Stress Testing Protocols Flashcards
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Read the first 7 Stress Testing Protocols flashcards as text
Which ECG finding during stress testing is considered a POSITIVE test for ischemia under standard ACC/AHA criteria?
Answer: ≥1 mm horizontal or downsloping ST depression 80 ms after the J-point
Horizontal or downsloping ST depression of ≥1 mm measured 80 ms after the J-point is the standard positive criterion for exercise-induced ischemia.
In dobutamine stress echocardiography, which dose range is typically used to achieve peak stress?
Answer: 20–40 mcg/kg/min
Dobutamine is titrated from 10 mcg/kg/min up to 40 mcg/kg/min (with atropine added if needed) to achieve 85% of maximum predicted heart rate.
A patient undergoing a Bruce protocol reaches Stage III. Approximately how many METs has this patient achieved?
Answer: 10 METs
Stage III of the Bruce protocol (3.4 mph at 14% grade) corresponds to approximately 10 METs of oxygen consumption.
What is the recommended minimum duration for the post-stress ECG monitoring period?
Answer: At least 6–8 minutes or until abnormalities resolve
Post-exercise monitoring should continue for at least 6–8 minutes or until ECG changes and symptoms fully resolve, as late findings are diagnostically important.
Which heart rate target is used to define an adequate pharmacologic stress with regadenoson or adenosine for nuclear imaging?
Answer: Heart rate response is NOT the endpoint; vasodilation itself is the stressor
Vasodilator agents like adenosine and regadenoson induce coronary hyperemia directly and do not require a heart rate endpoint the way exercise or dobutamine testing does.
During stress testing, ST elevation in leads without prior Q-waves (non-infarct territory) most likely represents:
Answer: Severe transmural ischemia or coronary spasm
Exercise-induced ST elevation in non-Q-wave leads indicates severe transmural ischemia, often from critical proximal coronary stenosis or vasospasm, and is a test-stopping criterion.
The Duke Treadmill Score incorporates which three variables for risk stratification?
Answer: Exercise time, ST deviation, and angina index
The Duke Treadmill Score = exercise time – (5 × ST deviation) – (4 × angina index), stratifying patients into low, intermediate, or high-risk categories.