CLINICAL EXERCISE TESTING AND PRESCRIPTION

Question 1

The PR interval is said to be the time from the starting of a P wave to begin the QRS complex. Shortened PR interval ranges 120 ms whereas; the normal range of PR intervals is 120 to 200 ms. Two associated conditions that are linked with shortened PR intervals at the time of resting ECG are pre-excitation syndrome and junctional arrhythmia (Bay et al. 2020). Examples of pre-excitation syndrome are Wolff-Parkinson-White (WPW) and Lown-Ganong-Levine (LGL) syndromes. On the contrary, junctional arrhythmia can be exemplified as atrioventricular reentrant tachycardia or the junctional rhythm.

Pathophysiological conditions of WPW include the presence of an alternative pathway that connects ventricles and atria. As per the opinion of Borloz (2020), impulses produced by this pathway are faster than the normal impulses and produce a shortened PR interval. Electrocardiographic characteristic of this condition involves broad QRS and delta waves implying a slurred upstroke to the QRS complex.

Junctional arrhythmia starts in the tissues of AV nodes and an enhanced condition results in an automated AV node. As per the views of Borloz (2020), the fast impulses exceed that of the sinus node and cause narrow complex rhythm. Characteristics of electrocardiography are demonstrated as absence or abnormal or inverted presence of the P wave.

Question 2

QT interval is termed to be measured from the starting of the QRS complex till the end of the T wave. It is represented as the amount of time consumed in the ventricular depolarisation and repolarization. As per the discussions of Meek and Morris (2002), normal range of QT intervals can be suggested as 0.35 to 0.45 seconds. An increase more than half of the interval between two adjacent R waved (R-R interval) is considered as abnormal. Measurement of QT intervals is important as a prolonged interval can be noticed in case of slow rate of the heart. However, aging of an individual is associated with increased QT intervals to some extent and a particular trend is observed in case of these intervals as well (Chorin et al. 2020). According to this trend, women are seen to experience longer QT intervals in comparison to males.

Measurement of this interval relies on Bazett’s correction and the equation can be given as below:

QTc = QT/√R-R (seconds)

This process of calculating the QT intervals needs to be corrected as prominent U waves resemble T waves. A mistake in this context can lead to overestimation of the QT intervals for an individual (Tomaselli Muensterman and Tisdale, 2018). Identification of a lead at a region with no prominent U waves can resolve this issue and an example can be given as lead of a VL.

Question 3

The review article is based on the abnormal ventilatory responses of the patients with chronic heart failure to exercises or peak oxygen consumption. Findings of this article shows that-Question 4

Heart rate is observed to increase in response to exercises and central withdrawal of parasympathetic inhibition and increase in sympathetic tone are responsible for this. Further increase of heart rate is associated with increment of sympathetic stimulation in the central nervous system and circulating catecholamine. As per the perspectives of Kligfield and Lauer (2006), chronotropic incompetence is defined as the condition where heart rate does not increase with physical exercise. It is determined that chronotropic incompetence can lead to various cardiac events such as all-cause mortality.

The major challenges associated with use of chronotropic incompetence in case of assessment of a clinical population are to determine the best of measuring it. The best way that is thought to be essential for characterizing the parameter is to record the peak heart rate before exercise and track the changes with exercises (Smarz et al. 2021). One of the problems associated with this process is that peak heart rate changes with the increasing age of humans.

Question 5

Cardiac axis is referred to as the mean direction of waves related to ventricular depolarization on a vertical plane and it is measured from a referencing point considered as zero. Measurement of cardiac axis is done with various methods and the most prevalent method is inspection of three leads called lead I, II and III. These methods can be described as below:

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