CVT Stress Testing Protocols 2 — Questions and Answers
Question 1: Which absolute contraindication requires immediate termination of a treadmill stress test?
- Patient reports mild fatigue
- Sustained ventricular tachycardia develops (Correct answer)
- Heart rate reaches 85% of maximum predicted
- Patient requests a water break
Correct answer: Sustained ventricular tachycardia develops
Sustained ventricular tachycardia is an absolute indication to stop a stress test immediately due to the risk of hemodynamic compromise.
Question 2: In the Naughton protocol, how does the workload progression differ from the Bruce protocol?
- Naughton uses steeper incline increases per stage
- Naughton increases workload more gradually, making it suitable for deconditioned patients (Correct answer)
- Naughton starts at a higher MET level than Bruce
- Naughton eliminates treadmill speed changes entirely
Correct answer: Naughton increases workload more gradually, making it suitable for deconditioned patients
The Naughton protocol uses smaller, more gradual increments in speed and grade, making it better tolerated by deconditioned or post-MI patients.
Question 3: What is the primary purpose of the recovery phase monitoring period following a stress test?
- To allow the patient to complete paperwork
- To detect delayed ischemic changes or arrhythmias that appear post-exercise (Correct answer)
- To calibrate the ECG equipment for the next patient
- To measure resting blood pressure only
Correct answer: To detect delayed ischemic changes or arrhythmias that appear post-exercise
Many significant ST changes and arrhythmias emerge or persist in recovery, making this phase critical for diagnostic accuracy.
Question 4: A patient's systolic blood pressure drops 20 mmHg below baseline during peak exercise. This finding most likely indicates:
- Normal hyperventilation response
- Significant left ventricular dysfunction or severe coronary artery disease (Correct answer)
- Appropriate peripheral vasodilation
- Equipment artifact from arm movement
Correct answer: Significant left ventricular dysfunction or severe coronary artery disease
Exertional hypotension (SBP drop ≥10–20 mmHg below baseline) suggests severe myocardial ischemia or left ventricular dysfunction and is a reason to stop the test.
Question 5: Which lead combination is considered MOST sensitive for detecting exercise-induced anterior ischemia during stress testing?
- aVR and aVL
- V4 and V5 (Correct answer)
- II and III
- aVF and V1
Correct answer: V4 and V5
Leads V4 and V5 overlie the anterior and lateral myocardium supplied by the LAD and are most sensitive for detecting anterior ischemic ST changes.
Question 6: During pharmacologic stress testing with adenosine, which medication should be withheld for at least 24 hours prior to the test?
- Aspirin
- Metformin
- Dipyridamole (Persantine) (Correct answer)
- Atorvastatin
Correct answer: Dipyridamole (Persantine)
Dipyridamole inhibits adenosine breakdown and potentiates its vasodilatory effects, making concomitant use dangerous and potentially causing excessive hypotension or heart block.
Question 7: What MET level is generally considered the threshold for good functional capacity in a standard adult stress test?
- 2 METs
- 5 METs
- 10 METs (Correct answer)
- 15 METs
Correct answer: 10 METs
Achieving ≥10 METs indicates good functional capacity and is associated with a favorable prognosis regardless of ST changes.
CVT Stress Testing Protocols 2
Which absolute contraindication requires immediate termination of a treadmill stress test?