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Comprehensive Pretest Evaluations for Cardiovascular Disorders Based on Risk Assessment

This document outlines the essential elements of pretest clinical evaluations for coronary artery disease (CAD) and other cardiovascular (CV) disorders, emphasizing the importance of risk assessment. A thorough pretest evaluation encompasses obtaining a detailed medical history, conducting a physical examination, and performing laboratory tests, including lipid panels and glucose levels. Key assessment factors include blood pressure readings and cholesterol levels, along with contraindications for exercise testing. Patient instructions prior to testing aim to improve test validity and accuracy.

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Comprehensive Pretest Evaluations for Cardiovascular Disorders Based on Risk Assessment

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  1. GXT 2008-CH 3 • Pretest clinical evaluations • based on risk assessment • absolutely necessary for CAD and other CV disorders • a comprehensive pretest evaluation includes : • medical history • physical exam • laboratory work

  2. MEDICAL HISTORY • Must include past and present information about: • any medical diagnosis • previous physical findings • present or past history of symptoms • recent illness, surgery, or hospitalization • orthopedic problems • medications, lifestyle habits, work demands • family history****

  3. PHYSICAL EXAM • Body weight plus anthropometrics (BMI, W/H ratio, waist girth and body composition) • BMI- factors (divide by 2.2 and multiple by 0.0254) • Resting HR and rhythm and lung auscultation • Resting BP-lying, sitting and standing • Auscultation of heart, carotid, femoral and abdominal arteries • Palpation and auscultation of abdomen and bowel

  4. MORE • Evaluation of extremities for edema and pulses • Presence of xanthomas • Orthopedic testing • Neurological testing • Skin inspection, especially of extremities

  5. LABORATORY TESTS • Total serum cholesterol and lipid panel • Fasting blood glucose • Fasting triglycerides • Thyroid function • Hemoglobin (good idea but not necessary). • Additional tests based on symptoms and/or disease

  6. BASIC MEASURES • Blood Pressure • diagnostic decisions made based on two or more readings • tables 3-1 and 3-2 give parameters • lifestyle modification cornerstone of therapy • drug therapy follows in given circumstances

  7. BP ASSESSMENT • Minimum of 5 minutes rest--no stimulants • Supine, sitting and standing measures • Cuff size and positioning imperative • Stethoscope placement and holding position • Inflation ( 20 mm/hg above known ) and deflation ( 2-5 mm/hg per s) most important • Become refined enough to differentiate between phase 4 and 5 of diastolic

  8. CHOLESTEROL AND TRIGLYCERIDES • Apparently healthy asymptomatic • HDL > 35 mg/dl • LDL < 160 mg/dl--<130 mg/dl with 2 or more RF and <100 mg/dl with disease • Triglycerides < 200 mg/dl • See figure 3-1, table 3-3 and table 3-4

  9. PULMONARY FUNCTION TESTS • Interpreted with caution due to patient effort required • Forced vital capacity • Forced expiratory volume in one second-FEV1 • Tidal volume • Impacted by age, gender and height

  10. CONTRAINDICATIONS TO EXERCISE TESTING • Absolute Issues • Relative Issues • uncontrolled hypertension • arrhythmias • neuromuscular, musculoskeletal, or arthritic disorders • uncontrolled metabolic disease • chronic infectious disease • other

  11. INFORMED CONSENT • Ethical and Legal purposes • States risks and ensures client understanding • Provides opportunity for questions • Protocol for testing a minor • Legal counsel of institution must OK consent form used • Consent for use of information in research

  12. OTHER ISSUES • Emergency equipment availability and trained personnel to use • Client information and confidentiality • Benefits expected from testing • Signatures and date--client, technician (doc), and witness

  13. PATIENT INSTRUCTIONS PRIOR TO TESTING • Purpose is to increase test validity and accuracy • Instructions will be dictated by test type and purpose • Generally speaking: well-rested • no food, alcohol, caffeine and tobacco 3 hours before • clothes, hydration and pretest exercise • medications--functional or diagnostic

  14. In class assignment • Develop patient instruction check list • Be creative, motivating, helpful and empathetic

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