Exercise and Ambulatory ECG Testing

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Questions and Answers

Match the following indications with their corresponding exercise (stress) ECG purposes:

Confirm diagnosis of angina = Diagnostic indication Evaluate stable angina = Diagnostic indication Assess prognosis following myocardial infarction = Prognostic indication Assess outcome after coronary revascularization = Treatment evaluation

Match the following positive test criteria with their respective descriptions:

Anginal pain occurs = Indicates a positive test ST segment shifts > 1 mm = Indicates a positive test Low threshold for ischaemia = High-risk finding Fall in BP on exercise = High-risk finding

Match the following high-risk findings with their definitions:

Widespread ischaemic ECG changes = Indicates severe risk during exercise Prolonged ischaemic ECG changes = Indicates severe risk during exercise Exercise-induced arrhythmia = Indicates potential cardiac risks Low threshold for ischaemia = Occurs at early exercise stages

Match the following conditions with their status regarding stress testing:

Acute coronary syndrome = Contraindication Decompensated heart failure = Contraindication Severe hypertension = Contraindication Stable angina = Allowed condition Signup and view all the answers

Match the following characteristics with their corresponding types of ECG recordings:

Continuous recordings = Ambulatory ECG Portable digital recorder = Ambulatory ECG Duration of 1 to 7 days = Ambulatory ECG Used for arrhythmia investigation = Ambulatory ECG purpose Signup and view all the answers

Match the following arrhythmia investigation uses with their respective purposes:

Suspected arrhythmia = Primary investigation indication Post-myocardial infarction monitoring = Prognostic evaluation Pre-operative assessment = Risk evaluation Heart failure management = Treatment evaluation Signup and view all the answers

Match the following test outcomes with their implications:

False positive results = Indicates a non-existent issue False negative results = Indicates missed diagnosis Unreliable screening = Inferior validity in general population Positive anginal response = Legitimate indication for further testing Signup and view all the answers

Match the following Bruce Protocol stages with their associated characteristics:

Stage 1 = Low exercise intensity Stage 2 = Moderate exercise intensity Stage 3 = High exercise intensity Stage 4 = Very high exercise intensity Signup and view all the answers

Match the following cardiac conditions with their corresponding diagnostic methods:

Acute Myocardial Infarction = Cardiac Troponins Valve Disease = Echocardiography Atrial Fibrillation = Echocardiography Pulmonary Embolus = Cardiac Troponins Signup and view all the answers

Match the following echocardiographic findings with their significance:

Left Ventricular Ejection Fraction = Assessment of Left Ventricular Function Vegetations = Endocarditis Pericardial Effusion = Detection of Fluid Around the Heart Structural Heart Disease = Atrial Fibrillation Signup and view all the answers

Match the following conditions with their association with troponin levels:

Septic Shock = Elevated Troponin Levels Congenital Heart Disease = Normal Troponin Levels Acute Pulmonary Oedema = Elevated Troponin Levels Myocarditis = Normal Troponin Levels Signup and view all the answers

Match the following echocardiography types with their definitions:

Two-Dimensional Echocardiography = Real-time imaging of heart structures Doppler Echocardiography = Assessment of blood flow using sound wave frequency shift Transesophageal Echocardiography = Imaging from the esophagus Stress Echocardiography = Assessment under physical or pharmacological stress Signup and view all the answers

Match the following indications for echocardiography with their descriptions:

Identification of Intracardiac Thrombus = Systemic Embolism Quantification of Valve Disease Severity = Heart Valve Assessment Detection of Atrial Fibrillation = Structural Heart Disease Identification Assessment of Wall Thickness = Left Ventricular Function Analysis Signup and view all the answers

Match the following cardiovascular conditions with relevant complications:

Acute Myocardial Infarction = Myocyte Damage Pulmonary Embolus = Hypoxia Septic Shock = Multi-organ Failure Acute Pulmonary Oedema = CHF Exacerbation Signup and view all the answers

Match the following cardiac biomarkers with their conditions:

Troponin I = Myocyte Necrosis B-type Natriuretic Peptide (BNP) = Heart Failure Creatine Kinase (CK) = Acute Coronary Syndrome Lactate Dehydrogenase (LDH) = Tissue Damage Signup and view all the answers

Match the following techniques with their functional roles in assessing heart health:

Echocardiography = Image Heart Structures Doppler Technique = Assess Blood Flow Dynamics Holter Monitoring = Arrhythmia Detection Cardiac MRI = Detailed Cardiac Imaging Signup and view all the answers

Match the following ECG technologies with their descriptions:

Ambulatory ECG = Monitors heart activity over an extended period for infrequent symptoms Patient-activated ECG recorders = Records rhythm during patient-activated episodes Implantable loop recorders = Implanted device for serious, infrequent symptoms investigation Holter monitor = Continuous monitoring of heart rhythms over 24-48 hours Signup and view all the answers

Match the cardiac biomarkers with their specific functions:

Brain natriuretic peptide = Secreted by the left ventricle, related to heart failure assessment NT-proBNP = Inactive fragment, useful for diagnosing heart dysfunction Troponin = Marker for myocardial infarction assessment Creatine kinase-MB = Enzyme that indicates myocardial damage Signup and view all the answers

Match the following ECG technologies with their lifespan or duration:

Ambulatory ECG = Used for several weeks until symptoms occur Patient-activated ECG recorders = Short-term use during symptom episodes Implantable loop recorders = Lasts for 1-3 years after implantation Holter monitor = Commonly used for 24-48 hours of continuous monitoring Signup and view all the answers

Match the following symptom conditions with the suitable ECG technology:

Infrequent symptoms = Patient-activated ECG recorders Serious symptoms such as syncope = Implantable loop recorders Transient myocardial ischaemia = Ambulatory ECG Continuous rhythm monitoring = Holter monitor Signup and view all the answers

Match the following biomarker characteristics with their descriptions:

BNP = Elevated in heart failure, assesses left ventricular function NT-proBNP = More useful for diagnosing and prognosing heart conditions Troponin = Sensitive indicator for myocardial injury Creatine kinase-MB = Provides information about recent myocardial infarction Signup and view all the answers

Match the following conditions with their related biomarkers:

Heart failure = Brain natriuretic peptide Myocardial infarction = Troponin Ischaemia = Creatine kinase-MB Systolic dysfunction = NT-proBNP Signup and view all the answers

Match the following explanations with the appropriate ECG method:

Record events as patient feels symptoms = Patient-activated ECG recorders Long-term monitoring device = Implantable loop recorders Provides continuous assessment for a short time = Holter monitor Used to assess heart rhythm during daily activities = Ambulatory ECG Signup and view all the answers

Match the terms related to atrial fibrillation with their definitions:

Rate control = Management of heart rate in atrial fibrillation patients Myocardial ischaemia = Condition of reduced blood flow to the heart muscle Cardiac biomarkers = Substances measured to evaluate heart conditions ST segment analysis = Used to detect ischemic changes in ECG Signup and view all the answers

Match the echocardiography types with their primary uses:

Doppler echocardiography = Detecting valvular regurgitation Transesophageal echocardiography = High-resolution images of cardiac structures Stress echocardiography = Investigating coronary artery disease Transthoracic echocardiography = Visualizing left atrial appendage and pulmonary veins Signup and view all the answers

Match the conditions investigated using echocardiography with their corresponding methods:

Prosthetic valve dysfunction = Transesophageal echocardiography Aortic dissection = Transesophageal echocardiography Infective endocarditis = Transesophageal echocardiography Coronary artery disease = Stress echocardiography Signup and view all the answers

Match the types of echocardiography with their advantages:

Transthoracic echocardiography = Non-invasive and easy to perform Transesophageal echocardiography = Great for structures difficult to visualize Doppler echocardiography = Measures blood flow direction and speed Stress echocardiography = Assesses myocardial viability under stress Signup and view all the answers

Match the patient conditions with the echocardiographic methods used:

Obesity or obstructive airways disease = Transthoracic echocardiography Mobility problems = Stress echocardiography Bundle branch block = Stress echocardiography High pressure gradients = Doppler echocardiography Signup and view all the answers

Match the echocardiographic techniques with their imaging characteristics:

Doppler echocardiography = Frequency shift measurement Transesophageal echocardiography = Invasive procedure for better images Transthoracic echocardiography = May produce poor images in certain patients Stress echocardiography = Performed with an inotrope infusion Signup and view all the answers

Match the abnormalities assessed by echocardiography with their corresponding tests:

Wall motion abnormality = Stress echocardiography Turbulence in flow = Doppler echocardiography Imperfect left ventricular function = Stress echocardiography Obstructed view of thoracic aorta = Transthoracic echocardiography Signup and view all the answers

Match the echocardiography types with their specific challenges:

Transthoracic echocardiography = Obese patients may cause poor images Transesophageal echocardiography = Invasive and requires sedation Stress echocardiography = Requires intravenous administration of drugs Doppler echocardiography = Affected by blood flow direction Signup and view all the answers

Match the conditions compatible with echocardiographic imaging to their discussion context:

Systemic embolism = Transesophageal echocardiography Congenital abnormalities = Transesophageal echocardiography Coronary artery disease = Stress echocardiography Valvular stenosis = Doppler echocardiography Signup and view all the answers

Match the imaging technique with its primary characteristic:

Computed Tomography (CT) = Useful for imaging cardiac chambers and great vessels Magnetic Resonance Imaging (MRI) = No ionizing radiation CT Coronary Angiography = Non-invasive assessment of chest pain Cardiac CT for quantification = Index of cardiovascular risk through coronary artery calcification Signup and view all the answers

Match the application of imaging with the technique used:

MRI = Imaging the aorta for suspected dissection CT = Imaging pulmonary arteries in suspected embolism CT Coronary Angiography = Initial assessment of coronary artery disease Cardiac CT scans = Quantification of coronary artery calcification Signup and view all the answers

Match the imaging technique with its primary usage context:

Computed Tomography = Suspected aortic dissection Magnetic Resonance Imaging = Congenital heart disease assessment Cardiac CT scans = Assessment of coronary artery disease risk CT Coronary Angiography = Exclusion of coronary artery disease Signup and view all the answers

Match the imaging modality with the type of radiation it uses:

Computed Tomography (CT) = Uses ionizing radiation Magnetic Resonance Imaging (MRI) = Uses magnetic fields Cardiac CT = Uses ionizing radiation CT Coronary Angiography = Uses ionizing radiation Signup and view all the answers

Match the imaging technique with its spatial resolution characteristic:

Multidetector CT = Spatial resolution approaching conventional coronary arteriography MRI = High-resolution cross-sectional images Standard CT = Lower radiation dose than traditional methods CT Coronary Angiography = High negative predictive value Signup and view all the answers

Match the imaging technique with the type of structures commonly imaged:

CT = Great vessels and mediastinal structures MRI = Heart, lungs, and aorta Cardiac CT scans = Coronary arteries CT Coronary Angiography = Coronary artery diseases Signup and view all the answers

Match the application context with the imaging technique:

MRI = Assessment of congenital heart anatomy CT = Imaging for suspected pulmonary embolism Cardiac CT scans = Assessment of cardiovascular risk CT Coronary Angiography = Evaluation of low or intermediate disease likelihood Signup and view all the answers

Match the use case with the imaging technique:

CT = Cardiac chamber imaging MRI = Non-invasive torso imaging CT Coronary Angiography = Chest pain evaluation Cardiac CT scans = Coronary artery calcification quantification Signup and view all the answers

Study Notes

Exercise (Stress) ECG

Common indications for exercise testing include confirming angina diagnosis, evaluating stable angina, assessing prognosis post-myocardial infarction, and diagnosing exercise-induced arrhythmias.
A stress test is considered positive with anginal pain or ST segment shifts >1 mm.
High-risk findings include a low threshold for ischemia (stages 1 or 2 of Bruce Protocol), a drop in blood pressure during exercise, and marked ischemic ECG changes.
Contraindications for stress testing include acute coronary syndrome, decompensated heart failure, severe hypertension, and severe pulmonary hypertension.

Ambulatory ECG

Continuous ambulatory ECG is recorded using portable digital devices for 1 to 7 days, indicated for suspected arrhythmias and assessing atrial fibrillation rate control.
Patient-activated ECG recorders allow patients to record episodes by placing a device on their chest, useful for infrequent symptoms.
Implantable loop recorders, lasting 1–3 years, investigate serious but infrequent symptoms like syncope.

Cardiac Biomarkers

Plasma or serum biomarkers assess myocardial dysfunction and ischemia, including Brain Natriuretic Peptide (BNP) and Troponin I/T.
BNP, secreted by the left ventricle, aids in diagnosing heart failure and differentiating cardiac causes of dyspnea. Its inactive fragment NT-proBNP is diagnostically more valuable due to its longer half-life.
Troponins are released during cardiac myocyte damage, crucial for diagnosing acute myocardial infarction, and can be elevated in pulmonary embolism and septic shock.

Echocardiography

Two-dimensional echocardiography visualizes heart structures in real-time for assessing cardiac function, especially left ventricular wall thickness and ejection fraction.
Common uses include evaluating left ventricular function, valve disease severity, and identifying vegetations in endocarditis, structural heart disease, and pericardial effusion.

Doppler Echocardiography

Utilizes the Doppler principle to measure blood flow speed and direction, helpful in detecting valvular regurgitation and stenosed valves through frequency shifts in reflected sound waves.

Transesophageal Echocardiography

Provides high-resolution images for difficult-to-visualize structures, useful for assessing prosthetic valve dysfunction, congenital abnormalities, aortic dissection, and infective endocarditis.

Stress Echocardiography

Used for patients unable to perform standard exercise stress testing; involves imaging before and after administering inotropes like dobutamine.
Identifies myocardial ischemia through wall motion abnormalities during stress, often examining myocardial viability in compromised left ventricular function.

Computed Tomographic Imaging

CT imaging is beneficial for visualizing cardiac chambers, great vessels, and mediastinal structures, especially in suspected aortic dissection and pulmonary embolism.
Cardiac CT can quantify coronary artery calcification, serving as an index for cardiovascular risk, and is effective for non-invasive coronary angiography with low radiation doses.

Magnetic Resonance Imaging (MRI)

MRI uses no ionizing radiation, providing cross-sectional imaging of the heart and surrounding structures.
Key applications include imaging the aorta for dissection and defining cardiac anatomy in congenital heart disease cases.

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Description

This quiz covers the indications and protocols for exercise and ambulatory ECG testing. You'll learn how to interpret results, understand contraindications, and the significance of various findings. Test your knowledge on these essential cardiovascular assessment techniques.