EKG certification Certification EKG Stress Testing & Holter Monitoring 1

Question 1

During a treadmill stress test, which EKG change is considered a positive finding indicating myocardial ischemia?

Accepted Answer

ST-segment depression of 2 mm that is horizontal or downsloping

Answer

T-wave inversion of 1 mm in V1

Answer

Sinus tachycardia reaching 85% of the maximum predicted heart rate

Answer

Occasional premature atrial contractions during peak exercise

Question 2

A Holter monitor records continuously for 24–48 hours. What is the main clinical advantage of this extended recording period compared to a standard resting 12-lead EKG?

Accepted Answer

It captures intermittent arrhythmias that may not occur during a brief office visit

Answer

It provides higher voltage sensitivity for detecting bundle branch blocks

Answer

It measures beat-to-beat blood pressure changes alongside rhythm

Answer

It eliminates baseline artifact caused by patient movement

Question 3

A patient's Holter monitor diary shows she noted 'chest tightness' at 10:42 AM. The technician reviews the corresponding strip and finds no arrhythmia but sees 1.5 mm ST depression. What does this correlation most likely represent?

Accepted Answer

Symptomatic myocardial ischemia without an arrhythmia

Answer

Artifact from electrode movement during activity

Answer

Silent atrial flutter with variable block

Answer

Normal physiologic response to increased activity

Question 4

Which of the following best describes the Bruce Protocol used in exercise stress testing?

Accepted Answer

A treadmill protocol with stages that increase speed and incline every 3 minutes

Answer

A pharmacologic stress test using adenosine infused at a fixed rate

Answer

A bicycle ergometer test that increases pedaling resistance every 2 minutes

Answer

A supine leg-press protocol designed for patients who cannot walk

Question 5

What is the most appropriate action when a patient's systolic blood pressure drops by more than 10 mmHg from baseline during an exercise stress test despite increasing workload?

Accepted Answer

Immediately terminate the stress test as this is an absolute indication to stop

Answer

Increase the treadmill speed to push the patient to target heart rate

Answer

Continue monitoring and document the finding for the interpreting physician

Answer

Administer sublingual nitroglycerin and continue the test at the same stage

Question 6

After completing a 48-hour Holter recording, the patient returns the device. The technician notices the electrode in lead V5 position had poor skin contact for the last 12 hours, producing significant artifact. What is the most appropriate next step?

Accepted Answer

Note the artifact in the report, analyze the remaining clean lead data, and flag the affected time period for the interpreting physician

Answer

Report the full 48 hours of data as valid since two leads remained clean

Answer

Discard the entire recording and repeat the Holter immediately

Answer

Re-apply the electrode and extend the recording by another 12 hours to compensate