|
Consent Form
|
|
|
Risk Factors
• • •
|
CABG Year
|
|
MI Year
|
PCI Year
|
|
Complaints
• • •
|
|
|
|
|
|
Indications
• • •
|
|
|
Risks/Benefits Explained
|
|
|
|
|
|
Standard/Modified
• • •
|
Minutes
• • •
|
|
Stopped
• • •
|
|
|
Heart Rate
• • •
|
Percentage
• • •
|
|
Blood Pressure
/
|
Peak Workload
• • •
|
|
Chest Pain
• • •
|
Baseline
• • •
|
|
MM
• • •
|
Depression
• • •
|
|
|
|
|
Wall Motion - Resting - Normal
|
Wall Motion - Stress - Normal
|
|
Resting - Ant Basal
• • •
|
Resting - Ant Mid
• • •
|
|
Resting - Ant Distal
• • •
|
Resting - Sept Basal
• • •
|
|
Resting - Sept Mid
• • •
|
Resting - Sept Distal
• • •
|
|
|
|
|
Resting - Lat Basal
• • •
|
Resting - Lat Mid
• • •
|
|
Resting - Lat Distal
• • •
|
Resting - Inf Basal
• • •
|
|
Resting: Inf Mid
• • •
|
Resting - Inf Distal
• • •
|
|
|
|
|
Resting - Post Basal
• • •
|
Resting - Post Mid
• • •
|
|
Resting - Post Distal
• • •
|
Resting - Apex
• • •
|
|
|
|
|
|
|
|
Stress - Ant Basal
• • •
|
Stress - Ant Mid
• • •
|
|
Stress - Ant Distal
• • •
|
Stress - Sept Basal
• • •
|
|
Stress - Sept Mid
• • •
|
Stress - Sept Distal
• • •
|
|
|
|
|
Stress - Lat Basal
• • •
|
Stress - Lat Mid
• • •
|
|
Stress - Lat Distal
• • •
|
Stress - Inf Basal
• • •
|
|
Stress - Inf Mid
• • •
|
Stress - Inf Distal
• • •
|
|
|
|
|
Stress - Post Basal
• • •
|
Stress - Post Mid
• • •
|
|
Stress - Post Distal
• • •
|
Stress - Apex
• • •
|
|
|
|
|
|
|
|
Impressions - Capacity
• • •
|
EKG Response
• • •
|
|
Clinical Response
• • •
|
Wall Motion Response
• • •
|
|
Resting Wall Motion ABNL
• • •
|
Exercise Wall Motion ABNL
• • •
|
|
Rhythm ABNL Rest
• • •
|
Rhythm ABNL Exercise
• • •
|
|
|
|
|
|
|
|
Conclusion #1
• • •
|
|
|
Concusion #2
• • •
|
|
|
Concusion#3
• • •
|
|
|
Concusion #4
• • •
|
|
