treadmillstresstestingfortheprimarycarephysician初级保健医师用跑步机压力测试.pptxVIP

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treadmillstresstestingfortheprimarycarephysician初级保健医师用跑步机压力测试.pptx

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Treadmill Stress Testingfor the Primary Care PhysicianAnthony Beutler, MDPrimary Care Sports MedicineThe ElectrocardiogramWhat isVO2max?The Electrocardiographic Response ObjectivesReview essential Exercise Test TerminologyDescribe the Performance of the Exercise Stress TestReview Exercise Test ResponsesDiscuss Interpretation of the Exercise Stress TestDiscuss Special Considerations in AthletesExercise Test TerminologyThe ElectrocardiogramVO2maxMETsMyocardial Oxygen ConsumptionMaximal Oxygen Uptake (VO2max)Greatest amount of oxygen an individual utilizes with maximal exercise (ml O2 per kilogram per minute)“Gold Standard” for cardiorespiratory fitnessFick EquationVO2max = (HRmax x SVmax) x (CaO2max - CvO2max)DiffusionVentilationPerfusionFICK EQUATION(220 - Age)Sinus Node DysfunctionDrugs (e.g., B - blockers)PaO2Hgb [ ]SaO2Skeletal MusclesAerobic EnzymesFiber TypeMuscle DiseaseCapillary DensityGenetic Factors (Heart Size)Conditioning Factors Contractility/Afterload/PreloadDisease Factors Wall Motion/Ventricular Fxn Valve Stenosis or RegurgitationVO2max = (HRmax X SVmax) X (CaO2max - CvO2max)The METMETSMetabolic Equivalents (METs)1 MET = 3.5 ml O2 per kilogram of body weight per minuteKey MET Values (part 1) 1 MET = "Basal" = 3.5 ml O2 /Kg/min 2 METs = 2 mph on level 4 METs = 4 mph on level < 5METs = Poor prognosis if < 65; limit immediate post MI; cost of basic activities of daily living Key MET Values (part 2) 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 = Ooh lah lah Aerobic athleteMyocardial (MO2) Accurate measurement requires cardiac catheterizationCoronary Flow x Coronary a - VO2 difference Wall Tension (Pressure x Volume, Contractility, Stroke Work, HR) Systolic Blood Pressure x HR Angina and ST Depression usually occurs at same Double Product in an individual** Direct relationship to VO2 is altered by beta-blockers, training,...Myoc