Exercise testing provides important information about cardiovascular function and prognosis. Key findings include heart rate and blood pressure response to exercise, presence of arrhythmias, ST segment changes indicating ischemia, and functional capacity measured in METs. Abnormal test results confer increased risk of cardiac events. Exercise testing is useful for evaluating known heart disease, stratifying risk before surgery or other procedures, and determining response to treatments like revascularization. Careful monitoring is needed due to small risks of complications from strenuous exercise.
This document provides information on treadmill exercise testing (TMT) including:
1. It describes how TMT is used to assess cardiovascular function and prognosis in patients with suspected or known cardiovascular disease by eliciting abnormalities not seen at rest.
2. It outlines normal physiological responses to exercise like increased heart rate, cardiac output and blood pressure and how these relate to metabolic equivalents (METs).
3. It discusses techniques for performing TMT including protocols, guidelines for patients, electrode placement, and criteria for interpreting abnormal ST segment changes and other exercise responses that provide diagnostic and prognostic information.
exercise testing and echocardiography.pptxEDWINjose43
This document discusses cardiopulmonary exercise testing (CPET), which evaluates the cardiovascular and respiratory systems' responses to exercise. CPET is used to diagnose and prognose cardiovascular and pulmonary diseases. It assesses functional capacity and identifies exercise-limiting factors. Common protocols include Bruce, Balke, and Naughton treadmill tests. Interpretation of CPET results considers symptoms, appearance, physical exam findings, exercise capacity, and hemodynamic responses. CPET provides diagnostic and prognostic information to evaluate functional impairment and guide treatment for cardiac and pulmonary conditions.
This document provides information about exercise stress testing, including:
1. Exercise stress testing is a fundamental test used to evaluate cardiovascular disease that is easy to perform, flexible, reliable, and inexpensive.
2. Exercise stress testing can elicit abnormalities not seen at rest, estimate functional capacity and prognosis of coronary artery disease, and evaluate many cardiovascular conditions.
3. Proper patient preparation, test protocol selection, monitoring during the test, and follow up are important to ensure safety and accurate results. Electrocardiogram measurements during the test help identify ischemic changes indicative of cardiovascular disease.
Tread mill test definition and indication.pptxsonsy
Exercise stress electrocardiography involves using exercise as a physiological stress to elicit cardiovascular abnormalities and assess cardiac function. It is a common noninvasive method to evaluate patients with suspected or proven cardiovascular disease. During exercise, there are increases in heart rate, blood pressure, cardiac output and oxygen consumption as the body's demands increase. Electrocardiographic changes during exercise can help estimate the likelihood and extent of coronary artery disease, prognosis, and response to therapy. Precise protocols, measurements, and safety procedures are followed during exercise testing.
Exercise stress electrocardiography is a noninvasive test used to assess cardiovascular function and detect abnormalities not present at rest. It places major demands on the cardiovascular system, increasing heart rate and cardiac output. Electrocardiographic measurements during exercise can detect ischemia through ST segment changes and estimate functional capacity. Precise protocols and safety guidelines are followed to safely conduct the test and interpret results.
Exercise stress testing can be used for diagnosis, prognosis, and treatment assessment of coronary artery disease. It measures a patient's functional capacity and oxygen uptake during exercise to evaluate disability. Electrocardiographic measurements are taken during exercise to detect ischemia through ST segment changes. An abnormal response is 1mm or greater of ST segment depression in multiple leads, indicating myocardial ischemia. Exercise stress testing has reasonable sensitivity and specificity for detecting coronary artery disease when used in intermediate-risk patients.
The document summarizes the treadmill exercise stress test, which evaluates blood flow to the heart muscle during physical exercise compared to at rest. It discusses the purpose of stress tests to detect abnormalities, describes how a regular treadmill stress test is performed involving gradually increasing the treadmill speed and monitoring the EKG and blood pressure. The nursing role is to prepare the patient, monitor them during the test, and provide instructions afterwards depending on the results.
This document provides information on treadmill exercise testing (TMT) including:
1. It describes how TMT is used to assess cardiovascular function and prognosis in patients with suspected or known cardiovascular disease by eliciting abnormalities not seen at rest.
2. It outlines normal physiological responses to exercise like increased heart rate, cardiac output and blood pressure and how these relate to metabolic equivalents (METs).
3. It discusses techniques for performing TMT including protocols, guidelines for patients, electrode placement, and criteria for interpreting abnormal ST segment changes and other exercise responses that provide diagnostic and prognostic information.
exercise testing and echocardiography.pptxEDWINjose43
This document discusses cardiopulmonary exercise testing (CPET), which evaluates the cardiovascular and respiratory systems' responses to exercise. CPET is used to diagnose and prognose cardiovascular and pulmonary diseases. It assesses functional capacity and identifies exercise-limiting factors. Common protocols include Bruce, Balke, and Naughton treadmill tests. Interpretation of CPET results considers symptoms, appearance, physical exam findings, exercise capacity, and hemodynamic responses. CPET provides diagnostic and prognostic information to evaluate functional impairment and guide treatment for cardiac and pulmonary conditions.
This document provides information about exercise stress testing, including:
1. Exercise stress testing is a fundamental test used to evaluate cardiovascular disease that is easy to perform, flexible, reliable, and inexpensive.
2. Exercise stress testing can elicit abnormalities not seen at rest, estimate functional capacity and prognosis of coronary artery disease, and evaluate many cardiovascular conditions.
3. Proper patient preparation, test protocol selection, monitoring during the test, and follow up are important to ensure safety and accurate results. Electrocardiogram measurements during the test help identify ischemic changes indicative of cardiovascular disease.
Tread mill test definition and indication.pptxsonsy
Exercise stress electrocardiography involves using exercise as a physiological stress to elicit cardiovascular abnormalities and assess cardiac function. It is a common noninvasive method to evaluate patients with suspected or proven cardiovascular disease. During exercise, there are increases in heart rate, blood pressure, cardiac output and oxygen consumption as the body's demands increase. Electrocardiographic changes during exercise can help estimate the likelihood and extent of coronary artery disease, prognosis, and response to therapy. Precise protocols, measurements, and safety procedures are followed during exercise testing.
Exercise stress electrocardiography is a noninvasive test used to assess cardiovascular function and detect abnormalities not present at rest. It places major demands on the cardiovascular system, increasing heart rate and cardiac output. Electrocardiographic measurements during exercise can detect ischemia through ST segment changes and estimate functional capacity. Precise protocols and safety guidelines are followed to safely conduct the test and interpret results.
Exercise stress testing can be used for diagnosis, prognosis, and treatment assessment of coronary artery disease. It measures a patient's functional capacity and oxygen uptake during exercise to evaluate disability. Electrocardiographic measurements are taken during exercise to detect ischemia through ST segment changes. An abnormal response is 1mm or greater of ST segment depression in multiple leads, indicating myocardial ischemia. Exercise stress testing has reasonable sensitivity and specificity for detecting coronary artery disease when used in intermediate-risk patients.
The document summarizes the treadmill exercise stress test, which evaluates blood flow to the heart muscle during physical exercise compared to at rest. It discusses the purpose of stress tests to detect abnormalities, describes how a regular treadmill stress test is performed involving gradually increasing the treadmill speed and monitoring the EKG and blood pressure. The nursing role is to prepare the patient, monitor them during the test, and provide instructions afterwards depending on the results.
This document provides information about treadmill stress testing, including indications, contraindications, preparation, technique, normal results, outcome measures, and clinical significance. It describes how treadmill stress testing involves monitoring electrocardiography and blood pressure during graded exercise to assess cardiovascular function and detect ischemia. Key aspects summarized are that it can help diagnose and assess prognosis of coronary artery disease, complications are rare but emergency equipment should be available, and abnormal results may warrant further testing or treatment depending on diagnostic accuracy and pretest likelihood of disease.
The document discusses an exercise tolerance test (ETT), which evaluates the cardiovascular system's response to exercise. During an ETT, a patient exercises on a treadmill or stationary bike while their heart rate, blood pressure, and ECG are monitored. The intensity of exercise is gradually increased until the patient becomes fatigued. ETTs can detect conditions like coronary artery disease and help develop safe exercise programs by assessing how the heart responds to exertion under stress. The procedure, indications, contraindications, and conditions detected are outlined.
Stress testing involves using exercise or medications to increase the heart rate and evaluate how the cardiovascular system responds to stress. There are several types of stress tests, with exercise stress tests being the most common. Exercise stress tests use treadmills or bicycles to gradually increase workload and monitor the patient's heart rate, blood pressure, ECG and symptoms. Stress tests can help detect ischemia, evaluate functional capacity and prognosis, and assess the effects of treatment in patients with suspected or known heart disease.
Exercise stress testing can be used to identify cardiovascular endurance and the likelihood of coronary artery disease. There are several types of stress tests that use equipment like treadmills, bicycles, or arm ergometers along with electrocardiogram monitoring. The tests aim to determine if physical exertion causes ischemia or inadequate oxygen supply to the heart. Results are reported as negative, positive, or inconclusive based on changes in the ECG tracing during physical exertion. Precautions must be taken as the tests carry a risk of inducing dangerous cardiac events.
The key points of exercise testing include manually measuring systolic blood pressure for safety, adjusting the protocol based on patient history, using the BORG scale to assess exertion rather than age-predicted heart rates, focusing on METs rather than exercise duration, using a ramp protocol when possible, avoiding hyperventilation and a cool down walk, using standard ECG analysis and a 3 minute recovery period, and considering heart rate recovery. The most important prognostic measurement is exercise capacity in METs. The most appropriate indicator of a maximal effort is the BORG scale.
The document describes a treadmill stress test procedure. It begins with an introduction explaining that a cardiac stress test measures the heart's response to external stress. It then discusses how treadmill tests work, providing indications and contraindications. Guidelines for the testing are provided, covering facilities, equipment, procedures, monitoring, termination criteria, and post-test monitoring. The full procedure is explained in detail over multiple steps.
This document summarizes several studies on the use of ACE inhibitors and angiotensin receptor blockers (ARBs) in treating heart failure and reducing cardiovascular risk. The HOPE trial showed that the ACE inhibitor ramipril reduced cardiovascular events in high-risk patients. The CHARM trial found that the ARB candesartan reduced cardiovascular outcomes in heart failure patients, both alone and in combination with ACE inhibitors. The ONTARGET trial aimed to compare the ARB telmisartan to ramipril, and their combination, to determine if telmisartan was non-inferior to ramipril and if their combination provided additional benefit.
The document provides information about Treadmill Test (TMT):
- TMT is a non-invasive method to evaluate ischemic heart disease by monitoring a patient's ECG, blood pressure, and symptoms while exercising on a treadmill.
- It can help detect abnormalities not seen at rest, estimate functional capacity and prognosis of coronary artery disease, and evaluate various cardiovascular conditions.
- During TMT, the treadmill speed and incline are increased according to a protocol while the patient is monitored for changes in ECG, heart rate, blood pressure, symptoms, and functional capacity measured in METs.
- Abnormal responses may include failure of heart rate to increase appropriately, chest pain, high blood pressure, and
Stress tests use physical or pharmacological stress to detect coronary artery disease. Exercise treadmill testing is commonly used but has limitations. Myocardial perfusion imaging and stress echocardiography can detect ischemia through changes in blood flow or wall motion abnormalities. The appropriate stress test depends on the patient's symptoms, physical limitations, and comorbidities to maximize diagnostic accuracy while avoiding risks.
Stress tests use physical or pharmacological stress to detect coronary artery disease. Exercise treadmill testing is commonly used but has limitations. Myocardial perfusion imaging and stress echocardiography can detect ischemia through abnormal perfusion or wall motion changes during stress. The choice of stress test depends on the patient's clinical characteristics and contraindications to certain stress modalities.
The document discusses different types of exercise tests used to evaluate cardiovascular function, including isometric, dynamic, and mixed exercises. It describes the Bruce protocol treadmill exercise test in detail as the gold standard. The document lists various indications for exercise tolerance testing according to guidelines including diagnosing coronary artery disease, risk assessment after acute myocardial infarction, and evaluating persons with valvular heart disease or congenital heart conditions. Contraindications and subject preparations are also outlined.
Cardiac rehabilitation aims to restore patients with cardiovascular disease to their optimal physiological and psychosocial status through a multiphase process. It focuses on exercise training, education, and risk factor reduction to improve outcomes such as exercise tolerance, symptoms, and quality of life while reducing mortality. Exercise begins conservatively in the inpatient phase and progresses in intensity through outpatient phases focused on maintenance.
This document provides guidelines for measuring, diagnosing, evaluating, and managing hypertension from the Department of Cardiology at Yangon General Hospital. It discusses proper techniques for measuring blood pressure, classifications of blood pressure levels, confirming a diagnosis of hypertension using ambulatory or home blood pressure monitoring, evaluating patients for target organ damage and cardiovascular risk factors, initial drug choices, lifestyle modifications, and managing special cases of hypertension. Resistant hypertension is addressed, defining it and outlining steps to identify and address contributing factors.
This document discusses the interpretation of clinical exercise test results, focusing on exercise testing as a screening tool for coronary artery disease. It provides details on typical and atypical angina symptoms and explains how exercise testing can be useful for assessing general health and precisely designing exercise prescriptions. The document also outlines various electrocardiographic, cardiorespiratory, and hemodynamic responses that can be measured during exercise testing, such as ST-segment changes, heart rate, blood pressure, and ventilatory measurements, and explains their clinical significance.
Clinical exercise testing is used increasingly in clinical practice for two main reasons (Wasserman)-Its impact in the clinical decision-making process -A growing awareness that resting cardiopulmonary measurements do not provide a reliable estimate of functional capacity. The following are the most popular clinical exercise tests, in order of increasing complexity: (a) 6-minute walk test (6MWT), (b) shuttle walk test, (c) exercise-induced bronchoconstriction (EIB), (d) cardiac stress test, and (e) cardiopulmonary exercise test (CPET). The modality is selected on the basis of clinical question to be addressed and the available equipment.
Modern devices such as implantable defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are playing an expanding role in treating heart failure. CRT aims to improve synchronization of ventricular contractions in patients with left bundle branch block and a widened QRS complex. It has been shown to improve symptoms, exercise capacity, and reduce hospitalizations and mortality in moderate to severe heart failure patients. ICDs provide protection against sudden cardiac death from arrhythmias in patients with reduced left ventricular ejection fraction. Guidelines recommend considering CRT for appropriate candidates with LVEF <35% and QRS >120ms and considering ICDs for those with LVEF <35% who are not in NYHA
principles of preoperative evaluation and preparation.pptxMahmood Hasan Taha
The importance of preoperative assessment and evaluation to prepare the patient to surgical procedure is directly proportional with the degree of successful of any surgical procedure.
So, good preoperative assessment and evolution is necessary to avoid the morbidity and mortality that expected to the surgical procedures.
This document provides an overview of hypertension including:
1. Definitions of hypertension and classifications of blood pressure levels.
2. Techniques for measuring blood pressure such as in-office or ambulatory monitoring.
3. Epidemiology and risk factors for hypertension including increased prevalence with age.
4. Approaches to evaluating and managing patients with hypertension including lifestyle modifications, pharmacologic treatments, and treatment goals.
Exercise testing is a noninvasive tool to evaluate the cardiovascular system's response to stress from exercise. During exercise, the body's metabolic rate and cardiac output increase substantially, placing high demands on the cardiopulmonary system. This makes exercise an effective way to assess cardiac function and perfusion. Various protocols exist for exercise testing using treadmills, bicycles, or other devices, with different protocols suited for evaluating patients with different cardiovascular conditions or exercise capacities. Careful analysis of electrocardiogram changes during and after exercise can provide information about myocardial ischemia.
This document discusses questions related to cardiac stress testing, including treadmill tests. It addresses indications for stress testing, how medications like beta-blockers may affect results, fasting requirements, contraindications, and the importance of Bayesian statistics in test ordering. Key points covered include overnight fasting or 2 hours post-prandial for exercise treadmill tests, >4 hours fasting for myocardial perfusion imaging tests, using stress tests to diagnose coronary artery disease or assess prognosis, and common reasons for exercise test termination.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
This document provides information about treadmill stress testing, including indications, contraindications, preparation, technique, normal results, outcome measures, and clinical significance. It describes how treadmill stress testing involves monitoring electrocardiography and blood pressure during graded exercise to assess cardiovascular function and detect ischemia. Key aspects summarized are that it can help diagnose and assess prognosis of coronary artery disease, complications are rare but emergency equipment should be available, and abnormal results may warrant further testing or treatment depending on diagnostic accuracy and pretest likelihood of disease.
The document discusses an exercise tolerance test (ETT), which evaluates the cardiovascular system's response to exercise. During an ETT, a patient exercises on a treadmill or stationary bike while their heart rate, blood pressure, and ECG are monitored. The intensity of exercise is gradually increased until the patient becomes fatigued. ETTs can detect conditions like coronary artery disease and help develop safe exercise programs by assessing how the heart responds to exertion under stress. The procedure, indications, contraindications, and conditions detected are outlined.
Stress testing involves using exercise or medications to increase the heart rate and evaluate how the cardiovascular system responds to stress. There are several types of stress tests, with exercise stress tests being the most common. Exercise stress tests use treadmills or bicycles to gradually increase workload and monitor the patient's heart rate, blood pressure, ECG and symptoms. Stress tests can help detect ischemia, evaluate functional capacity and prognosis, and assess the effects of treatment in patients with suspected or known heart disease.
Exercise stress testing can be used to identify cardiovascular endurance and the likelihood of coronary artery disease. There are several types of stress tests that use equipment like treadmills, bicycles, or arm ergometers along with electrocardiogram monitoring. The tests aim to determine if physical exertion causes ischemia or inadequate oxygen supply to the heart. Results are reported as negative, positive, or inconclusive based on changes in the ECG tracing during physical exertion. Precautions must be taken as the tests carry a risk of inducing dangerous cardiac events.
The key points of exercise testing include manually measuring systolic blood pressure for safety, adjusting the protocol based on patient history, using the BORG scale to assess exertion rather than age-predicted heart rates, focusing on METs rather than exercise duration, using a ramp protocol when possible, avoiding hyperventilation and a cool down walk, using standard ECG analysis and a 3 minute recovery period, and considering heart rate recovery. The most important prognostic measurement is exercise capacity in METs. The most appropriate indicator of a maximal effort is the BORG scale.
The document describes a treadmill stress test procedure. It begins with an introduction explaining that a cardiac stress test measures the heart's response to external stress. It then discusses how treadmill tests work, providing indications and contraindications. Guidelines for the testing are provided, covering facilities, equipment, procedures, monitoring, termination criteria, and post-test monitoring. The full procedure is explained in detail over multiple steps.
This document summarizes several studies on the use of ACE inhibitors and angiotensin receptor blockers (ARBs) in treating heart failure and reducing cardiovascular risk. The HOPE trial showed that the ACE inhibitor ramipril reduced cardiovascular events in high-risk patients. The CHARM trial found that the ARB candesartan reduced cardiovascular outcomes in heart failure patients, both alone and in combination with ACE inhibitors. The ONTARGET trial aimed to compare the ARB telmisartan to ramipril, and their combination, to determine if telmisartan was non-inferior to ramipril and if their combination provided additional benefit.
The document provides information about Treadmill Test (TMT):
- TMT is a non-invasive method to evaluate ischemic heart disease by monitoring a patient's ECG, blood pressure, and symptoms while exercising on a treadmill.
- It can help detect abnormalities not seen at rest, estimate functional capacity and prognosis of coronary artery disease, and evaluate various cardiovascular conditions.
- During TMT, the treadmill speed and incline are increased according to a protocol while the patient is monitored for changes in ECG, heart rate, blood pressure, symptoms, and functional capacity measured in METs.
- Abnormal responses may include failure of heart rate to increase appropriately, chest pain, high blood pressure, and
Stress tests use physical or pharmacological stress to detect coronary artery disease. Exercise treadmill testing is commonly used but has limitations. Myocardial perfusion imaging and stress echocardiography can detect ischemia through changes in blood flow or wall motion abnormalities. The appropriate stress test depends on the patient's symptoms, physical limitations, and comorbidities to maximize diagnostic accuracy while avoiding risks.
Stress tests use physical or pharmacological stress to detect coronary artery disease. Exercise treadmill testing is commonly used but has limitations. Myocardial perfusion imaging and stress echocardiography can detect ischemia through abnormal perfusion or wall motion changes during stress. The choice of stress test depends on the patient's clinical characteristics and contraindications to certain stress modalities.
The document discusses different types of exercise tests used to evaluate cardiovascular function, including isometric, dynamic, and mixed exercises. It describes the Bruce protocol treadmill exercise test in detail as the gold standard. The document lists various indications for exercise tolerance testing according to guidelines including diagnosing coronary artery disease, risk assessment after acute myocardial infarction, and evaluating persons with valvular heart disease or congenital heart conditions. Contraindications and subject preparations are also outlined.
Cardiac rehabilitation aims to restore patients with cardiovascular disease to their optimal physiological and psychosocial status through a multiphase process. It focuses on exercise training, education, and risk factor reduction to improve outcomes such as exercise tolerance, symptoms, and quality of life while reducing mortality. Exercise begins conservatively in the inpatient phase and progresses in intensity through outpatient phases focused on maintenance.
This document provides guidelines for measuring, diagnosing, evaluating, and managing hypertension from the Department of Cardiology at Yangon General Hospital. It discusses proper techniques for measuring blood pressure, classifications of blood pressure levels, confirming a diagnosis of hypertension using ambulatory or home blood pressure monitoring, evaluating patients for target organ damage and cardiovascular risk factors, initial drug choices, lifestyle modifications, and managing special cases of hypertension. Resistant hypertension is addressed, defining it and outlining steps to identify and address contributing factors.
This document discusses the interpretation of clinical exercise test results, focusing on exercise testing as a screening tool for coronary artery disease. It provides details on typical and atypical angina symptoms and explains how exercise testing can be useful for assessing general health and precisely designing exercise prescriptions. The document also outlines various electrocardiographic, cardiorespiratory, and hemodynamic responses that can be measured during exercise testing, such as ST-segment changes, heart rate, blood pressure, and ventilatory measurements, and explains their clinical significance.
Clinical exercise testing is used increasingly in clinical practice for two main reasons (Wasserman)-Its impact in the clinical decision-making process -A growing awareness that resting cardiopulmonary measurements do not provide a reliable estimate of functional capacity. The following are the most popular clinical exercise tests, in order of increasing complexity: (a) 6-minute walk test (6MWT), (b) shuttle walk test, (c) exercise-induced bronchoconstriction (EIB), (d) cardiac stress test, and (e) cardiopulmonary exercise test (CPET). The modality is selected on the basis of clinical question to be addressed and the available equipment.
Modern devices such as implantable defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are playing an expanding role in treating heart failure. CRT aims to improve synchronization of ventricular contractions in patients with left bundle branch block and a widened QRS complex. It has been shown to improve symptoms, exercise capacity, and reduce hospitalizations and mortality in moderate to severe heart failure patients. ICDs provide protection against sudden cardiac death from arrhythmias in patients with reduced left ventricular ejection fraction. Guidelines recommend considering CRT for appropriate candidates with LVEF <35% and QRS >120ms and considering ICDs for those with LVEF <35% who are not in NYHA
principles of preoperative evaluation and preparation.pptxMahmood Hasan Taha
The importance of preoperative assessment and evaluation to prepare the patient to surgical procedure is directly proportional with the degree of successful of any surgical procedure.
So, good preoperative assessment and evolution is necessary to avoid the morbidity and mortality that expected to the surgical procedures.
This document provides an overview of hypertension including:
1. Definitions of hypertension and classifications of blood pressure levels.
2. Techniques for measuring blood pressure such as in-office or ambulatory monitoring.
3. Epidemiology and risk factors for hypertension including increased prevalence with age.
4. Approaches to evaluating and managing patients with hypertension including lifestyle modifications, pharmacologic treatments, and treatment goals.
Exercise testing is a noninvasive tool to evaluate the cardiovascular system's response to stress from exercise. During exercise, the body's metabolic rate and cardiac output increase substantially, placing high demands on the cardiopulmonary system. This makes exercise an effective way to assess cardiac function and perfusion. Various protocols exist for exercise testing using treadmills, bicycles, or other devices, with different protocols suited for evaluating patients with different cardiovascular conditions or exercise capacities. Careful analysis of electrocardiogram changes during and after exercise can provide information about myocardial ischemia.
This document discusses questions related to cardiac stress testing, including treadmill tests. It addresses indications for stress testing, how medications like beta-blockers may affect results, fasting requirements, contraindications, and the importance of Bayesian statistics in test ordering. Key points covered include overnight fasting or 2 hours post-prandial for exercise treadmill tests, >4 hours fasting for myocardial perfusion imaging tests, using stress tests to diagnose coronary artery disease or assess prognosis, and common reasons for exercise test termination.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
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Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
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Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
3. MET Values
1 MET = "Basal" = 3.5 ml O2 /Kg/min
2 METs = 2 mph on level
4 METs = 4 mph on level
4. 10 METs = As good a prognosis with
medical therapy as CABS
13 METs = Excellent prognosis, regardless
of other exercise responses
16 METs = Aerobic master athlete
20 METs = Aerobic athlete
5. Calculation of METs on the Treadmill
METs = Speed x [0.1 + (Grade x 1.8)] + 3.5
3.5
Calculated automatically by Device!
Note: Speed in meters/minute
conversion = MPH x 26.8
Grade expressed as a fraction
6. Exercise is a common physiological stress used to
elicit cardiovascular abnormalities not present at rest
and to determine adequacy of cardiac function.
TMT is the one of the most frequent noninvasive
modalities used to assess patients with suspected or
proven cardiovascular disease.
It is used to estimate the prognosis and to determine
functional capacity, the likelihood and extent of CAD
& effects of therapy.
7.
8. Tread mill protocol
1.Bruce multistage maximal treadmill protocol has
3min periods to achive steady state before workload is
increased. In older individuals or those whose exercise
capacity is limited, it can be modified by two 3 min
warm up stages at 1.7mph and 0 percent grade and
1.7mph and 5%grade.
2.The Naughton and Weber protocols use 1-2min stages
with 1-MET increments between stages,
3.Asymptomatic cardiac ischemia pilot trial and
modified ACIP protocols use 2min stages with 1.5mets
increments between stages after two 1min warm up
9. Formula to estimate VO2 from treadmill speed and grade
is
Vo2 (ml O2/kg/min)=(mph *2.68)
+(1.8*26.82*mph*grade/100)+3.5
10.
11.
12.
13.
14. Technique
1.Patients should be instructed not to drink,eat caffeinated
beverages or smoke 3hr before testing & to wear
comfortable shoes and clothes.
2.Unusual physical exertion should be avoided
3.Brief history & physical examination should be
performed
4.Should be instructed about risks and benefits
5. Informed consent is taken
15. 6.12 lead ECG is recorded with electrodes at the distal
extremities
8.Torso ECG is obtained in standing and sitting position
9.If false +ve test is suspected,hyperventilation should be
performed
11.Area of electrode application should be rubbed with
alcohol saturated pad to remove oil and rubbed with
sand paper to reduce skin resistance to 5000ohms or less
16. 12.cables should be light flexible and shielded
13 room temp should be 18 –24 C & humidity less than
60%
13.walking should be demonstrated to the patient
14.HR, BP & ECG should be recorded at the end of each
stage.
15.Minimum of 3 leads should be displayed continuously
on the monitor
16.A resuscitator cart, defibrillator and appropriate
cardioactive drugs should be available in the TMT room.
17. IV line should be started in high risk patients.
17.
18.
19. Lead system:
1.Arm electrodes should be located in the most lateral aspect
of infra clavicular fosse & leg electrode should be above ant
iliac crest and below rib cage
2.bipolar lead groups place the negative electrode over
manubrium(CM5), right scapula (CB5), RV5 (CC5),or on
the forehead (CH5) and active electrode at V5
20. 1.In myocardial ischemia, ST segment becomes horizontal,
with progressive exercise depth of ST segment may increase
2.In immediate post recovery phase ST segment displacement
may persist with down sloping ST segments and T wave
inversion returning to baseline after 5-10 min
3.In 10% , ischemic response may appear in recovery phase
21. 1. PQ junction is chosen as isoelectric point , TP segment is
true isoelectric point but impractical choice
2. Development of 0.1mv (1mm) or greater of ST segment
depression measured from PQ junction with a relatively flat
ST segment slope (e.g. <0.7-1mv /sec), 80 msec after J point
(ST 80) in 3 consecutive beats with a stable base line is
considered to be abnormal response
22.
23. 3.When ST 80 measurement is difficult to determine at
rapid heart rates ST 60 measurements should be used
4.when ST segment is depressed at rest, j point or ST 80
measurements should be depressed an additional 0.1mv
or more, to consider abnormal
24. Upsloping ST segment
In patients with high CAD prevalence, slow up sloping ST
segment depressed 0.15mv or greater at 80msec, after J point
is considered abnormal
ST segment elevation
Development of 0.1mv ( 1mm) or greater of J point
elevation, at 60msec after J point in 3 consecutive beats with
stable baseline is considered abnormal response.
Occurs in 30% of AWMI & 15% of IWMI
When it occurs in non q wave lead in a patient without
previous MI it indicates transmural ischemia caused by
coronary spasm or high grade coronary narrowing.
ST elevation is relatively specific for territory of ischemia
25.
26.
27.
28. Blood pressure:
1.Normal exercise response is to increase systolic BP
progressively with increasing workloads. In normal persons
diastolic BP doesn’t change significantly
2.Failure to increase systolic BP beyond 120mm Hg, or a
sustained decrease greater than 10 mmHg is abnormal
29. Heart rate response
Sinus rate increases progressively with exercise.
Inappropriate increase in heart rate at low exercise work
loads may occur in patients who are in AF,physically
deconditioned, hypovolumic, anemic, or have marginal left
ventricular function
30. Chronotropic incompetence is determined by decreased heart
rate sensitivity to the normal increase in sympathetic tone
during exercise and is defined as inability to increase heart rate
to at least 85%of age predicted maximum. Heart rate reserve is
calculated as
Chronotropic index refers to heart rate increment per stage
of exercise that is below normal.
It indicates autonomic dysfunction, sinus node disease, drug
therapy(beta blockers), myocardial ischemic response.
When chronotropic index is less than 80%, long term
mortality is increased
31. Tread mill (TM) score: is designed to provide survival
estimates based on results from exercise test. Provides accurate
prognostic & diagnostic information
TM score:
Exercise time-(5*ST deviation)-(4*treadmill angina index)
Angina index-
0-if no angina
1-if typical angina occurs during exercise
2-if angina was the reason pt stopped exercise
<5-low risk:no coronary art stenosis or svd-5yr survival of 97%
-10 to+4 :-moderate risk --- 5yr survival of 91%
>11– high risk: 3vd or Lt main CAD:- 5yr survival of 72%
32. Rate-pressure product
Heart rate –systolic BP product increases progressively with
exercise and peak rate pressure product can be used to
characterize cardiovascular performance.
Normal individuals develop peak rate-pressure product of 20-
35 mmHg *beats/min* 10-3
Chest discomfort
Chest discomfort usually occurs after the onset of ST segment
abnormality
33. 1.Sensitivity in patients with CAD is 68% and specificity is
77%
2.In SVD -- sensitivity is 25-71%
3.In multivessel CAD-- sensitivity is 81%, specificity is 66%
4.Left main or 3vd -- sensitivity is 86%, specificity is 53%
34.
35.
36. Asymptomatic population
Prevalence of abnormal TMT in asymptomatic middle
aged men ranges from 5-12%.
Appropriate asymptomatic subjects would be those with an
estimated annual risk greater than 1 or 2% per year.
Symptomatic patients
Exercise should be routinely performed in patients with
chronic ischemic heart disease before CAG.
Patients who have excellent effort tolerance (>10 METS)
have excellent prognosis regardless of anatomical
extent of CAD.
37.
38. Salient myocardial ischemia
In patients with documented CAD, exercised induced ST
segment depression confers increased risk of subsequent
cardiac events
Acute coronary syndrome
Incidence of angina or ST segment abnormalities in these
patients ranges from 30-40%.
ST segment changes or chest pain is associated with
significantly increased risk of subsequent cardiac events
39. After MI
Exercise testing is useful to determine
1.risk stratification and assessment of prognosis
2.functional capacity for activity prescription
3.assessment of adequacy of medical therapy & need to use
supplemental diagnostic or treatment options
Ability to complete 5-6METS of exercise or , 70-80% age
predicted maximum in the absence of abnormal ECG or BP is
associated with 1 year mortality rate of 1-2%.
40.
41. Preoperative risk stratification before non-cardiac surgery
It provides measurement of functional capacity and potential
to identify the likelihood of perioperative ischemia in patients
with low ischemic threshold
42.
43. Cardiac arrythmias & conduction disturbances
VPCs are common during exercise test & increase with age.
Occur in 0-5% of asymptomatic subjects.
Suppression of VPCs during exercise is nonspecific.
20% of patients with known heart disease and 50-70% of
sudden cardiac death survivors have repetitive ventricular
beats induced by exercise.
In patients with recent MI, presence of repetitive forms is
associated with increased risk of cardiac events.
5 yr all cause mortality is higher in patients who have frequent
ectopics in recovery phase.
44. Test is useful in evaluating :
1.effects of antiarrhythmic drugs
2.detecting supraventricular arrhythmias
3.treating patients with chronic AF to test for ventricular
rate control
4.possible drug toxicity in patients on antiarrhythmic drugs
Evaluation of ventricular arrythmia
1.Exercise testing provokes VPCs in most patients
with sustained ventricular tachyarrythmia.
2.VPC that occurs in the early post exercise phase is
associated with worse long term prognosis.
45. Supraventricular arrythmias
Premature beats are seen in 4-10%of normal persons, 40%of
patients with underlying heart disease.
Sustained arrythmia occur in 1-2%. May approach
10-15% in patients referred for management of episodic
arrythmias.
46.
47. Atrial fibrillation
Rapid ventricular response is seen in initial stages of exercise.
Sinus node dysfunction
Lower heart rate response is seen at submaximal and maximal
workloads.
Atrioventricular block
In congenital AV block, exercise induced heart rate is low .
Some develop symptomatic rapid junctional rhythms.
In acquired diseases, exercise can elicit advanced AV block.
48. LBBB
ST depression is seen in patients with LBBB
& cant be used as diagnostic indicator.
Relative risk of death or other major cardiac events in these
patients is increased three fold.
RBBB
Exercise induced ST depression in leads V1-V4 is common in
patients with RBBB and is non-diagnostic
49. In patients with RBBB
• 1.new onset ST depression in V5 & V6, or L II or avF
• 2.reduced exercise capacity
• 3.inability to adequately increase systolic BP
-------indicate presence of CAD.
New development of exercise induced RBBB is uncommon
(0.1%)
Preexcitation syndrome
Presence of WPW syndrome invalidates the use of ST
segment analysis as a diagnostic method.
False +ve ischemic changes are seen
Exercise may normalise QRS complex with disappearance of
delta waves in 20-50%
50. Exercise induced disappearance of delta wave is more frequent
with left sided than right sided pathway
Cardiac pacemakers and ICD
Test is useful in
1.Evaluating sensor trigger rate adaptive pacing
2.To assess performance following CRT in patients with heart
failure and ventricular conduction delay
51. Influence of drugs and other factors
In cold sensitive individuals, cooler environment results in
earlier onset of ST depression.
Cigarette smoking reduces ischemic response threshold.
Hypokalemia & digoxin are associated with exertional ST
depression
Nitrates, beta blockers, calcium channel blockers can prolong
the time to onset of ischemic ST depression, increase exercise
tolerance, and may normalize exercise ECG response in
documented CAD patients.
52. Women
Diagnostic accuracy is less in women due to lower prevalence
and extent of CAD.
False +ve results are common during menses or preovulation,
& in postmenopausal women on estrogen therapy
53. Elderly patients
Test should be started at slowest speed with 0% grade and
adjusted according patient’s ability
Frequency of abnormal results is more and risk of cardiac
events is also more
Diabetes mellitus
In patients with autonomic dysfunction and sensory
neuropathy anginal threshold is increased and abnormal heart
rate and BP response is common
Probability of adverse cardiac outcome is increased
54. Valvular heart disease
Exercise test can provide information on timing of operative
intervention and to estimate degree of incapacitation
Hypotension during test in asymptomatic patients with AS is
sufficient to consider for valve replacement.
In patients with MS, excessive HR response to relatively low
levels of exercise, reduction of cardiac output, and chest pain
are indicators that favour earlier valve repair.
55.
56. In MVP without regurgitation at rest, exercise induced MR is
associated with subsequent development of progressive MR.
In HCM peak VO2 and anerobic threshold are reduced.
Inability to increase BP by 20mmHg is asso with adverse
prognosis
Coronary bypass grafting
ST depression may persist when incomplete
revascularisation is achieved and also in 5% of persons in
whom complete revascularisation is achieved.
57. Significant increase in exercise capacity is seen when large
amount of dysfunctional but viable myocardium is
revascularised
Percutaneous coronary intervention
Exercise ECG has low diagnostic accuracy to detect restenosis
in the early phase(<1mon).
6-12 mon post procedure test helps to detect restenosis
58.
59. Cardiac transplantation
A peak VO2 of less than 12-14ml O2/kg/min or 40-50% of
predicted VO2 is associated with 2 year survival rates from
30-50%
Maximal O2 uptake & work capacity are reduced as compared
with age matched controls but improved as compared with
pre-operative findings.
Abnormalities that may be seen are
1.resting tachycardia
2.slow HR response during mild to moderate exercise
3.more rapid HR response during more strenous exercise
4.more prolonged time for ventricular rate to return to
baseline during recovery
60. Safety and risks of TMT
Mortality is <0.01%, morbidity is <0.05%
Relative risk of major complication is twice when symptom
limited protocol is used as compared with low level protocol