AHA Risk Stratification Criteria - Cardiac Rehab Lecture

Question 1

Class A - Apparently Healthy

Answer 1

Children, adolescents, men < 45, women < 55 w/ no sx or presence of heart disease or major RFs

Men 45 or older and women 55 or older w/ no sx/presence of HD w/ < 2 major CV RFs

Men 45 or older and women 55 or older w/ no sx/presence of HD and w/ 2 or more RFs

Question 2

Class A Guidelines

Answer 2

No activity restrictions
45-85% HRR (Karvonen)
12-16 BORG

No medical clearance required
No EKG
No supervision
Classes A2&3 should undergo medical supervision for HIGH INTENSITY exercise

Question 3

Class B: Known Stable Cardiovascular Disease - Low Risk

Answer 3

Any of the dx:
MI
CABG
PTCA
Angina
Abnormal exercise test
Abnormal angiogram
Valve disease that is stable 

AND

NYHA classes I & II
Exercise capacity 6 METs or less (4.5mph walking)
No ischemia or angina @ rest or w/ GXT when workload < 6 METs
BP appropriately rises w/ exercise
No tachycardia @ rest
Can self-monitor activity

Question 4

NYHA Class I

Answer 4

No limitation of physical activity

Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea

Question 5

NYHA Class II

Answer 5

Slight limitation of physical activity

Comfortable @ rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea

Question 6

Class B Guidelines

Answer 6

MEDICAL CLEARANCE PRIOR TO EXERCISE INITIATION
Supervised exercise program during initial sessions:
Supervised sessions by non-medical personnel after first few sessions of normal response to exercise
Can be unsupervised when person able to self-monitor
Useful to have EKG during first 6-12 sessions (to monitor rhythm)

Question 7

Class C: Known Cardiovascular Disease - Moderate-High Risk

Answer 7

CAD
Valve disease
Congenital heart disease
Cardiomyopathy w/ EF < 30%
Dysrhythmia not well-controlled 

NYHA Class III or IV
Exercise capacity < 6 METs
Angina or ischemic ST depression @ workload 6 METs or lower
Fall in SBP w/ exercise
Non-sustained ventricular tachycardia w/ exercise
Previous cardiac arrest

Question 8

Class C Guidelines

Answer 8

Medical clearance required
Exercise stress test
Medical supervision during sessions
ECG monitoring

Question 9

Class D: Unstable Disease with Activity Restriction

Answer 9

Unstable ischemia
Severe valve stenosis or regurgitation
Uncompensated HF
Uncontrolled dysrhythmia

Question 10

Class D Guidelines

Answer 10

No activity until medically cleared!