CCRP Exercise Testing 2 — Questions and Answers
Question 1: Which of the following is an absolute contraindication to exercise stress testing?
- Stable angina with recent medication adjustment
- Acute myocardial infarction within the past 2 days (Correct answer)
- Controlled hypertension with resting BP 150/90 mmHg
- Well-compensated chronic heart failure
Correct answer: Acute myocardial infarction within the past 2 days
Acute myocardial infarction within the past 2 days is an absolute contraindication to exercise stress testing per ACC/AHA guidelines due to risk of hemodynamic instability and infarct extension.
Question 2: What systolic blood pressure response during exercise testing indicates an absolute need to terminate the test?
- Rise to 180 mmHg in a symptomatic patient
- Drop of 10 mmHg or more from baseline despite increasing workload (Correct answer)
- Rise to 200 mmHg without associated symptoms
- Failure to exceed 130 mmHg at peak exercise
Correct answer: Drop of 10 mmHg or more from baseline despite increasing workload
A drop in systolic BP of 10 mmHg or more from baseline with increasing workload (exertional hypotension) is an absolute indication for test termination, suggesting severe LV dysfunction or hemodynamic compromise.
Question 3: In heart failure, a peak VO2 below what threshold indicates severely impaired functional capacity and may prompt transplant evaluation?
- 20 mL/kg/min
- 15 mL/kg/min
- 10 mL/kg/min (Correct answer)
- 25 mL/kg/min
Correct answer: 10 mL/kg/min
A peak VO2 below 10 mL/kg/min indicates severely impaired functional capacity and is one criterion used in heart failure advanced therapy and transplant listing decisions.
Question 4: The ventilatory (anaerobic) threshold during CPET is best defined as which of the following?
- The point at which heart rate exceeds 85% of the age-predicted maximum
- The exercise intensity at which lactate production exceeds clearance, causing a nonlinear rise in ventilation relative to VO2 (Correct answer)
- The maximum workload achieved during the exercise test
- The point at which respiratory rate exceeds 30 breaths per minute
Correct answer: The exercise intensity at which lactate production exceeds clearance, causing a nonlinear rise in ventilation relative to VO2
The ventilatory threshold is identified by a nonlinear increase in VE relative to VO2 (V-slope method), reflecting the point where lactate production exceeds buffering and clearance capacity.
Question 5: Chronotropic incompetence is defined as failure to achieve what percentage of the age-predicted maximum heart rate during maximal exercise testing?
- 70%
- 75%
- 80% (Correct answer)
- 90%
Correct answer: 80%
Chronotropic incompetence is defined as the inability to achieve 80% or more of the age-predicted maximum heart rate during maximal exercise, indicating impaired sympathetic heart rate augmentation.
Question 6: The Duke Treadmill Score is calculated using which combination of variables?
- Exercise duration, ST deviation, and angina index (Correct answer)
- Maximum heart rate, ST elevation, and peak blood pressure
- Peak VO2, RPE, and ST deviation
- Exercise duration, peak heart rate, and presence of arrhythmia
Correct answer: Exercise duration, ST deviation, and angina index
Duke Treadmill Score equals exercise time in minutes minus 5 times ST deviation in mm minus 4 times the angina index, stratifying patients into low, intermediate, or high cardiovascular risk categories.
Question 7: For an exercise stress test to be considered diagnostically adequate, what percentage of the age-predicted maximum heart rate should be achieved?
- 70%
- 75%
- 85% (Correct answer)
- 95%
Correct answer: 85%
Achieving 85% or more of the age-predicted maximum heart rate (220 minus age) is required for an exercise stress test to be diagnostically adequate, ensuring sufficient myocardial oxygen demand to provoke detectable ischemia.
CCRP Exercise Testing 2
Which of the following is an absolute contraindication to exercise stress testing?