ACSM CEP Exam Test Questions and Answers Graded A+
1. Absolute Con- • A recent significant change in the resting ECG suggesting significant ischemia,
traindications to recent MI (within 2 d), or other acute cardiac event
Exercise Testing • Unstable angina
• Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compro-
mise
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Suspected or known dissecting aneurysm
• Acute systemic infection, accompanied by fever, body aches, or swollen lymph
glands
2. Relative Con- • Left main coronary stenosis
traindications to • Moderate stenotic valvular heart disease
Exercise Testing • Electrolyte abnormalities (hypokalemia or hypomagnesemia)
• Severe arterial hypertension (SBP>200 mmHg and/or DBP >110 mmHg) at rest
• Tachydysrhythmia or bradydysrhythmia
• Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
• Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by
exercise
• High-degree AV block
• Ventricular aneurysm
• Uncontrolled metabolic disease (diabetes, thyrotoxicosis, or myxedema)
• Chronic infectious disease (e.g. HIV)
• Mental or physical impairment leading to inability to exercise adequately
3. General Indica- • Onset of angina or angina-like symptoms
tions for Stop- • Drop in SBP of 1e0 mmHg with an increase in work rate or if SBP decreases below
ping an Exercise the value obtained in the same position prior to testing
Test • Excessive rise in BP: SBP>250 mmHg and/or DBP>115 mmHg
• Shortness of breath, wheezing, leg cramps, or claudication
, ACSM CEP Exam Test Questions and Answers Graded A+
• Signs of poor perfusion: light-headedness, confusion, ataxia (loss of full control
of bodily movements), (pallor) unhealthy pale appearance, cyanosis (bluish skin
color), nausea, or cold and clammy skin
• Failure of HR to increase with increased exercise intensity
• Noticeable change in heart rhythm by palpation or auscultation
• Subject requests to stop
• Physical or verbal manifestations of severe fatigue
• Failure of the testing equipment
4. Absolute Indica- • Drop in SBP 1e0 mmHg with an increase in work rate, or if SBP decreases below
tions for stop- the value obtained in the same position prior to testing when accompanied by
ping an exercise other evidence of ischemia
test • Moderately severe angina (defined as 3 on standard scale)
• Increasing nervous system symptoms (e.g. ataxia, dizziness, or near syncope)
• Signs of poor perfusion (cyanosis or pallor)
• Technical diflculties monitoring the ECG or SBP
• Subject's desire to stop
• Sustained ventricular tachycardia
• ST elevation (+1.0 mm) in leads without diagnostic Q waves (other than V1 or
aVR)
5. Relative Indica- • Drop in SBP 1e0 mmHg with an increase in work rate, or if SBP below the value
tions for stop- obtained in the same position prior to testing
ping an exercise • ST or QRS changes such as excessive ST depression (>2 mm horizontal or down
test sloping ST-segment depression) or marked axis shift
• Arrhythmias other than sustained V Tach, including multifocal PVCs, triplets of
PVCs, SVT, heart block, or bradyarrhythmias
• Fatigue, shortness of breath, wheezing, leg cramps, or claudication
• Development of bundle-branch block or intraventricular conduction delay that
cannot be distinguished from V Tach
• Increasing chest pain
• Hypertensive response (SBP>250 mmHg and/or DBP>115 mmHg)
, ACSM CEP Exam Test Questions and Answers Graded A+
6. ST segment de- 1e mm of horizontal or down sloping ST“60-80 ms beyond the J point suggesting
pression myocardial ischemia
7. Chronotropic in- 1. Peak exercise HR about 20 BPM below the age predicted HRmax or an inability
competence to achieve > 85% of the age predicted HRmax for subjects limited by volitional
fatigue.
2. Chronotropic index <.8
8. Heart Rate Recov- less than or equal to 12 BPM at 1 minute for walking, or less than or equal to 22
ery BPM at 2 mins for supine position
9. Sensitivity % of pts. tested with known CVD who demonstrate significant ST segment
changes.
Exercise EKG sensitivity usually requires greater than or equal to 70% stenosis
10. True Positive Horizontal or down sloping ST segment depression of 1e. 0 mm and correctly
identifies a patient with CVD
11. False Negative test shows no or non-diagnostic ECG changes and fails to identify patients with
underlying CVD
12. Specificity % of pts. without CVD who demonstrate non significant ST segment changes
13. True Negative Correctly identifies an individual without CVD
14. Causes of False • Failure to reach an ischemic threshold
Negative Test Re- • Monitoring an insuflcient number of leads to detect ECG changes
sults • Failure to recognize non-ECG signs and symptoms that may be associated with
underlying CVD
• Angiographically significant CVD compensated by collateral circulation
• Musculoskeletal limitations to exercise preceding cardiac abnormalities
• Technical or observer error
15. Predictive Value
1. Absolute Con- • A recent significant change in the resting ECG suggesting significant ischemia,
traindications to recent MI (within 2 d), or other acute cardiac event
Exercise Testing • Unstable angina
• Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compro-
mise
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Suspected or known dissecting aneurysm
• Acute systemic infection, accompanied by fever, body aches, or swollen lymph
glands
2. Relative Con- • Left main coronary stenosis
traindications to • Moderate stenotic valvular heart disease
Exercise Testing • Electrolyte abnormalities (hypokalemia or hypomagnesemia)
• Severe arterial hypertension (SBP>200 mmHg and/or DBP >110 mmHg) at rest
• Tachydysrhythmia or bradydysrhythmia
• Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
• Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by
exercise
• High-degree AV block
• Ventricular aneurysm
• Uncontrolled metabolic disease (diabetes, thyrotoxicosis, or myxedema)
• Chronic infectious disease (e.g. HIV)
• Mental or physical impairment leading to inability to exercise adequately
3. General Indica- • Onset of angina or angina-like symptoms
tions for Stop- • Drop in SBP of 1e0 mmHg with an increase in work rate or if SBP decreases below
ping an Exercise the value obtained in the same position prior to testing
Test • Excessive rise in BP: SBP>250 mmHg and/or DBP>115 mmHg
• Shortness of breath, wheezing, leg cramps, or claudication
, ACSM CEP Exam Test Questions and Answers Graded A+
• Signs of poor perfusion: light-headedness, confusion, ataxia (loss of full control
of bodily movements), (pallor) unhealthy pale appearance, cyanosis (bluish skin
color), nausea, or cold and clammy skin
• Failure of HR to increase with increased exercise intensity
• Noticeable change in heart rhythm by palpation or auscultation
• Subject requests to stop
• Physical or verbal manifestations of severe fatigue
• Failure of the testing equipment
4. Absolute Indica- • Drop in SBP 1e0 mmHg with an increase in work rate, or if SBP decreases below
tions for stop- the value obtained in the same position prior to testing when accompanied by
ping an exercise other evidence of ischemia
test • Moderately severe angina (defined as 3 on standard scale)
• Increasing nervous system symptoms (e.g. ataxia, dizziness, or near syncope)
• Signs of poor perfusion (cyanosis or pallor)
• Technical diflculties monitoring the ECG or SBP
• Subject's desire to stop
• Sustained ventricular tachycardia
• ST elevation (+1.0 mm) in leads without diagnostic Q waves (other than V1 or
aVR)
5. Relative Indica- • Drop in SBP 1e0 mmHg with an increase in work rate, or if SBP below the value
tions for stop- obtained in the same position prior to testing
ping an exercise • ST or QRS changes such as excessive ST depression (>2 mm horizontal or down
test sloping ST-segment depression) or marked axis shift
• Arrhythmias other than sustained V Tach, including multifocal PVCs, triplets of
PVCs, SVT, heart block, or bradyarrhythmias
• Fatigue, shortness of breath, wheezing, leg cramps, or claudication
• Development of bundle-branch block or intraventricular conduction delay that
cannot be distinguished from V Tach
• Increasing chest pain
• Hypertensive response (SBP>250 mmHg and/or DBP>115 mmHg)
, ACSM CEP Exam Test Questions and Answers Graded A+
6. ST segment de- 1e mm of horizontal or down sloping ST“60-80 ms beyond the J point suggesting
pression myocardial ischemia
7. Chronotropic in- 1. Peak exercise HR about 20 BPM below the age predicted HRmax or an inability
competence to achieve > 85% of the age predicted HRmax for subjects limited by volitional
fatigue.
2. Chronotropic index <.8
8. Heart Rate Recov- less than or equal to 12 BPM at 1 minute for walking, or less than or equal to 22
ery BPM at 2 mins for supine position
9. Sensitivity % of pts. tested with known CVD who demonstrate significant ST segment
changes.
Exercise EKG sensitivity usually requires greater than or equal to 70% stenosis
10. True Positive Horizontal or down sloping ST segment depression of 1e. 0 mm and correctly
identifies a patient with CVD
11. False Negative test shows no or non-diagnostic ECG changes and fails to identify patients with
underlying CVD
12. Specificity % of pts. without CVD who demonstrate non significant ST segment changes
13. True Negative Correctly identifies an individual without CVD
14. Causes of False • Failure to reach an ischemic threshold
Negative Test Re- • Monitoring an insuflcient number of leads to detect ECG changes
sults • Failure to recognize non-ECG signs and symptoms that may be associated with
underlying CVD
• Angiographically significant CVD compensated by collateral circulation
• Musculoskeletal limitations to exercise preceding cardiac abnormalities
• Technical or observer error
15. Predictive Value
