ACSM CEP COMPREHENSIVE EXAMS UPDATED
QUESTIONS AND ANSWERS SURE A+
✔✔MUGA scan - ✔✔imaging the motion of heart wall muscles and assessing the
function of the heart via a multiple-gated acquisition scan, which uses radioactive
chemicals
Gold standard for measuring EF
✔✔coronary angiogram - ✔✔specialized type of angiography that helps diagnose
stenosis or obstruction of the arteries that supply blood to the heart muscle special dye
✔✔echocardiography - ✔✔an ultrasonic diagnostic procedure used to evaluate the
structures and motion of the heart
✔✔Criteria for maximal exercise test - ✔✔RER 1.10
steady-state HR (steady oxygen and blood; failure of HR to increase w increasing
workloads cardiovascular system meets the demands of exercise
A pleatue in VO2
VE/Vco2 slope
RPE>17
post exercise blood lactation concentration >8
,✔✔Chronotropic incompetence - ✔✔a condition in which the heart rate increases slowly
during exercise and never reaches maximum
85% APHRM
62% w beta blocker
✔✔Indications for clinical exercise test - ✔✔-diagnosis (presence of disease or
abnormal response)
-prognosis (risk of adverse effect)
-evaluation of physiologic response to exercise
better idea of HR and BP response can further guide exercise intensity in cardiac rehab
✔✔Absolute indications to cease exercise test - ✔✔ST-elevation >1mm
drop in SBP >10 mmHg with increasing workload w evidence of ischemia
moderate to severe angina (3/4)
central nervous system symptoms (dizziness, ataxia, near syncope)
signs of poor perfusion (cyanosis, pale)
sustained vtach, 2nd or 3rd-degree AVB that interferes with cardiac output
technical difficulties monitoring ECG or blood pressure
the subject request to stop
✔✔Relative indications for terminating an exercise test - ✔✔onset of angina like
symptoms
drop in SBP 10 mmhg with increase in work rate
excessive rise in SBP >250 mmhg 115 DBP
shortness of breath, wheezing, leg cramps, or claudication
signs of poor perfusion; lightheadedness, confusion, ataxia, pallor, cyanosis, nausea,
cold clammy skin
Failure of HR to increase with increasing work loads
noticeable changes in heart rhythm by palpation
physical or verbal manifestation of severe fatigue
failure of the testing equipment
new arrhythmias (EP discretion)
>80% SPO2
development of BBB that cannot be distinguished from VTACH
✔✔HR recovery after exercise test - ✔✔decrease 12 bpm 1st minute
22 bpm 2nd minute
related to prognosis
✔✔Duke Treadmill Score (DTS) - ✔✔Risk estimate based on treadmill test
Includes;
-length of exercise
-ST deviation mm/10=mV
-angina index score
, ✔✔Rate Pressure Product (double product) - ✔✔The product of heart rate and systolic
blood pressure, which provides a noninvasive estimate of myocardial oxygen
consumption.
a good estimate of ischemic threshold
25,000-40,000mmHg
✔✔Pulse Pressure (PP) - ✔✔difference between systolic and diastolic pressure
40 rest 120-140 maximal exercise
✔✔best marker for ischemic threshold - ✔✔RPP
✔✔Mean Arterial Pressure (MAP) - ✔✔pressure forcing blood into tissues averaged
over a cardiac cycle
normal between 65-110mmHg
✔✔Stroke Volume (SV) - ✔✔The amount of blood pumped out of the heart with each
contraction.
EDV-ESV
50-100ml
✔✔Ventilatory Efficiency - ✔✔The amount of ventilation required per liter of oxygen
consumed to expel one liter of CO2 (i.e., VE/Vo2).
HF increase in VE VCO2 response associated with increased ventilation and perfusion
mismatching
34 good
>45 abnormal
✔✔ejection fraction - ✔✔measurement of the volume percentage of left ventricular
contents ejected with each contraction
SV/EDV 60-70% less than 40 HF
✔✔Main coronary arteries - ✔✔Right Coronary Artery (RCA)
- Supplies blood to the right side of the ♥ (inferior)
II, III, AVF
RA, RV
Inferior wall of LV
1/3 of interventricular system
Left Coronary Artery (Main)- Branches off to Circumflex & LAD
- Supplies blood to left side of ♥ (lateral)
I, AVL, V5, V6
Circumflex Branch
- Goes behind heart
Left Anterior Descending (LAD)
- Widow maker anterior portion of heart
V1-V4
QUESTIONS AND ANSWERS SURE A+
✔✔MUGA scan - ✔✔imaging the motion of heart wall muscles and assessing the
function of the heart via a multiple-gated acquisition scan, which uses radioactive
chemicals
Gold standard for measuring EF
✔✔coronary angiogram - ✔✔specialized type of angiography that helps diagnose
stenosis or obstruction of the arteries that supply blood to the heart muscle special dye
✔✔echocardiography - ✔✔an ultrasonic diagnostic procedure used to evaluate the
structures and motion of the heart
✔✔Criteria for maximal exercise test - ✔✔RER 1.10
steady-state HR (steady oxygen and blood; failure of HR to increase w increasing
workloads cardiovascular system meets the demands of exercise
A pleatue in VO2
VE/Vco2 slope
RPE>17
post exercise blood lactation concentration >8
,✔✔Chronotropic incompetence - ✔✔a condition in which the heart rate increases slowly
during exercise and never reaches maximum
85% APHRM
62% w beta blocker
✔✔Indications for clinical exercise test - ✔✔-diagnosis (presence of disease or
abnormal response)
-prognosis (risk of adverse effect)
-evaluation of physiologic response to exercise
better idea of HR and BP response can further guide exercise intensity in cardiac rehab
✔✔Absolute indications to cease exercise test - ✔✔ST-elevation >1mm
drop in SBP >10 mmHg with increasing workload w evidence of ischemia
moderate to severe angina (3/4)
central nervous system symptoms (dizziness, ataxia, near syncope)
signs of poor perfusion (cyanosis, pale)
sustained vtach, 2nd or 3rd-degree AVB that interferes with cardiac output
technical difficulties monitoring ECG or blood pressure
the subject request to stop
✔✔Relative indications for terminating an exercise test - ✔✔onset of angina like
symptoms
drop in SBP 10 mmhg with increase in work rate
excessive rise in SBP >250 mmhg 115 DBP
shortness of breath, wheezing, leg cramps, or claudication
signs of poor perfusion; lightheadedness, confusion, ataxia, pallor, cyanosis, nausea,
cold clammy skin
Failure of HR to increase with increasing work loads
noticeable changes in heart rhythm by palpation
physical or verbal manifestation of severe fatigue
failure of the testing equipment
new arrhythmias (EP discretion)
>80% SPO2
development of BBB that cannot be distinguished from VTACH
✔✔HR recovery after exercise test - ✔✔decrease 12 bpm 1st minute
22 bpm 2nd minute
related to prognosis
✔✔Duke Treadmill Score (DTS) - ✔✔Risk estimate based on treadmill test
Includes;
-length of exercise
-ST deviation mm/10=mV
-angina index score
, ✔✔Rate Pressure Product (double product) - ✔✔The product of heart rate and systolic
blood pressure, which provides a noninvasive estimate of myocardial oxygen
consumption.
a good estimate of ischemic threshold
25,000-40,000mmHg
✔✔Pulse Pressure (PP) - ✔✔difference between systolic and diastolic pressure
40 rest 120-140 maximal exercise
✔✔best marker for ischemic threshold - ✔✔RPP
✔✔Mean Arterial Pressure (MAP) - ✔✔pressure forcing blood into tissues averaged
over a cardiac cycle
normal between 65-110mmHg
✔✔Stroke Volume (SV) - ✔✔The amount of blood pumped out of the heart with each
contraction.
EDV-ESV
50-100ml
✔✔Ventilatory Efficiency - ✔✔The amount of ventilation required per liter of oxygen
consumed to expel one liter of CO2 (i.e., VE/Vo2).
HF increase in VE VCO2 response associated with increased ventilation and perfusion
mismatching
34 good
>45 abnormal
✔✔ejection fraction - ✔✔measurement of the volume percentage of left ventricular
contents ejected with each contraction
SV/EDV 60-70% less than 40 HF
✔✔Main coronary arteries - ✔✔Right Coronary Artery (RCA)
- Supplies blood to the right side of the ♥ (inferior)
II, III, AVF
RA, RV
Inferior wall of LV
1/3 of interventricular system
Left Coronary Artery (Main)- Branches off to Circumflex & LAD
- Supplies blood to left side of ♥ (lateral)
I, AVL, V5, V6
Circumflex Branch
- Goes behind heart
Left Anterior Descending (LAD)
- Widow maker anterior portion of heart
V1-V4
