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