Cardiac Stress Testing Protocols Flashcards
7 cards from real CCI practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Cardiac Stress Testing Protocols flashcards as text
Which lead configuration is considered most sensitive for detecting stress-induced ischemic ST changes during exercise ECG testing?
Answer: Leads V4, V5, and V6
The lateral precordial leads V4, V5, and V6 are most sensitive for detecting subendocardial ischemia during stress testing.
A patient with known Wolff-Parkinson-White (WPW) syndrome is referred for stress testing. Which statement about ST changes in WPW during exercise is correct?
Answer: WPW causes baseline ST abnormalities that make ECG interpretation unreliable during stress
The delta wave and secondary ST-T changes in WPW render ECG-based ischemia assessment unreliable; imaging modalities should be added for diagnostic purposes.
What is the minimum recommended systolic blood pressure threshold at which exercise stress testing should be terminated to prevent hypertensive emergency?
Answer: 220 mmHg
A systolic BP exceeding 220 mmHg during exercise is a relative indication to stop; >250 mmHg is considered a threshold for mandatory termination to prevent hypertensive crisis.
During a nuclear stress test using regadenoson, a patient develops a new fixed perfusion defect compared to rest images. What does a fixed defect most likely represent?
Answer: Prior myocardial infarction with scar tissue
A fixed (non-reversible) perfusion defect present on both stress and rest images indicates infarcted, non-viable myocardium.
In stress echocardiography, which wall motion abnormality pattern is most consistent with multi-vessel ischemia rather than single-vessel disease?
Answer: Stress-induced wall motion abnormalities in multiple non-contiguous territories
New wall motion abnormalities in multiple non-contiguous coronary territories at peak stress indicate multi-vessel disease with widespread ischemia.
What phenomenon is observed when a stress echocardiogram shows improved wall motion in a hypokinetic segment at low-dose dobutamine (5-10 mcg/kg/min) that worsens at high-dose dobutamine?
Answer: Hibernating myocardium — indicates viability and potential for recovery with revascularization
The biphasic response (improvement at low dose, deterioration at high dose) is the hallmark of hibernating myocardium, indicating viability and benefit from revascularization.
Which patient would be LEAST appropriate for a standard symptom-limited maximal exercise treadmill test without imaging?
Answer: 55-year-old male with prior CABG and baseline LBBB on ECG
LBBB on baseline ECG causes false-positive ST changes during exercise, making ECG-only stress testing uninterpretable and necessitating imaging adjuncts.