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Stress Testing Protocols Flashcards

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  1. Which absolute contraindication requires immediate termination of a treadmill stress test?

    Answer: Sustained ventricular tachycardia develops

    Sustained ventricular tachycardia is an absolute indication to stop a stress test immediately due to the risk of hemodynamic compromise.

  2. In the Naughton protocol, how does the workload progression differ from the Bruce protocol?

    Answer: Naughton increases workload more gradually, making it suitable for deconditioned patients

    The Naughton protocol uses smaller, more gradual increments in speed and grade, making it better tolerated by deconditioned or post-MI patients.

  3. What is the primary purpose of the recovery phase monitoring period following a stress test?

    Answer: To detect delayed ischemic changes or arrhythmias that appear post-exercise

    Many significant ST changes and arrhythmias emerge or persist in recovery, making this phase critical for diagnostic accuracy.

  4. A patient's systolic blood pressure drops 20 mmHg below baseline during peak exercise. This finding most likely indicates:

    Answer: Significant left ventricular dysfunction or severe coronary artery disease

    Exertional hypotension (SBP drop ≥10–20 mmHg below baseline) suggests severe myocardial ischemia or left ventricular dysfunction and is a reason to stop the test.

  5. Which lead combination is considered MOST sensitive for detecting exercise-induced anterior ischemia during stress testing?

    Answer: V4 and V5

    Leads V4 and V5 overlie the anterior and lateral myocardium supplied by the LAD and are most sensitive for detecting anterior ischemic ST changes.

  6. During pharmacologic stress testing with adenosine, which medication should be withheld for at least 24 hours prior to the test?

    Answer: Dipyridamole (Persantine)

    Dipyridamole inhibits adenosine breakdown and potentiates its vasodilatory effects, making concomitant use dangerous and potentially causing excessive hypotension or heart block.

  7. What MET level is generally considered the threshold for good functional capacity in a standard adult stress test?

    Answer: 10 METs

    Achieving ≥10 METs indicates good functional capacity and is associated with a favorable prognosis regardless of ST changes.