CCI Cardiac Stress Testing Protocols 5

Question 1

A patient is referred for stress testing with a resting heart rate of 110 bpm. What is the most appropriate initial management before proceeding?

Accepted Answer

Investigate and treat the underlying cause of tachycardia before stress testing

Answer

Resting sinus tachycardia >100 bpm is a relative contraindication to stress testing; the cause should be identified and treated before proceeding.

Question 2

What is the significance of ST-segment elevation (not depression) appearing in leads without Q waves during an exercise stress test?

Accepted Answer

Indicator of severe transmural ischemia or coronary spasm requiring immediate attention

Answer

Exercise-induced ST elevation in leads without Q waves indicates severe transmural ischemia or vasospasm and requires immediate test termination.

Question 3

Which MET level achieved on exercise stress testing is generally considered to indicate good functional capacity and a favorable prognosis?

Accepted Answer

≥10 METs

Answer

Achieving ≥10 METs is associated with excellent prognosis regardless of ST-segment changes, as it reflects good cardiorespiratory fitness.

Question 4

A patient on a treadmill stress test develops a new 2 mm ST depression at 7 METs that fully resolves within 2 minutes of recovery. Using the Duke Treadmill Score formula (Exercise time − 5 × ST deviation − 4 × angina index), this would place the patient in which risk category?

Accepted Answer

Intermediate risk (score −10 to +4)

Answer

With approximately 7 minutes exercise time and 2 mm ST depression without angina: 7 − (5×2) − (4×0) = −3, which falls in the intermediate-risk range (−10 to +4).

Question 5

During a vasodilator pharmacological stress test, a patient develops complete heart block. What is the correct immediate intervention?

Accepted Answer

Administer aminophylline IV and place the patient supine

Answer

Aminophylline reverses adenosine receptor-mediated complete heart block; the agent's short half-life also means the block typically resolves rapidly with antagonism.

CCI - Cardiovascular Credentialing International Practice Test

CCI - Cardiovascular Credentialing International Practice Test

CCI Cardiac Stress Testing Protocols 5