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.7/10.0
    450
    14.0
    4
    w1kJg
    300
    (level
    Surfre)
    10.5
    3
    150
    7.0
    2
    Bed exer-
    cise (arm
    exercises
    in supine
    or sining)
    Sources: Data from Amencan Heart Association, Comminee on Exercise. Exercise Testing
    and Traimng of Apparently Healthy Individuals: A Handbook for Physicians. Dallas, 1972;
    rcse
    and GA Brooks, TO Fahey, TP Whlre (eds). Exe i Physiology: Human Bioenergetics and
    Its Applications (2nd ed). Mountain View, CA: Mayfield Publishmg, 1 996.

    36 ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS
    Clinical Tip
    Synonyms for exercise tests include exercise tolerance test
    and graded exercise test.
    Thallium Stress Testing
    Thallium stress testing is a stress test that involves the injection of a
    radioactive nuclear marker for the detection of myocardial perfusion.
    The injection is typically given (via an intravenous line) during peak
    exercise or when symptoms are reported during the Stress test. After
    the test, the subject is passed under a nuclear scanner to be evaluated
    for myocardial perfusion by assessment of the distribution of thallium
    uptake. The subject then returns 3-4 hours later to be re-evaluated
    for myocardial reperfusion. This test appears to be more sensitive
    than stress tests without thallium for identifying patients with coronary artery �isease. 12
    Persantine Thallillm Stress Testing
    Persantinq thallium stress testing is the use of dipyridamole (Persantine) to dilate coronary arteries. Coronary arteries with atherosclerosis do not dilate; therefore, dipyridamole shunts blood away from these areas. It is typically used in patients who are very unstable,
    deconditioned, or unable to ambulate or cycle for exercise-based
    stress testing.33 Patients are asked to avoid all food and drugs containing methylxantines (e.g., coffee, tea, chocolate, cola drinks) for at least 6 hours prior to the test as well as phosphodiesterase drugs, such
    as aminophyline, for 24 hours. While the patient is supine, an infusion of dipyridamole (0.56 ml/kg diluted in saline) is given intravenously over 4 minutes (a large-vein intracatheter is used). Four minutes aftet the infusion is completed, the perfusion marker (thallium) is injected, and the patient is passed under a nuclear scanner to be evaluated for myocardial perfusion by assessment of rhe disrriburion of rhallium uprake."
    Cardiac Catheterization
    Cardiac catheterization, classified as either right or left, is an invasive
    procedure that involves passing a flexible, radiopaque catheter into
    the heart to visualize chambers, valves, coronary arteries, great vessels, cardiac pressures and volumes to evaluate cardiac function (estimate EF, CO).

    CARDIAC SYSTEM
    37
    The procedure is also used in the following diagnostic and therapeutic techniques!2:
    • Angiography
    • Percutaneous transluminal coronary angioplasty (PTCA)
    • Electrophysiologic studies (EI'Ss)
    • Cardiac muscle biopsy
    Right-sided catheterization involves entry through a sheath that is
    inserted into a vein (commonly subclavian) for evaluation of right
    heart pressures; calculation of CO; and angiography of the right
    atrium, right ventricle, tricllspid valve, pulmonic valve, and pulmonary artery. 12 It is also used for cominuous hemodynamic monitoring in patients with present or very recent heart failure to monitor cardiac
    pressures (see Appendix III-A). Indications for right heart catheterization include an intracardiac shunt (blood flow between right and left arria or right and left ventricles), myocardial dysfunction, pericardial
    constriction, pulmonary vascular disease, valvular heart disease, and
    status post-heart transplam.
    Left-sided catheterization involves entry through a sheath that is
    inserted into an artery (commonly femoral) to evaluate the aorta,
    left atrium, and left ventricle; left ventricular function; mitral and
    aortic valve function; and angiography of coronary arteries. Indications for left heart catheterization include aortic dissection, atypical angina,