stress test Depending on the level of actvity this oxygen required

will increase
the purpose of the stress test is to produce
ischemia to find out if the heart as a significant 2mets equal to walking on a speed of 2mph
stable coronary artery disease. (from the word 4mets = walking
itself we try to give stress to the heart) <5mets = poor prognosis

when we say significant- there is a lesion in the Age predicted max HR (PMHR) = 220-age
coronary artery about 40-60% or any blockages You should achieve at least 85% to have a good
in the arteries of your heart. prognosis for tx

evaluate the blood flow to your heart Terminaton:

Doctors wil look for any significant ST segment
Indicatons contraindicatons elevaton or depression (upward/downward sloping) in
all leads but lead V5 outweigh any other leads esp limb
Types: leads bec it is prone for actfacts

There are different modalities of Stress testing 2 forms:

1. Routine treadmill using ECG only It is also 1.exercise
known as Exercise treadmill testing ETT or functional capacity- best predictor of how well someone
treadmill test TMT. This is where you run on a is going to do
treadmill
2. Stress Echocardiography in this test instead of purpose:
using the ECG, echo is used to evaluate the functional it is a non-invasive procedure
status of the heart in relation to the stress.
there are 2 ways to use stress echo: chest pain
1. Dobutamine stress echo or chemical stress echo CSE chek-up
where you inject dobutamine and increase the inotropic cardiac disease
and chronotropic activity of the heart and
look at the echo equipment
2. Exercise Stress Echo post exercise stress that iv inserted
means the patient can go on a treadmill with the ECG ekg
and also record the echo before, during and bp cuff
after the exercise spo2 monitor
3. Nuclear Imaging - Myocardial perfusion index this is treadmill
where a nuclear agent is used. This test take anywhere scanning machine
bet 2-4 hours
the MPI is calculated using a chemical stress either nuclear
dobutamine, adenosine or persantine arrive, get ur iv, inject agent (cardiolite) and it takes an
to increase the workload of the heart and see the hour to circulate thru ur system and collect into ur heart.
perfusion of the myocardium using a nuclear imaging then youl be taken images usually take 15 mins, then
where they take picture of your heart youl go to the stress lab and you will undergo either a
treadmill or a chemical agent like dobutamine. and then
preparaton: u will be injected again with the cardiolite isotope and
the ul wait another hour and then youl take another
equipments: images. (4hrs)

Protocols: lexiscant (before adenosine) dilates coronary arteries in

5-10secs, SOB, nausea, abd cramps, headache, flush
Mets: amount of oxygen required under vessel dobutamine (asthma) - iv drip increase overtym, heart
conditons. They required 3.5 mL O2/kg/min. increase to a target hr, and inject with radioisotope
exercise nuclear
performed on a treadmill, bruce protocol (start slow then
incline every 3mins and speed up and monitor changes
with the ekg

routine exercise stress (no nuclear)

you get up on the treadmill, attach on the ekg and bp
cuff, and you just exercise until you hit target HR using
protocol (Bruce) and a doctor wait for the client to reach
the HR and will look for any changes or any symptoms
you may be having, not as indepth as in nuclear imaging.
these may be stopped if the client experience
excruciating chest pain or significant ekg changes.

stress echo
Treadmill
chemical
resting echo using an ultrasound which will look into the
pumping action of your heart and do physical exercise
like treadmill or chemical like dobutamine to increase
you HR. when you reach the target HR they will take an
echo to see the perfusion of your heart

preparations:
nuclear stress (exercise/chemical)
NPO 4-6hrs
lexiscant (no persantine for , aminophylline for 24 hrs -
antidote, no caffeine, cofee, tea, meds for 24 hrs)
dobutamine (hold beta blockers, trop levels, hgb, hct, K,
Mg, Ph, D dimers)
routine exercise (iv, no beta blockers, NPO 4hrs,)
stress echo (npo 4hr, iv, no beta blockers)