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

Horizontal or downsloping ST-segment depression of ≥1 mm (and especially ≥2 mm) during exercise is the classic EKG sign of exercise-induced myocardial ischemia, reflecting subendocardial oxygen demand that outpaces supply.

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

Many arrhythmias — such as paroxysmal atrial fibrillation or nonsustained ventricular tachycardia — occur sporadically. A 24–48 hour Holter recording vastly increases the chance of capturing these transient events that a short resting EKG would miss.

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

When a patient's symptom diary timestamp aligns with ST depression on the Holter recording, it strongly suggests that the chest tightness was caused by ischemia rather than an arrhythmia, even in the absence of rhythm disturbances.

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

The Bruce Protocol is the most widely used treadmill exercise stress test, consisting of successive 3-minute stages where both belt speed and incline (grade) increase, progressively raising the patient's workload and heart rate.

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

A drop in systolic blood pressure of ≥10 mmHg from baseline during increasing exercise — known as exertional hypotension — is an absolute indication to stop the stress test immediately, as it may signal severe left ventricular dysfunction or hemodynamic instability.

EKG certification Practice Test

EKG certification Practice Test

EKG certification Certification EKG Stress Testing & Holter Monitoring 1