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KIN 429 > 3.2 Risk Stratification > Flashcards

3.2 Risk Stratification Flashcards

1
Q

Risk stratification is based on what idea?

Is this idea always true?

A

A patient’s history and profile can suggest who should be watched closely for complications (ex. cardiac arrest)

should be taken with a grain of salt, because cardiac events can occur without normal symptoms, and from plaque build-ups <70%

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2
Q

What do we want to consider when determining if the patient needs supervision?

A

Absolute risk
disease progression
concurrent disease conditions
age
possible complications that can occur during exercise

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3
Q

What factors are believed to increase risk of adverse cardiac events during physical exertion?

A
  • high intensity exercise
  • known CVD
  • high probability of CVD
  • ppl with many risk factors, especially if uncontrolled
  • beginning an exercise program
  • showing up to exercise UNWELL
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4
Q

How often will you see some type of problem during exercise for cardiac rehab patient?

A

every 320 hrs of exercise

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5
Q

In risk stratification, what factors do we want to consider?

A

Left ventricular ejection fraction
Ischemic load
Exercise tolerance
Ventricular Dysrhythmia
Control of risk factors affecting disease progression
Age
Co-morbidities

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6
Q

What are the 2 “shockable” arrhythmia?

A

VTAC or VFIB

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7
Q

What are the signs and symptoms to be aware of in risk stratification?

A

discomfort
short of breath
fatigue
orthopnea (short of breath laying down)
dizziness or syncope
ankle edema - pitting edema
palpitations
other target organ damage, claudication, etc.

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8
Q

What is orthopnea?

A

shortness of breath while laying down

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9
Q

What is syncope and pre-syncope?

A

syncope: fainting
pre-syncope: light-headedness or faint

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10
Q

What is the AHA risk stratification criteria for Class A 1,2,3?

A

A-1: child, adolescent, men<45, women<55 who have no symptoms or known CVD or coronary risk factors

A-2: men≥45yrs, women≥55yrs; no symptoms or known CVD, <2 major CV risk factors

A-3: men≥45yrs, women ≥55yrs, no symptoms or known CVD, ≥3 major CV risk factors

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11
Q

What is the AHA risk stratification criteria for Class B?

A

known, stable CVD with low risk for complications with vigorous exercise, but slightly greater than apparently health individuals

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12
Q

AHA Class B includes individuals with what diagnoses?

A
  • CAD (MI, CABGS, PTCA) - but stable conditions
  • Valvular heart disease (excluding severe valvular stenosis or regurgitation)
  • Congenital heart disease
  • Cardiomyopathy
  • Exercise test abnormalities that don’t meet class C criteria

-medically stable
-NO unstable angina

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13
Q

What is the exercise capacity of a class B individual?

A

≥ 6 METS

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14
Q

What are the symptoms of a AHA class B individual?

A

no symptoms, or no symptoms below exercise at 6 METS

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15
Q

What is the AHA risk stratification criteria for Class C?

A

individuals with moderate to high risk for cardiac complications during exercise and/or unable to self-regulate activity or understand recommended activity level

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16
Q

AHA Class C includes individuals with what diagnoses?

A
  • CAD (MI, CABGS, PTCA) - but stable conditions
  • Valvular heart disease (excluding severe valvular stenosis or regurgitation)
  • Congenital heart disease
  • Cardiomyopathy, EF ≤30%
  • Complex ventricular arrhythmias not well controlled
17
Q

What are the clinical characteristics of a class C individual?

A
  • Exercise capacity <6 METS
  • Angina or ischemia ST depression at workload <6 METS
  • Fall in systemic BP below resting level with exercise
  • Nonsustained ventricular tachycardia with exercise
  • previous cardiac arrest that was not in presence of acute MI or during clinical procedure
  • physician believes they have a possibly life threatening med problem
18
Q

What is the difference between class B and class C in terms of supervision?

A

B - medical supervision suggested for initial prescription session; then supervision by trained nonmedical personnel until able to monitor activity

C - medical supervision during all exercise sessions until safety is established

19
Q

What individuals are classified in AHA Class D?

A
  • unstable ischemia
  • severe and symptomatic valvular stenosis or regurgitation
  • congenital heart disease
  • heart failure that’s not compensated
  • uncontrolled arrhythmias
  • other medical conditions that can be aggravated by exercise
20
Q

What are the activity guidelines for Class D?

A

no activity
daily activities must be prescribed on the basis of the individual assessment by the patient’s physician

21
Q

What is the risk rate compared to functional capacity (METS)?

A

low risk: >8 METS
intermediate risk: 5-8 METS
high risk: <5 METS

22
Q

If not able to achieve _ METS, the risk of premature death is a lot higher.
However, you maximize benefit (plateau) at about __ METS.

A

<7 METS - risk of premature death is a lot higher

Maximize benefit at about 10 METS

23
Q

A brisk walk would be considered about _ METS.

A

3 METS

24
Q

Myocardial ischemia is caused by what?

A

decreased supply (primary ischemia)

increased demand (secondary ischemia)

or a combination (mixed ischemia)

25
Q

What is ischemic burden?

A

the sum of all episodes of myocardial ischemia (with or without angina) = ichemic burden

26
Q

What aspects of dysrhythmias predict health outcomes?

A

> 10 PVC’s per min
Non-sustained VT
Sustained VT

27
Q

What is a PVC?

A

premature ventricular contraction

28
Q

Is prolonged strenuous exercise a good thing (ie., marathons or ultra runs)?

A

Can have damage on the heart

ex. study with rats and long-term intensive exercise training = increased myocardial inflammation, fibrosis, reduced arrhythmia threshold

29
Q

Extreme endurance exercise is associated with the release of what?
It may be associated with what diagnoses?

A

Release of troponin, CPK-MB, and BNP (increase in cardiac enzymes, damaging heart muscle)

Transient cardiac dysfunction
Cardiac fibrosis
Dysrhythmias
can generate scar tissue in the heart
- may see calcification in coronary arteries after long-term

30
Q

What are the signs and symptoms below which an upper limit for exercise intensity should be set?

A

onset of angina pectoris (chest pain)
decreased SBP, SBP > 240mmHg
DBP >110mmHg
≥ 1mm ST-segment depression
Evidence of left ventricular dysfunction
Threatening ventricular arrhythmias

31
Q

Peak exercise HR should be at least __beat/min below the HR associated with these signs and symptoms of upper limit.

A

10 beats/min

32
Q

For an individual that suffers an out-of-hospital sudden cardiac arrest, the likelihood that they will survive through hospital discharge is __%.

A

6%

33
Q

With every additional minute of cardiac arrest, what happens to the likelihood of survival?

A

survival drops 10%

34
Q

In the population that routinely exercise, the risk of MI or SCD increases by how much when participating in vigorous aerobic exercise?

A

risk of MI increases 2-5x

35
Q

What are the guidelines for progression to independent exercise with minimal or no supervision?

A

-Functional capacity ≥ 8 METS
-appropriate hemodynamic response to exercise and recovery
-appropriate ECG response at peak exercise
-cardiac symptoms are stable or absent
-stable and/or controlled baseline HR and BP
-adequate management of risk factors
- knowledge and understanding of safe exercise prescription
-knowledge of disease process, signs and symptoms, medication use and side effects
-compliance and success with program of risk intervention

KIN 429 (10 decks)

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