Bipolar and Unipolar Leads
13
Hexaxial Array With the Angular Designations
14
Ventricular Activation
15
Three Sets of Chest Lead ECGs Showing Different
Patterns of R Wave Progression
16
Three Laws of Electrocardiography
17
Abnormal ECG Results

• Ischemic responses
• Subendocardial ischemia
• Transmural ischemia
• Arrhythmias
• Supraventricular arrhythmias
• Sinus bradycardia and sinus tachycardia
• Sinus arrhythmia
• Atrial premature beats and junctional premature
  beats
• Paroxysmal supraventricular tachycardia
• Atrial flutter and atrial fibrillation
• Ventricular arrhythmias

18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
(No Transcript)