Cardiology Assessment Quiz
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Questions and Answers

Which condition is commonly associated with a bluish coloration of the skin and mucous membranes?

  • Jaundice
  • Cyanosis (correct)
  • Pallor
  • Malar flush

Which posture is specifically indicative of left heart failure?

  • Prayer’s posture
  • Orthopneic posture (correct)
  • Squatting
  • Leaning forward

What does the presence of fever in a cardiac examination likely indicate?

  • Aortic incontinence
  • Pericarditis (correct)
  • Congestive heart failure
  • Rheumatic heart disease

Which of the following features would likely be seen in a patient with Marfan syndrome during a cardiac examination?

<p>Tall stature with sternum depression (C)</p> Signup and view all the answers

What abnormality might be detected from palpation of arterial pulsation during a general cardiac examination?

<p>Delayed pulsation (A)</p> Signup and view all the answers

What is a thrill at the apex indicative of?

<p>Mitral regurgitation (A)</p> Signup and view all the answers

In which location can a thrill associated with aortic stenosis be palpated during systole?

<p>Second right intercostal space (C)</p> Signup and view all the answers

What heart sound marks the beginning of diastole?

<p>S2 (D)</p> Signup and view all the answers

Which valve can be auscultated at the fourth left intercostal space?

<p>Tricuspid valve (D)</p> Signup and view all the answers

What is the characteristic sound of S3 during auscultation?

<p>Lub-dub-ta (A)</p> Signup and view all the answers

During which position is the thrill at the base of the heart best felt?

<p>Leaning forward and holding expiration (C)</p> Signup and view all the answers

Which of the following heart sounds is NOT of valvular origin?

<p>S3 (C)</p> Signup and view all the answers

What is the sound of S1 primarily caused by?

<p>Closure of atrioventricular valves (D)</p> Signup and view all the answers

What does the S4 sound indicate during auscultation?

<p>Blood being forced into a stiff or hypertrophic ventricle (A)</p> Signup and view all the answers

Which of the following best describes heart murmurs?

<p>Extra sounds made by turbulent blood flow due to faulty valves (C)</p> Signup and view all the answers

What is a primary purpose of cardiopulmonary exercise testing (CPET)?

<p>To assess exercise tolerance limits and mechanisms (C)</p> Signup and view all the answers

How does CPET differ from traditional exercise testing methods?

<p>It provides a noninvasive overview of multiple organ systems (B)</p> Signup and view all the answers

What is the aim of the exercise stimulus in CPET?

<p>To progressively increase the workload for evaluation (C)</p> Signup and view all the answers

Which condition is NOT an indication for cardiopulmonary exercise testing?

<p>Measurement of blood glucose levels (C)</p> Signup and view all the answers

What information does CPET provide that individual organ system assessments might not?

<p>Comprehensive insights into the integrative exercise responses of different body systems (B)</p> Signup and view all the answers

What is typically measured during cardiopulmonary exercise testing?

<p>Peak oxygen consumption per unit time (A)</p> Signup and view all the answers

What is defined as the resting metabolic unit equal to 3.5 ml O2 consumed per kilogram of body weight per minute?

<p>Metabolic Equivalent (MET) (A)</p> Signup and view all the answers

Which of the following is NOT a criterion for determining maximum exercise testing?

<p>Respiratory rate exceeding 50 breaths per minute (D)</p> Signup and view all the answers

What is a significant limitation faced by individuals during maximal exercise testing?

<p>Inability to reach Vo2max due to fatigue or impairments (B)</p> Signup and view all the answers

Which of the following best describes a submaximal exercise test?

<p>It can be used to predict maximum aerobic capacity. (D)</p> Signup and view all the answers

Which submaximal exercise test aims to predict maximal aerobic capacity?

<p>Modified Bruce Treadmill Test (B)</p> Signup and view all the answers

What is a common reason for using submaximal exercise testing over maximal testing?

<p>It is better suited for individuals with limitations like pain or fatigue. (A)</p> Signup and view all the answers

Which of the following types of tests is NOT included under submaximal exercise testing?

<p>Maximal performance tests (C)</p> Signup and view all the answers

What does Total Oxygen Consumption (VO2) primarily represent?

<p>The work of peripheral skeletal muscles (B)</p> Signup and view all the answers

What is the primary purpose of cardiopulmonary exercise testing?

<p>To evaluate organs and systems during exercise response (D)</p> Signup and view all the answers

Which of the following best describes the 12-Minute Walk Test?

<p>Covering as much ground as possible within 12 minutes (B)</p> Signup and view all the answers

Which exercise protocol involves short periods of exercise separated by rest?

<p>Discontinuous protocol (B)</p> Signup and view all the answers

What is the main advantage of using a treadmill or cycle ergometer in exercise testing?

<p>They allow for the study of exercise intensities in a short time (C)</p> Signup and view all the answers

During the 12-Minute Walk Test, what should be done if the participant needs encouragement?

<p>Provide predetermined phrases every 30 seconds (B)</p> Signup and view all the answers

What differentiates the progressive incremental exercise protocol from the constant work rate protocol?

<p>Incremental protocol increases work rate every minute (A)</p> Signup and view all the answers

Which of the following tests is NOT a self-paced walking test?

<p>20-Meter Shuttle Test (A)</p> Signup and view all the answers

How is the intensity of a discontinuous exercise protocol typically structured?

<p>Short periods of constant intensity with progressive increases (A)</p> Signup and view all the answers

What does a reduced Vo2 max primarily reflect?

<p>Oxygen transport problems (D)</p> Signup and view all the answers

Which factor influences the anaerobic threshold (AT) in individuals?

<p>Type of aerobic exercise (A)</p> Signup and view all the answers

At what range does the anaerobic threshold typically occur in sedentary individuals?

<p>35–80% Vo2max predicted (B)</p> Signup and view all the answers

Which physiological consequence does the buildup of lactic acid cause?

<p>Decreased pH in blood and interstitial fluid (B)</p> Signup and view all the answers

What might be indicated by a Vo2 max prediction below 40%?

<p>Potentially compromised cardiac performance (C)</p> Signup and view all the answers

How does increased ventilation (VE) help during exercise?

<p>By regulating gases and acid-base status (A)</p> Signup and view all the answers

Which of the following factors is NOT a limitation that could contribute to reduced Vo2 max?

<p>Increased body temperature (B)</p> Signup and view all the answers

Which of the following statements about the anaerobic threshold (AT) is true?

<p>AT is a measure of metabolic acidosis onset (A)</p> Signup and view all the answers

Flashcards

Orthopnea

Orthopnea is the difficulty in breathing when lying down, which is a common symptom of left-sided heart failure (LHF).

Squatting in CHD

Squatting is a position adopted by people with congenital heart disease (CHD) to improve their blood flow and reduce shortness of breath.

Leaning Forward in Pericarditis

Leaning forward is a posture characteristic of patients with pericarditis (inflammation of the sac surrounding the heart) or mediastinal syndrome, as it helps to ease the chest pain.

Cyanosis

Cyanosis is a bluish discoloration of the skin and mucous membranes due to low oxygen levels in the blood. It can be central (affecting the entire body) or peripheral (mainly affecting the extremities) and can be a sign of heart conditions, respiratory problems, or circulatory issues.

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Cardiac Edema

Cardiac edema is swelling caused by fluid build-up in the tissues due to heart failure. This can happen in the legs, ankles, or feet.

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Thrill

A palpable vibration felt over the chest wall, often associated with murmurs, indicating vigorous heart muscle contraction.

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Apical Thrill

A thrill felt at the apex of the heart when the patient is in the left lateral decubitus position and holding their breath during expiration. It can be systolic or diastolic.

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Basal Thrill

A thrill felt at the base of the heart when the patient is leaning forward and holding their breath during expiration. It is typically systolic.

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Thrill at the Base - Aortic Stenosis

A palpable vibration felt over the base of the heart at the 2nd intercostal space, right of the sternum, during systole. It is often associated with aortic stenosis.

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Thrill at the Apex - Mitral Regurgitation

A palpable vibration felt at the apex during systole. It is often associated with mitral regurgitation.

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Thrill at the Left 2nd ICS - Pulmonary Stenosis

A palpable vibration felt at the 2nd intercostal space to the left of the sternum during systole. It is often associated with pulmonary stenosis.

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Thrill at the Left 4th ICS - Ventricular Septal Defect

A palpable vibration felt at the 4th intercostal space to the left of the sternum. It is often associated with a small ventricular septal defect (Roger's disease).

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S1 Sound - Lub

The first heart sound, often described as 'lub', represents the closure of the AV valves (mitral and tricuspid).

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What is an S4 heart sound?

An extra heart sound produced by the sound of blood being forced into a stiff or hypertrophic ventricle; occurs prior to the first heart sound (S1).

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What are heart murmurs?

Extra sounds heard during the cardiac cycle, often described as whooshing or swishing sounds, caused by turbulent blood flow often due to a faulty valve.

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What is cardiopulmonary exercise testing (CPET)?

A comprehensive evaluation of the body's response to exercise, providing insights into the limits and mechanisms of exercise tolerance, as well as functional reserves of the organ systems involved.

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What is the significance of the integrative nature of CPET?

A dynamic physiological assessment that examines the integrative response of different body systems to exercise, providing a more complete picture compared to just looking at individual organ functions.

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What is the stimulus-response method used in CPET?

The application of a standard exercise stimulus to a subject to measure their physiological response and compare it to established standards.

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What is the purpose of progressively increasing the exercise stimulus in CPET?

The exercise stress is progressively increased to evaluate the response of organs and systems involved in oxygen transport from the environment to the body's tissues.

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What are normative standard values in CPET?

The values used as a comparison point for an individual's CPET results, derived from the typical responses of a healthy population to the same exercise stimulus.

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How is CPET used in clinical settings?

CPET is utilized in various clinical settings for assessing exercise tolerance, evaluating undiagnosed exercise intolerance, and identifying the limitations at peak exercise.

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Cardiopulmonary exercise testing

A type of exercise test that assesses how well the body responds to increasingly intense physical activity.

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Progressive incremental exercise protocol

A standard test that gradually increases the workload on the legs, usually by running on a treadmill or cycling on a stationary bike, to assess cardiovascular function.

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Multistage exercise protocol

A type of exercise test where the intensity is increased in stages, with a brief rest period at each level to allow the body to reach a steady state.

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Constant work rate protocol

An exercise test where the workload remains constant for a specific duration, typically 5 to 30 minutes, allowing the body to adapt to a specific level of exertion.

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Discontinuous exercise protocol

A type of exercise test that involves alternating between short bursts of exercise and rest periods, progressively increasing the workload with each cycle.

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12-Minute Walk Test

A walk test that measures how far a person can walk in 12 minutes. It is used to assess endurance and exercise capacity.

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Corridor for 12-Minute Walk Test

A corridor, approximately 20 meters in length, used for conducting walking tests, such as the 12-Minute Walk Test.

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Encouragement during 12-Minute Walk Test

Consistent encouragement given to the participant during the 12-Minute Walk Test, delivered every 30 seconds to help maintain motivation and a steady pace.

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Metabolic Equivalent (MET)

The amount of oxygen consumed by the whole body during rest; 1 MET is equivalent to 3.5 ml of oxygen consumed per kilogram of body weight per minute.

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Maximum Oxygen Consumption (VO2max)

The maximum amount of oxygen that the body can consume during exercise; a key indicator of cardiovascular fitness.

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Maximal Exercise Test

A type of exercise test that measures or predicts VO2max. It is considered the gold standard for assessing fitness.

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Predictive Submaximal Exercise Tests

These tests are designed to predict VO2max without requiring the subject to reach their maximum effort. They're often used for people who are unable to perform maximal tests due to limitations.

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Modified Bruce Treadmill Test

A popular predictive submaximal test that uses a treadmill and gradually increases the workload.

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Performance Submaximal Exercise Tests

These tests evaluate exercise performance without predicting VO2max. They're used to diagnose limitations, assess the effects of therapy, and track progress.

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Respiratory Exchange Ratio (RER) > 1.10

A respiratory exchange ratio greater than 1.10 indicates that the body is primarily using carbohydrates as fuel during exercise.

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Respiratory Exchange Ratio (RER)

This ratio is calculated during an exercise test by dividing carbon dioxide production by oxygen consumption.

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What are the factors that contribute to reduced VO2 max?

A multifaceted cause of reduced VO2 max, including factors such as oxygen transport, lung function, tissue oxygen extraction, muscle limitations and effort.

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What is the anaerobic threshold?

The point during exercise when the body starts to rely more heavily on anaerobic metabolism due to the increasing rate of lactate production.

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How is the anaerobic threshold measured?

The anaerobic threshold is expressed as a percentage of the predicted maximum oxygen uptake (VO2 max).

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What are the negative effects of increased lactic acid during exercise?

Increased lactic acid production during exercise reduces blood pH, which can impair cellular function.

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How does the body respond to increased lactic acid production during exercise?

Reduced blood pH stimulates ventilation as the body tries to remove carbon dioxide and buffer the excess acid.

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What is the typical range for anaerobic threshold in sedentary individuals?

The anaerobic threshold typically occurs between 50% to 60% of the predicted VO2 max in sedentary individuals, with a wide range of normal values.

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What factors influence the anaerobic threshold?

The anaerobic threshold is influenced by age and the type of exercise performed. Different muscle groups and exercise modalities can affect the threshold.

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What does a low anaerobic threshold indicate?

A low anaerobic threshold (below 40% of predicted VO2 max) can indicate heart, lung, or tissue oxygen supply problems, or underlying mitochondrial dysfunction.

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Study Notes

Cardiac Examination

  • Cardiac examination involves a subjective and objective approach.
  • Subjective assessment is based on patient interviews, including open-ended questions about symptoms related to heart conditions (e.g., dyspnea, chest pain, palpitations, syncope, cough, hemoptysis).
  • Objective assessment examines the patient, including general and local examinations, and specific tests like ECG, chest radiographs, and echocardiography.
  • Patient history involves medical record review, cognitive assessment, and symptom description by the patient.
  • Cardiac symptoms are pain above the waist that worsens with exertion and is relieved by rest. They commonly include chest pain, tightness, pressure, shortness of breath, palpitations, indigestion, and burning sensations.
  • A cardiac history includes identifying risk factors for heart disease, which are categorized as reversible (e.g., sedentary lifestyle, hyperlipidemia, cigarette smoking, diabetes mellitus, hypertension, obesity) and irreversible (e.g., male gender, past history of vascular disease, age, family history).

General Cardiac Examination

  • Physical development (body build) including posture (orthopneic and prayer posture).
  • Vital signs (heart rate—HR, respiratory rate, blood pressure—BP) and color (pallor, malar flush, cyanosis).
  • Additional physical assessments might include finger clubbing, edema, nodules, and fever.
  • Height and weight are important factors and might indicate conditions associated with CHD or RHD or with Atherosclerosis.

Local Cardiac Examination

  • Shape of precordium (bulging or chest deformities).
  • Identification of apex beat site.
  • Detection of abnormal pulsations and thrills.

Cardiopulmonary Exercise Testing (CPET)

  • CPET is a tool to assess exercise tolerance limits and mechanisms.
  • It evaluates functional reserves of organ systems during exercise and the onset of system limitations at peak exercise.
  • Exercise testing utilizes the stimulus-response method, where a standard stimulus is applied to a subject, and their physiological response is measured. Normative standard values of oxygen consumption (VO2) are derived from a healthy matched population.
  • CPET involves progressively increasing exercise intensity (e.g., by increasing workload or the rate of exercise) to measure responses at various levels of exertion.
  • CPET provides comprehensive assessment of multiple body systems;
  • This assessment differs from measuring individual organ system function.
  • CPET is noninvasive but can utilize additional equipment (e.g., electrocardiograph machine). Trained staff (especially, cardiologists) are commonly involved.
  • The test uses various submaximal and maximal testing protocols and equipment to achieve its results.
  • Maximum exercise tests are used to measure VO2max or determine this measure indirectly.
  • Submaximal tests are used to predict VO2max and for assessing functional limitations, outcomes of interventions, and the results of medication use.
  • Types of CPET are categorized as maximal tests and submaximal tests (predictive and performance submaximal types).
  • Specific examples of predictive submaximal tests include: Modified Bruce Treadmill Test, Single-Stage Submaximal Treadmill Walking Test, Astrand and Rythming Cycle Ergometer Test, Canadian Aerobic Fitness Test, 12-Minute Run Test, and 20-Meter Shuttle Test.
  • Specific examples of performance submaximal tests include: Self-Paced Walking Test, Modified Shuttle Walking Test, Bag and Carry Test, Timed Up & Go Test, and 12-and 6-Minute Walk Tests.
  • Equipment and methodology are part of the evaluation. Protocols include progressive incremental/continuous, multistage, and constant work-rate protocols. The approach considers efficiency and intensity.

Main measurements during CPET

  • Maximal oxygen uptake (VO2 max), is the maximum oxygen uptake, during dynamic exercise, or the highest obtainable O₂ value from inspired air during vigorous exercise. It involves large muscle group involvement.
  • Anaerobic threshold (AT), is a key index and is considered the threshold when metabolic acidosis takes place mainly due to the increased rate of rise of arterial lactic acid during exercise.
  • Ventilation (VE, VT, FR): These are key values assessed,
  • Peak respiratory exchange ratio (RER), is the ratio VCO₂/VO₂, an index of exercise output,
  • Exercise heart rate (HR); An increase of ~10 beats suggests a 3.5 increase (mL/min) in VO₂, and good effort means at least 85% of the predicted HR.
  • Exercise blood pressure (BP): An increase ~10 mm Hg in SBP per a 3.5-mL increase in VO2 is typical, but there are conditions where upper limits suggest problems (e.g., CVD).

Diagnostic criteria for CPET

  • Absolute end points: Signs of severe fatigue, patient request, sustained ventricular tachycardia, supraventricular tachycardia, moderate to severe angina, signs of poor perfusion, technical difficulties in monitoring ECG or BP, a drop in systolic BP despite increasing workload, new-onset atrial fibrillation, an ST elevation >1 mm, or an ST depression >2 mm, and systolic BP > 250 mmHg OR diastolic BP > 115 mmHg.

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Description

Test your knowledge on cardiac examination techniques and indicators. This quiz covers important aspects such as heart sounds, conditions associated with skin coloration, and features seen in specific syndromes like Marfan syndrome. Assess your understanding of left heart failure and the related findings during a cardiac exam.

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