Download Stress Testing Powerpoint

Stress Testing
Daymar College
Lisa H. Young, RN, BSN, MA Ed.
Kattus or Stress Testing
Diagnostic
Procedure
•Chest Pain
•Determine function capacity of
the heart after surgery or MI
•Screen for heart disease (CAD)
•Set limitations for exercise
program
•Abnormal heart rhythms
•Effectiveness of heart
medications
•Post angioplasty
•Family history of heart disease
http://www.youtube.com/watch?v=Z8nJgg59JsM&list=PL510FBA78000A7A05 &
http://www.youtube.com/watch?v=W9mxeMp7zHg
Absolute Contraindications
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Acute or Recent MI
Unstable angina or angina at rest
Rapid atrial or ventricular rhythms
Severe aortic stenosis
Dissecting aneurysm
2 or 3 degree heart block
Inflammation surrounding the heart
Severe anemia
Uncontrolled Hypertension
CHF
Relative Contraindications
• Uncontrolled rapid supraventricular rhythms
• Frequent PVCs
• Uncontrolled hypertension
• Mild or moderate aortic stenosis
Educating the Patient
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Possible complications and safety measures
Reason for the test
Explain the procedure
“Informed Consent”
Clothing
Medications
Preparing for the Stress Test
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Equipment check
Supplies
Emergency supplies
Physician’s order
Complete medical history, vital signs, EKG
Informed consent
Safety equipment
Test protocol
Belt length X cycles/minute (RPM) = speed
Post Stress Test Procedure
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Monitor and observe patient
Collect supplies
Avoid tobacco, caffeine and alcohol
Avoid extreme temperature changes
Rest
Results in approximately 10 days
Documentation
12 Lead Electrode Placement for
Ambulatory Monitoring/ Stress Test
Arm Ergometer
Leg Ergometer
Metabolic Equivalents
• Reflection of oxygen consumption
• 1 MET = person at rest/ 3.5 ml oxygen/kg/min
• 3 – 6 METs = moderate physical activity
• 4 METs = possible ischemia with CAD patient
Bruce and Modified Bruce Protocol
Naughton Protocol
Double Product
• Determine the level of exercise achieved
• HR X SBP = DP
• Exampled: SBP = 118
HR = 88
DP = 10384
Target or Maximum Heart Rate
• 220 minus age
• At least 85% of THR is achieved
• Example: pt age 60
220 --- 60 = 160
85% of 160 = 136
• 70% post MI
Termination of Stress Test
ST segment elevation/ ST depression > 3mm
Sustained Ventricular tachycardia or frequent PVCs
Chest pain/ pale and diaphoretic
Drop in blood pressure or failure of the BP to rise with
exercise/ elevation of 240mmHg or diastolic BP
above 120 mmHg
• Bradycardia, especially development of AV block
• Pt voices inability to continue; symptoms
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Stress Test Expected EKG Changes
• Shortened PR interval , RT interval & QT interval
• Decreased R wave amplitude (lower voltage
QRS)
• Tall P waves; increased amplitude
• Rightward axis shift
• T wave may become taller or inverted
• Increased heart rate (shorter R-R intervals)
• Increased ectopic activity with maximum
exercise
Chronotropic reserve
Chronotropic incompetence
Expected Clinical Symptoms
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Vasodilation decreasing systemic vascular resistance
Increased respiratory rate
Sweating
Fatigue
Muscle cramping
J point depression
Increased systolic blood pressure and slight
(5 – 10 mmHg) increase in diastolic pressure
Inotropic reserve / inotropic incompetence
Positive Stress Test
• ST segment depression or elevation of 1 mm or
more
• U wave inversion or new appearance
• Increased R wave amplitude in multiple leads
• QT interval lengthens with exercise with CAD
Reliability of Stress Test
• Angiogram
• Sensitivity
Positive
• Specificity
Negative
Categories of Stress Test
• True Positive
• False Positive
• True Negative
• False Negative
Bayes’s Theorem
• Accuracy
• Patient’s probability
of disease
• Risk assessment
Factors Affecting Interpretation
• Assess the equipment and settings
• Patient characteristics: activity level
medical problems
medications
• Interpretation of ECG strip: heart rate
regularity
ST segment changes
Post Stress Test
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“Cooling down” 10 – 15 minutes
Rest
Avoid extreme temperature changes
Avoid stimulants for at least 3 hours
Do not take a hot shower / bath
Results in about 10 days
Discuss results with physician
Poor Prognostic Findings
• Low workload
• Less than 6.5 METs
• Less than 5 – 6 minutes
• Low peak heart rate
• Low systolic blood pressure
• Significant ST segment depression or prolonged ST
segment depression
Nuclear Stress Test
• Radioactive substance (radiotracer)
• Noninvasive procedure/ 4- 6 hours
• Depict how the heart muscle is working
• Resting portion and exercise portion
Exercise Echo or Stress Echo
• Combines echocardiogram with exercise
• Diagnose coronary heart disease, assess results of
coronary procedures, certain types of heart muscle or
heart valve disease
• Performed at rest, then during and after exercise test
• 3 phases: resting echo images, exercise, & second
echo images
• http://www.youtube.com/watch?v=87XWZTIr-Xc
Pharmacologic Stress Test
• Physical limitations
• IV dose of medication
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Cardiolyte
Dobutamine
Dipyridamole
Adenosine
http://www.youtube.com/watch?v=wY347r1gFSg
Homer Heart Attack
Lexiscan
• Regadenoson
• IV dose 5 ml (0.4 mg)
• Not given with second or third degree AV blocks or
sinus node dysfunction (pacemaker)
• No caffeine for 12 hours before test
• Monitor for hypersensitivity
Dobutamine Stress Test
• Most commonly used
medication
• Adrenergic agonist
• Increased blood pressure
and heart rate
• Increased workload of the
heart
http://www.youtube.com/watch?v=t
qfwdzgB9cU
Dipyridamole or Persantine Stress Test
• Antiplatelet agent
• Dilates coronary vessels
• Accumulation adenosine
• http://www.youtube.com/watch?v=PZKScVAUEsk
Cardiolyte Stress Test
• Radioactive technetium
• Exercise and rest
• With a pharmacologic
stress test
• Labels red blood cells
• http://www.youtube.com/watch?v=g9LtAyJ4gZw
Adenosine or Cardiac Stress Test
http://www.youtube.com/watch?v=4tU9DC5ueio
Thallium Stress Test
• Myocardial perfusion
• Thallium 201
• “cold spot” vs
“hot spot”
• Side effects
• http://www.youtube.com/watch?v=fmtG4hx5F0Q
Tilt Table Test
http://www.youtube.com/watch?v=5H5FZTAic7c&list=PLjjz5qBEvYVX
c8yyflUWJcTC7NsEr_SAR
Tilt Table Procedure
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Supine position on table (feet flush to edge)
Strap patient to table
BP and 6 lead EKG
Tilt table 80 degrees for 30- 45 minutes
Isuprel infusion started
Alternate tilting table and increasing isuprel
Positive vs. Negative results
Recovery
Cardiac Scoring
• Test to assess risk of heart disease
• High-speed CT scanner
• 10 minutes
• Images of hardening arteries
• http://www.youtube.com/watch?v=HFeQZA0Ygrg
MUGA Stress Test
Echocardiogram: TE
Transthoracic echocardiogram
• Ultrasonic waves
• Diagnosis heart problems
• Doppler
http://www.youtube.com/watch?v=yVZ7jvsgyU4
http://www.youtube.com/watch?v=ZpGTq0vuO7E
Transesophageal Echocardiogram
• Scope with ultrasound
transducer
• Passed into esophagus
• Diagnose heart damage
• Valve damage
http://www.youtube.com/watch?v=42vaOjNdErQ
http://www.youtube.com/watch?v=VB4kDng3Frg
Intravascular Ultrasound
http://www.youtube.com/watch?v=N9Za6K2HyIQ
Positron Emission Tomography
http://www.youtube.com/watch?v=ltesoTEu7JE
CT Scanner/ CTA
http://www.youtube.com/watch?v=D3WynbxwTuI
MRI Scanner
http://www.youtube.com/watch?v=xeRyGuwpxWs
Life Vest
http://www.bing.com/videos/search?q=lifevest+video&FORM=VIRE12#vie
w=detail&mid=9F37968281C2800935AF9F37968281C2800935AF