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Cardiac Stress Testing Protocols Flashcards

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  1. An 82-year-old female with limited mobility due to severe osteoarthritis is referred for a symptom-limited stress test to evaluate exertional dyspnea. Which of the following treadmill protocols would be most appropriate for this patient?

    Answer: Naughton Protocol

    The Naughton protocol is designed for deconditioned or elderly patients. It begins at a very low workload and increases the intensity in smaller, more gradual increments (typically 1 MET per stage) compared to the Standard Bruce or Ellestad protocols, making it more suitable for patients with limited exercise capacity. [3, 26] Dobutamine is a pharmacologic agent, not a treadmill protocol.

  2. What are the defining characteristics of each stage in the standard Bruce treadmill protocol?

    Answer: The speed and grade both increase every 3 minutes.

    The standard Bruce protocol is characterized by 3-minute stages where both the treadmill speed and the percent grade (incline) are increased simultaneously, leading to significant jumps in metabolic equivalents (METs) between stages. [11, 22, 25]

  3. A patient undergoing a dobutamine stress echocardiogram is unable to reach their target heart rate with the maximal dobutamine infusion. Which medication is commonly administered adjunctively to help achieve the target heart rate?

    Answer: Atropine

    Atropine is frequently used during dobutamine stress tests when the heart rate response is suboptimal. It is an anticholinergic agent that blocks the vagus nerve's effect on the heart, thereby increasing the heart rate to help reach the diagnostic target. [15] Metoprolol is a beta-blocker and would have the opposite effect.

  4. According to ACC/AHA guidelines, which of the following is considered an absolute indication to terminate an exercise stress test?

    Answer: Drop in systolic blood pressure >10 mmHg from baseline, accompanied by other evidence of ischemia

    A drop in systolic blood pressure of more than 10 mmHg from baseline during exercise, especially when accompanied by other signs of ischemia (like angina or significant ECG changes), is an absolute indication for immediate test termination due to the risk of severe myocardial dysfunction. [1, 2, 10] The other options are generally considered relative indications for termination.

  5. A 55-year-old patient is scheduled for a treadmill stress test. What is the patient's age-predicted maximum heart rate (APMHR), and what is the heart rate corresponding to 85% of the maximum, a common target for a diagnostically adequate study?

    Answer: APMHR: 165 bpm; 85% Target: 140 bpm

    The most commonly used formula to estimate age-predicted maximum heart rate is 220 minus the patient's age. For a 55-year-old: 220 - 55 = 165 bpm. To find the 85% target, calculate 165 * 0.85, which equals 140.25, rounded to 140 bpm. [8, 16, 22]

  6. A patient with a history of severe, active bronchospastic asthma requires a pharmacologic stress test. Which of the following agents is most strongly contraindicated?

    Answer: Adenosine

    Adenosine (and Dipyridamole) can cause significant bronchospasm and is contraindicated in patients with active wheezing or severe reactive airway disease. [4, 9, 14] Regadenoson is a more selective A2A agonist with a lower risk of bronchospasm, but caution is still advised. Dobutamine is an inotropic agent and is generally considered the safest pharmacologic stress agent for patients with severe bronchospastic disease. [4, 14]

Cardiac Stress Testing Protocols Flashcards — CCI Study Cards with Answers