4.5 - Cardiac Rehab Flashcards
Week 4, Friday
Describe the abnormal responses to exercise (indications to terminate)
Dizziness, lightheadedness
Angina
Claudication
Cyanosis, pallor
Marked Dyspnea
Excessive fatigue
Hypertensive BP response >200/110
Drop in SBP >10 mmHg
SBP not increasing with increasing workloads
Significant change in EKG rhythm
Describe / review the indications to begin cardiac rehab
Medically stable post-MI
Stable angina
CABG
Stable heart failure
Heart transplantation
Valvular heart surgery
PAD, CAD
“Stable conditions”
“Post-surgical”
Describe / review contraindications to begin cardiac rehab
Unstable angina
Uncontrolled HTN (>200 or >110)
Orthostatic hypotension
Aortic stenosis
Uncontrolled arrhythmias
Pericarditis / myocarditis
3rd deg AV black w/o pacemaker
Uncontrolled PE / DVT
“Any unstable conditions”
Describe how to calculate RPP
RPP = HR x BP
Describe a (+) vs (-) exercise tolerance test
(+) = signs of myocardial oxygen supply inadequate for demand
(-) = balanced oxygen supply and demand
Describe the norms for the 6-minute walk test for “good long-term survival rate”
> 300m (~1000 ft)
Review Borg’s RPE scale
Simple way to remember: multiples 6-20 scale by 10 to get ~HR at that intensity
At what RPE does the majority of cardiac rehab take place?
12-15 (somewhat hard to hard)
4-6 (somewhat hard to hard) on 0-10 scale
Summarize the three phases of cardiac rehab
Phase 1
- Inpatient, acute stay
- Goal: get back to ADLs
Phase 2:
- Outpatient phase
- Progressively increase tolerance to activity
Phase 3:
- Community program
- Self-regulated, maintenance / progression
Describe the appropriate exercise intensity for phase I cardiac rehab
HRrest +20-30 bpm (HR<120 total)
Borg RPE <13/20
“Light exercise w/ minimal increase in HR”
Describe the appropriate exercise intensity for phase 2 cardiac rehab
55-90% HRmax
Borg RPE 12-16 (light to somewhat hard)
5-9 METs
“Progressively increase tolerance to activity”
Describe the appropriate RPP for phase II cardiac rehab
Keep activities <90% of ISCHEMIC RPP
Ischemic RPP - RPP at which ischemic symptoms are noted
Describe phase III cardiac rehab
Community program
Self-regulated, maintenance / progression
x6-12 months
Describe the Karvonen method for determining exercise intensity
(HRmax-HRrest) x %intensity + HRrest = Target HR
HRreserve = HRmax - HRrest
Determine the appropriate target HR for a 55 yo male exercising at an intensity of 75% HRreserve
HRrest = 65 bpm
(165 - 65) x .75 + 65 = 140 bpm
Describe the appropriate parameters for strength training during cardiac rehab
10-15 repetitions comfortably
40-60% 1RM
11-13 RPE
Large muscle groups
Exhalation w/ exertion (AVOID valsalva maneuver)
Describe the sternal precautions
Post sternectomy
AVOID:
- UE lifting >10 lbs
- Pushing / pulling
- Scapular adduction (activates pec major)
- UE resistive exercises above 90 deg
- NO UE assistance w/ S2S
- Sternal “splinting” w/ cough, laugh, or sneeze
What are the common classes of cardiac medications?
Beta-blockers
ACE inhibitors
Calcium channel blockers
Beta-blockers
Describe how recognize this medications
MOA
Clinical considerations / Side effects
“-lols”
- metropolol, propranolol, etc.
MOA:
- Blocks beta-receptors in heart –> doesn’t allow for NE & E to bind receptors –> decreases sympathetic stimulation
- Decrease HR, decrease contractility
Clinical Considerations:
- Do NOT use HR as a measure for exercise intensity with these patients
- Meds decrease submaximal and maximal HR & BP response to exercise
- Patients fatigue more easily
Side Effects:
- Fatigue
- Orthostatic hypotension
- Dizziness
- (Bronchoconstriction)
ACE Inhibitors
Describe how to identify
MOA
Clinical considerations / Side Effects
“-prils”
- Lisinopril, captopril, etc.
MOA:
- Blocks production of ACE (angiotension-converting enzyme) –> vasodilation
- Reduces BP
Side Effects:
- Orthostatic hypotension
- Cough (annoying, but not life-threatening)
- Dizziness, fatigue
- HYPERkalemia (due to inhibition of aldosterone –> decrease Na+ & K+ reabsorption)
Calcium Channel Blockers
Common medications
MOA
Clinical Considerations / Side Effects
“pines” - amlodipine, nifedipine
verapamil, diltiazem
“Pine trees have lots of Ca++; have to take these trees to the ‘mil’.”
MOA:
- Block calcium entry into cardiac muscle tissue –> vasodilation & decreased vascular resistance
- Decreases BP, HR
Nitrates (nitroglycerin)
MOA
Describe how to administer
Clinical Considerations / Side Effects
MOA:
- Releases nitric oxide - a potent vasodilator
- Vasodilation –> increases BF to cardiac tissue; decreases BP (peripheral resistance) to decrease cardiac workload
Administer:
- Patient bring their OWN medications
- Sublingual
- Repeat up to 3x every 5 min
- If no resolution of symptoms after 15 min –> emergent referral
Adverse Effects:
- Headache
- Orthostatic hypotension
Clinical Considerations:
- Have patient lie down when taking due to high risk of hypotension!
Cardiac glycosides
Common medications
MOA
Digoxin, digitoxin, digitalis
MOA:
- Decrease HR –> increased filling time –> increased EDV –> improved myocardial contraction force
- Inhibits sympathetic NS; slows sodium-potassium pump
- “Fewer, but better beats!”
Side Effects:
- GI distress - n/v, diarrhea
- Cognitive functioning - drowsiness, confusion, fatigue
- Arrhythmias - PAC, PVC, a-tach, v-tach, AV blocks
