ACSM TEST EXAM ANSWERS AND QUESTIONS GRADED A+
✔✔pt had a complicated revascularization. what risk category do they belong in? -
✔✔high
✔✔Pt case:
resting EF = 37%
CHF
ST segment depression = 2 mm
BP decreases with increased WL
what risk category according to AACVRP? - ✔✔high
✔✔How often should staff train for emergencies? - ✔✔Every 3 months (at least)
✔✔When is age a risk factor for CVD? - ✔✔M ≥ 45 and F ≥ 55
✔✔when is fam hx a risk factor for CVD? - ✔✔MI, coronary revascularization, or sudden
death in a 1st degree member M < 55 F < 65
✔✔when is cigarette smoking a risk factor? - ✔✔current smoker, quit w/in last 6 mo, or
exposed via environment
✔✔when is physical inactivity a risk factor? - ✔✔if individual does NOT do at the least
moderate PA for 30 min/day, 3 days/wk for 3 months
✔✔What BMI is risk factor for CVD (obesity)? - ✔✔BMI ≥30 kg/m²
✔✔What waist circumference is a risk factor for CVD (obesity)? - ✔✔M > 102 cm or 40
in
F > 88 cm or 35 in
✔✔When is HTN a risk factor? - ✔✔SBP ≥ 140 OR DBP ≥ 90 on at least 2 different
occasions OR individual is on anti-HTN drug
✔✔when is LDL a risk factor for CVD (dyslipidemia)? - ✔✔≥ 130 mg/dL
✔✔When is HDL a positive risk factor for CVD (dyslipidemia)? - ✔✔< 40 mg/dL
✔✔When is HDL a negative risk factor for CVD (dyslipidemia)? - ✔✔≥ 60 mg/dL
✔✔what is used for determining dyslipidemia if HDL and LDL are not given? - ✔✔total
serum cholesterol ≥ 200 mg/dL
,✔✔If pt is on lipid-lowering meds, does this count as an automatic risk factor for CVD
(dyslipidemia)? - ✔✔Yes
✔✔when is fasting plasma glucose a risk factor for CVD (diabetes)? - ✔✔≥ 126 mg/dL
✔✔when is OGTT a risk factor for CVD (diabetes)? - ✔✔≥ 200 mg/dL
✔✔OGTT - ✔✔oral glucose tolerance test
✔✔when is HbA1c a risk factor for CVD (diabetes)? - ✔✔≥ 6.5%
✔✔normal fasting glucose - ✔✔60-99 mg/dL
✔✔what do aspartate transaminase (AST) and alanine transaminase (ALT) indicate? -
✔✔presence of liver abnormalities
✔✔what blood tests would be appropriate for pts taking meds that may alter renal fxn? -
✔✔-GFR
-blood urea nitrogen (BUN)
-BUN/creatinine ration
-serum sodium (for volume depletion)
-serum potassium
✔✔BUN - ✔✔blood urea nitrogen
✔✔coronary artery disease (CAD) - ✔✔process of atherosclerotic disease in coronary
arteries
✔✔what is an MI most commonly caused by? - ✔✔blood clot (thrombosis) that gets
stuck by blockage and gets lodged in existing occlusion (70% of MIs occurs w/out
occlusion)
✔✔which coronary artery feeds the right side and posterior? - ✔✔right coronary artery
✔✔when coronary artery splits into the anterior interventricular artery (AIA) and the
circumflex - ✔✔left coronary artery
✔✔which coronary artery feeds the apical and central heart? - ✔✔the anterior
interventricular artery
✔✔which coronary artery feeds the left side and posterior - ✔✔circumflex
✔✔what makes a plaque more stable? - ✔✔-thick fibrous cap
,-high collagen content
-small lipid pool
-few inflammatory cells
-Low Lp-PLA₂ content (reddish-brown staining)
✔✔What is the PLAC test? - ✔✔measures serum levels of an enzyme thats
manufactured by macrophages (another inflammatory marker), called lipoprotein-
associated phospholipase A2 and abbreviated Lp-PLA₂. The test is not intended to
replace existing lipid/lipoprotein measures; it simply adds complementary information.It
helps predict cardiovascular events
✔✔What kind of pts has the PLAC test shown to be most useful for? - ✔✔Pts with
relatively low LDL (<130 mg/dL)
✔✔what risk factors induce endothelial dysfunction? - ✔✔-LDL
-diabetes
-hypertension
-homocysteine
-smoking
✔✔homocysteine - ✔✔a common amino acid in your blood. You get it mostly from
eating meat. High levels of it are linked to early development of heart disease
✔✔by what mechanisms do risk factors cause dysfunction to endothelial cells? - ✔✔-
vasoconstriction
-smooth m cell growth & proliferation
-platelet and leukocyte adhesion & infiltration
-lipid accumulation & oxidation
-thrombosis
✔✔When should exercise be discontinued due to angina? - ✔✔when ≥ 2+ on a 4-point
scale
✔✔what kind of symptoms are angina equivalents? - ✔✔-nausea
-SOB
-pressure
-squeezing
-burning
-fatigue
✔✔When is angina stable? - ✔✔predictable at consistent
frequency, duration, intensity, precipitating factors (ie environmental conditions) for 60
days
, ✔✔when is angina unstable? - ✔✔happening at new onset of frequency (progressing
from exertion only to rest), intensity, duration or precipitating factors or vasospastic
angina (very unpredictable and sick endothelium)
✔✔how is atherosclerosis diagnosed? - ✔✔1. graded exercise test
2. GXT with nuclear imaging
3. stress echocardiograph
4. pharmacological testing
5. coronary angiography
✔✔what are the symptoms of atherosclerosis? - ✔✔angina or equivalent
✔✔balloon angioplasty - ✔✔camera looks outside as dye is injected and shows where
the occlusion in, then a balloon catheter is placed and expands inside occlusion to get
blood flowing again
✔✔When is CABG indicated? - ✔✔when percutaneous coronary intervention (PCI) is
not indicated or has failed (large occlusions)
*usually saphenous vein or mammary artery
✔✔why is dyspnea an angina equivalent? - ✔✔b/c the rate of death from cardiac
causes is significantly higher in pts with dyspnea (2x the risk of sudden death as pts w/
typical angina)
✔✔CHF - ✔✔decreased wall fxn of left and/or right ventricle. leads to diminished fxnal
capacity and aerobic endurance. reduced ejection fraction
✔✔ejection fraction equation - ✔✔EF = SV/EDV = % of blood ejected from L ventricle
w/each contraction
*SV = EDV-ESV
*EDV = end diastolic volume
✔✔explain the pathophysiology behind HF - ✔✔diastolically, there is increased
resistance to ventricular filling which leads to back-flow and increases pressure in the
lungs; decreased contractility due to weakening leads to decreased Q and SV and EF
*myocardium thickens
✔✔how is CHF diagnosed? - ✔✔EF < 40%
1. echocardiogram
2. heart catheterization
3. MUGA (nuclear scan) *gold standard
4. lab eval for BNP
✔✔BNP and what does it diagnose? at what amount is it diagnostic? - ✔✔B-type
natriuretic protein is
✔✔pt had a complicated revascularization. what risk category do they belong in? -
✔✔high
✔✔Pt case:
resting EF = 37%
CHF
ST segment depression = 2 mm
BP decreases with increased WL
what risk category according to AACVRP? - ✔✔high
✔✔How often should staff train for emergencies? - ✔✔Every 3 months (at least)
✔✔When is age a risk factor for CVD? - ✔✔M ≥ 45 and F ≥ 55
✔✔when is fam hx a risk factor for CVD? - ✔✔MI, coronary revascularization, or sudden
death in a 1st degree member M < 55 F < 65
✔✔when is cigarette smoking a risk factor? - ✔✔current smoker, quit w/in last 6 mo, or
exposed via environment
✔✔when is physical inactivity a risk factor? - ✔✔if individual does NOT do at the least
moderate PA for 30 min/day, 3 days/wk for 3 months
✔✔What BMI is risk factor for CVD (obesity)? - ✔✔BMI ≥30 kg/m²
✔✔What waist circumference is a risk factor for CVD (obesity)? - ✔✔M > 102 cm or 40
in
F > 88 cm or 35 in
✔✔When is HTN a risk factor? - ✔✔SBP ≥ 140 OR DBP ≥ 90 on at least 2 different
occasions OR individual is on anti-HTN drug
✔✔when is LDL a risk factor for CVD (dyslipidemia)? - ✔✔≥ 130 mg/dL
✔✔When is HDL a positive risk factor for CVD (dyslipidemia)? - ✔✔< 40 mg/dL
✔✔When is HDL a negative risk factor for CVD (dyslipidemia)? - ✔✔≥ 60 mg/dL
✔✔what is used for determining dyslipidemia if HDL and LDL are not given? - ✔✔total
serum cholesterol ≥ 200 mg/dL
,✔✔If pt is on lipid-lowering meds, does this count as an automatic risk factor for CVD
(dyslipidemia)? - ✔✔Yes
✔✔when is fasting plasma glucose a risk factor for CVD (diabetes)? - ✔✔≥ 126 mg/dL
✔✔when is OGTT a risk factor for CVD (diabetes)? - ✔✔≥ 200 mg/dL
✔✔OGTT - ✔✔oral glucose tolerance test
✔✔when is HbA1c a risk factor for CVD (diabetes)? - ✔✔≥ 6.5%
✔✔normal fasting glucose - ✔✔60-99 mg/dL
✔✔what do aspartate transaminase (AST) and alanine transaminase (ALT) indicate? -
✔✔presence of liver abnormalities
✔✔what blood tests would be appropriate for pts taking meds that may alter renal fxn? -
✔✔-GFR
-blood urea nitrogen (BUN)
-BUN/creatinine ration
-serum sodium (for volume depletion)
-serum potassium
✔✔BUN - ✔✔blood urea nitrogen
✔✔coronary artery disease (CAD) - ✔✔process of atherosclerotic disease in coronary
arteries
✔✔what is an MI most commonly caused by? - ✔✔blood clot (thrombosis) that gets
stuck by blockage and gets lodged in existing occlusion (70% of MIs occurs w/out
occlusion)
✔✔which coronary artery feeds the right side and posterior? - ✔✔right coronary artery
✔✔when coronary artery splits into the anterior interventricular artery (AIA) and the
circumflex - ✔✔left coronary artery
✔✔which coronary artery feeds the apical and central heart? - ✔✔the anterior
interventricular artery
✔✔which coronary artery feeds the left side and posterior - ✔✔circumflex
✔✔what makes a plaque more stable? - ✔✔-thick fibrous cap
,-high collagen content
-small lipid pool
-few inflammatory cells
-Low Lp-PLA₂ content (reddish-brown staining)
✔✔What is the PLAC test? - ✔✔measures serum levels of an enzyme thats
manufactured by macrophages (another inflammatory marker), called lipoprotein-
associated phospholipase A2 and abbreviated Lp-PLA₂. The test is not intended to
replace existing lipid/lipoprotein measures; it simply adds complementary information.It
helps predict cardiovascular events
✔✔What kind of pts has the PLAC test shown to be most useful for? - ✔✔Pts with
relatively low LDL (<130 mg/dL)
✔✔what risk factors induce endothelial dysfunction? - ✔✔-LDL
-diabetes
-hypertension
-homocysteine
-smoking
✔✔homocysteine - ✔✔a common amino acid in your blood. You get it mostly from
eating meat. High levels of it are linked to early development of heart disease
✔✔by what mechanisms do risk factors cause dysfunction to endothelial cells? - ✔✔-
vasoconstriction
-smooth m cell growth & proliferation
-platelet and leukocyte adhesion & infiltration
-lipid accumulation & oxidation
-thrombosis
✔✔When should exercise be discontinued due to angina? - ✔✔when ≥ 2+ on a 4-point
scale
✔✔what kind of symptoms are angina equivalents? - ✔✔-nausea
-SOB
-pressure
-squeezing
-burning
-fatigue
✔✔When is angina stable? - ✔✔predictable at consistent
frequency, duration, intensity, precipitating factors (ie environmental conditions) for 60
days
, ✔✔when is angina unstable? - ✔✔happening at new onset of frequency (progressing
from exertion only to rest), intensity, duration or precipitating factors or vasospastic
angina (very unpredictable and sick endothelium)
✔✔how is atherosclerosis diagnosed? - ✔✔1. graded exercise test
2. GXT with nuclear imaging
3. stress echocardiograph
4. pharmacological testing
5. coronary angiography
✔✔what are the symptoms of atherosclerosis? - ✔✔angina or equivalent
✔✔balloon angioplasty - ✔✔camera looks outside as dye is injected and shows where
the occlusion in, then a balloon catheter is placed and expands inside occlusion to get
blood flowing again
✔✔When is CABG indicated? - ✔✔when percutaneous coronary intervention (PCI) is
not indicated or has failed (large occlusions)
*usually saphenous vein or mammary artery
✔✔why is dyspnea an angina equivalent? - ✔✔b/c the rate of death from cardiac
causes is significantly higher in pts with dyspnea (2x the risk of sudden death as pts w/
typical angina)
✔✔CHF - ✔✔decreased wall fxn of left and/or right ventricle. leads to diminished fxnal
capacity and aerobic endurance. reduced ejection fraction
✔✔ejection fraction equation - ✔✔EF = SV/EDV = % of blood ejected from L ventricle
w/each contraction
*SV = EDV-ESV
*EDV = end diastolic volume
✔✔explain the pathophysiology behind HF - ✔✔diastolically, there is increased
resistance to ventricular filling which leads to back-flow and increases pressure in the
lungs; decreased contractility due to weakening leads to decreased Q and SV and EF
*myocardium thickens
✔✔how is CHF diagnosed? - ✔✔EF < 40%
1. echocardiogram
2. heart catheterization
3. MUGA (nuclear scan) *gold standard
4. lab eval for BNP
✔✔BNP and what does it diagnose? at what amount is it diagnostic? - ✔✔B-type
natriuretic protein is
