Ischemia, MI Stages, and ECG Changes Quiz

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Questions and Answers

What is the purpose of comparing resting and activity levels in the same position when analyzing HR and BP responses to exercise and ADL?

To measure the ABI interpretation accurately.

To assess the impact of autonomic nervous system dysfunction.

To determine the status of the cardiovascular system with activity. (correct)

To evaluate the effectiveness of exercise prescription.

What does a decrease in SBP or DBP without an increase in HR indicate when changing positions from supine/sitting to standing?

Normal HR and BP response.

Indicates peak activity level.

Presence of autonomic nervous system dysfunction. (correct)

Sign of recovery phase after exercise.

What is the significance of ABI in assessing cardiovascular health?

Assessing arterial insufficiency in the legs. (correct)

Evaluating autonomic nervous system function.

Determining resting BP levels.

Measuring ankle and brachial pressure ratios.

Which technique is used to calculate the ankle-brachial ratio (ABI) for assessing cardiovascular health?

Applying cuff to the calf for leg pressure measurement. Signup and view all the answers

What does a 30/15 ratio < 1 indicate during HR and BP response analysis with positional changes?

Indicates presence of cardiovascular system dysfunction. Signup and view all the answers

Why is a higher ankle-brachial ratio considered normal in ABI interpretation?

boldTo show appropriate blood flow to the legs.bold Signup and view all the answers

What happens to Premature Ventricular Contractions (PVCs) with exercise?

PVCs decrease as heart rate increases Signup and view all the answers

How is ischemia related to the occurrence of angina?

Ischemia is brought on by exercise and relieved with rest or nitroglycerine Signup and view all the answers

What change in ST segment on an EKG indicates possible ischemia?

ST segment depression of 2 mm from the baseline Signup and view all the answers

How should angina be managed during exercise?

Terminate exercise and decrease workload Signup and view all the answers

What is the significance of distinguishing angina from other causes of chest pain?

To ensure proper management and treatment based on the cause Signup and view all the answers

What is the main reason for the increase in systolic blood pressure (SBP) during exercise?

Increased venous return Signup and view all the answers

In the context of cardiovascular dynamics during exercise, what does the rate pressure product (RPP) represent?

Measure of myocardial oxygen demand Signup and view all the answers

What characterizes an abnormal heart rate (HR) response during exercise known as arrhythmia?

Interruption in the normal rhythm of the heart Signup and view all the answers

In the context of acute responses to exercise, what is the likely cause of a poor and slow rise in heart rate with increased workloads?

Deconditioning and poor physical condition Signup and view all the answers

How does atrial arrhythmia affect forward blood flow in the cardiovascular system?

Decreases forward blood flow Signup and view all the answers

Which of the following is a sign of severe pain during exercise, comparable to the pain felt during a heart attack?

Pain becoming more intense causing the patient to stop what they are doing Signup and view all the answers

Which of the following is a reason to discontinue exercise based on the text provided?

Three or more consecutive PVC's Signup and view all the answers

What abnormal response should prompt one to seek medication for relief during exercise?

Drop in BP with exercise and dizziness Signup and view all the answers

When is Congestive Heart Failure (CHF) most likely to occur according to the text?

At rest or with exercise Signup and view all the answers

What is a key feature associated with Supraventricular Tachycardia (SVT) mentioned in the text?

Rise in heart rate Signup and view all the answers

During exercise, why does the coronary blood flow occur mainly in diastole?

To ensure the arteries are not choked off by high intramyocardial pressures Signup and view all the answers

Which vessels arise at an angle from epicardial vessels and branch within the subepicardial layer?

Class A vessels Signup and view all the answers

What happens to coronary blood flow during exercise compared to rest?

Stays constant at 4.5% of cardiac output Signup and view all the answers

Which statement best describes when coronary arteries fill and supply blood to the heart?

Primarily during diastole when the heart is relaxed Signup and view all the answers

Study Notes

Symptoms and Premature Ventricular Contraction (PVC)

Lightheadedness, dizziness, and syncope are symptoms of PVC
PVC requires closer evaluation and can be common in adults due to caffeine or pulmonary disease
Wide bizarre complexes can be dangerous and lead to lethal arrhythmia

PVC's and Exercise

PVC's decrease with exercise, which is a desired response, as higher heart rate suppresses PVC's
PVC's increase with exercise, which is a less desirable response, and may be ischemic in origin
No change in PVC's with exercise indicates that they are not exercise-related

Ischemia

Ischemia occurs when oxygen demand exceeds supply
It is brought on by exercise and relieved with rest or nitroglycerine
Changes in ST segment on EKG indicate ischemia, such as 1 mm depression or 2 mm depression if baseline is already depressed

Angina

Angina is a crushing sensation, but can also present as pain in jaw, arm, neck, or GI disturbances
It can be confused with musculoskeletal pain
If a patient develops angina, terminate exercise, decrease workload, and notify MD

Angina Levels

Level I: initial perception of discomfort
Level II: minimal discomfort worsens or extends to another area
Level III: pain becomes more intense and patient must stop activity
Level IV: severe pain, same as during a heart attack

Congestive Heart Failure (CHF)

Can have chronic CHF at rest or develop with exercise
Development of S3 heart sound, crackles in lungs, drop in SBP, rise in HR, and SOB indicate CHF

Reasons to Discontinue Exercise

3 or more consecutive PVC's
New onset multifocal PVC's
New onset A-fib or flutter
New onset supraventricular tachycardia (SVT)
New onset heart block
Chest discomfort
New onset dyspnea at lower workload than usual
Drop in BP with exercise
Dizziness
New musculoskeletal discomfort
New orthopedic or neurologic condition

Cardiac Rehabilitation

A multidisciplinary program for patients with heart disease to reach maximal functional potential
Includes education, psychosocial support, and exercise

Ischemia and MI

Ischemia requires 12-lead ECG and shows T-wave inversion and ST segment depression
Changes associated with MI include trans-mural and sub-endocardial MI, acute ST elevation, and hyper-acute T waves

STEMI and NSTEMI

STEMI: trans-mural MI, acute ST elevation, and hyper-acute T waves
NSTEMI: sub-endocardial MI, ST segment depression, and T-wave inversion

Cardiac Tamponade

Compression of the heart due to accumulation of fluid in the pericardial sac
Prevents ventricle from filling and contracting properly
Medical emergency and can be a complication of surgery or occur spontaneously

Phase I, II, and III Cardiac Rehabilitation

Phase I: early post-op, 1-2 days, focus on preventing pulmonary complications
Phase II: outpatient, 30-60 min, 3 days/week, for patients with arrhythmias, angina, or other medical issues
Phase III: location-based, 6-12 months, recommend regular medical check-ups

Conduction Disturbances

Disruptive of normal rate or rhythm, can be symptomatic (syncope, dizziness, angina, dyspnea, palpitations) or lethal (sudden cardiac death)
Treatment: medical, pacemaker, or AICD (Automatic Implantable Cardioverter Defibrillator)

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Description

Test your knowledge on ischemia, myocardial infarction stages (STEMI, NSTEMI), and ECG changes associated with different stages of MI. This quiz covers topics such as T wave inversion, ST segment depression, hyper-acute T waves, and more.