Cardiac Stress Testing Protocols Flashcards
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Read the first 7 Cardiac Stress Testing Protocols flashcards as text
Which stress testing modality is preferred for evaluating coronary artery disease in a patient with a left bundle branch block (LBBB)?
Answer: Adenosine or regadenoson myocardial perfusion imaging
LBBB causes false-positive septal perfusion defects with exercise; vasodilator pharmacological stress (adenosine/regadenoson) with imaging avoids this artifact.
What is the maximum infusion rate of dobutamine typically used in a standard dobutamine stress echocardiography protocol?
Answer: 40 mcg/kg/min
The standard dobutamine stress echo protocol escalates to a maximum of 40 mcg/kg/min, with atropine added if target heart rate is not achieved.
A patient experiences chest pain and 3 mm downsloping ST depression in leads V4-V6 at 5 METs on a treadmill test. According to Duke Treadmill Score, which risk category does this represent?
Answer: High risk
A Duke Treadmill Score ≤ -11 (calculated from exercise time, ST deviation, and angina index) corresponds to high risk with significant ST depression at low workload.
What is the reversal agent for adenosine-induced severe bronchospasm or hypotension during pharmacological stress testing?
Answer: Aminophylline 50-100 mg IV
Aminophylline (theophylline) competitively antagonizes adenosine receptors and rapidly reverses adenosine-induced side effects.
Which of the following represents an absolute contraindication to exercise stress testing?
Answer: Uncontrolled symptomatic heart failure with resting dyspnea
Decompensated heart failure with active symptoms at rest is an absolute contraindication to exercise stress testing due to risk of acute decompensation.
During a stress test, a patient develops 2 mm horizontal ST depression in 5 leads at peak exercise, with the changes persisting for 8 minutes into recovery. What does prolonged ST depression recovery suggest?
Answer: More extensive ischemia and higher risk of significant CAD
ST depression persisting beyond 5 minutes into recovery is associated with more extensive ischemia and increased likelihood of significant multi-vessel coronary disease.
A technologist is setting up a modified Bruce protocol instead of the standard Bruce protocol. What is the key difference in a modified Bruce protocol?
Answer: It begins with two lower-workload warm-up stages before stage 1 of the standard protocol
The modified Bruce protocol adds stages 0 and 0.5 (lower speed/grade) before the standard stage 1, making it more appropriate for deconditioned or elderly patients.