Cardiac

Question 0

What is Aerobic capacity (VO2 Max)?

Answer 0

Aerobic capacity is a term used to measure the maximum oxygen consumption an individual can achieve during exercise. As the individual increases the workload or exercise, VO2 increases in a linear fashion until it levels off and reaches a plateau, despite further increases in the workload. This is the aerobic capacity of individual. It is usually expressed in millimeters of O2 consumed per kilogram of body weight per minute.

VO2= HR x SV x A-VO2 diff.

Question 1

What is VO2?

Answer 1

Total oxygen consumption (VO2) represent the oxygen consumption of the whole body. it represents the work of the peripheral skeletal muscles rather than the myocardial muscles.

Question 2

Myocardial oxygen consumption MVO2

Answer 2

Myocardial oxygen consumption is the actual oxygen consumption of the heart. It can be measured directly with cardiac catheterization. In The clinical setting, however, the rate pressure product (RPP) can be used to estimate the MVO2 since the heart rate and systolic blood pressure correlate well with it.

Question 3

What is the rate pressure product (RPP) a.k.a. double product?

Answer 3

RPP refers to the work required of the heart which closely parallels the systolic blood pressure -> heart rate

Question 4

How do you calculate the Estimated MVO2?

Answer 4

MVO2=RPP= SBP x HR

Question 5

How do you calculate cardiac output?

Answer 5

CO= HR x Stroke volume

Question 6

Stroke volume=

Answer 6

The amount of blood pumped by the left ventricle in one contraction.

End diastolic volume - End systolic volume

Not healthy 70 kg man it is roughly 70 mL

Question 7

Fick equation

Answer 7

VO2 max = Cardiac output x AVO2 Difference

Question 8

Define 1MET

Answer 8

• Defined as the ratio of working metabolic rate to Basal resting metabolic rate.
• 1 MET= 3.5 mL O2 Consumed per kilogram of body weight per minute.
• -1 MET= Energy consumption while at basal metabolic rate. (Seated rest)

Question 9

Which cardiac response is increased as a result of aerobic training?

A. Oxygen consumption VO2
B. Maximal heart rate
C. Anginal threshold
D. stroke volume at rest

Answer 9

D. After an aerobic training program, the anginal threshold is unchanged. Oxygen consumption (VO2) at rest, and during any given submaximal load remains unchanged, while VO2 max is increased. The maximal heart rate also does not change, but the heart rate is lower both at rest and during any submaximal load (Bradycardia of training). The stroke volume at rest increased, reciprocal to the decrease in heart rate. Although angina threshold is unchanged, myocardial oxygen demand decreases relative to oxygen consumption, which allows more intense activity before the ischemic threshold is reached.

Question 11

What is the average decline in physical work capacity between the ages of 40 and 60 years old?

Answer 11

20%
While variation exists an average decline of 20% in physical work capacity is been reported between the ages of 40 and 60 years, due to decreases in aerobic and musculoskeletal capacity. However, differences in habitual physical activity will influence the variability seen in individual physical work capacity and its components.

Question 12

15. A 32 year old man has BP of 190/90 with 10 METS of exercise. What is the diagnosis?
    A) hypertension
    B) post-cardiac transplant
    C) coronary artery disease normal exercise response
    D) normal exercise response

Answer 12

Answer: D
During exercise testing, the predicted rise in BP for sedentary middle-aged men is ≥205/≥95. In general, the systolic BP should increase in proportion to the workload but should not be greater than 250 mm Hg. The diastolic BP should not exceed 120 mm Hg or increase by more than 20 mm Hg. 1 MET is equal to 3.5 ml O2 consumption/kg/min at rest. 10 METS of exercise is considered to be very heavy activity.

Question 13

58. What should be done following lumpectomy for breast cancer?
    A) start ROM within 48 hours
    B) start ROM after 1 week
    C) apply compression garments immediately to prevent lyumphedema
    D) no rehabilitation necessary

Answer 13

Answer: A
In general, postmastectomy patients without reconstruction are allowed to perform shoulder ROM to 40° of abduction and flexion immediately after surgery. Other therapy consists of hand, wrist, and elbow ROM, positioning, and postural exercises. External rotation of the shoulder and scapular retraction are also indicated. After surgical drains are removed, AROM can be increased. When all sutures are removed, facilitated and passive stretch can be pursued. (I couldn’t find anything specifically on patients s/p lumpectomy but if the above therapy can be done after a mastectomy, I don’t see why it can’t be done after a lumpectomy)

Compression garments are a treatment (not prevention) for lymphedema. Lymphedema can occur after lumpectomy, segmental resection, or radial mastectomy. Etiology is multifactorial, caused by a combination of excision of lymph channels, inflammation, coagulation of lymph, fibrosis of breast tissue (i.e. post-radiation), and local infection.

Ref: PM&R Secrets: p 332

Question 14

Q180 What symptoms do you discontinue cardiac rehab?
A)	SBP decrease by 20mmHg
B)	With asymptomatic diaphoresis
C)	Heart rate increase by 20
D)	SBP increase by 20mmHg

Answer 14

A (Correct answer given is SBP decrease by 20mmHg)
Risk of Ischemia during Cardiac Rehab include:
Drop in SBP 10 points or more with exercise, LVEF<35%, NYHA III-IV CHF, postop V-tach or V-fib, ventricular ectopy with exercise,
Braddom 2nd ed. table 32-15 p 684

Question 15

Does cardiac rehabilitation increase cardiac output?

Answer 15

Yes and no. Cardiac rehabilitation increases maximum cardiac output however, it does not increase resting cardiac output.

Question 16

Does cardiac rehabilitation reduce the rate of recurrent MI?

Answer 16

Yes cardiac rehabilitation reduces the rate of recurrence and my by 17%, decreases mortality secondary to MI by 15% to 20%, and increases LV ejection fraction after MI.

Question 17

Describe phase 1 of cardiac rehab.

Answer 17

Phase 1 for last 1 to 14 days. The focus of this phase is to closely monitor the patient while increasing metabolic equivalents by 1 to 2 each day until a met of four is reached.

It is possible to skip phase 1 and some patients to which is intermediate open patient phase after after a noninvasive procedure.

Question 18

Describe phase 2 cardiac rehab

Answer 18

Phase 2 is a supervised ambulatory outpatient program lasting 3 to 6 months. An exercise tolerance test is usually performed at this phase to guide the rehabilitation. This is an immediate outpatient phase that requires a higher level of monitoring.

Question 19

Describe phase 3.

Answer 19

Phase 3 begins after the determination of hemodynamic ability established with exercise tolerance testing during phase 2. Phase 3 sets a higher target heart rate for patient and sets a goal to maximize therapeutic benefit of cardiac rehabilitation before maintenance begins.

Question 20

Describe phase 4 of cardiac rehab

Answer 20

Phase 4 is also known as the maintenance phase. The focus is on maintaining goals met during the initial phases of rehab by incorporating a home exercise program and continuing risk factor management. Initial gains made during the first three rehab phases may decrease with time if the patient does not continue with exercises to maintain conditioning.

Question 21

What is the Borg scale?

Answer 21

Widely used scale that quantifies exertion by the patient and helps Taylor rehabilitation for the patient. The original Borg scale was a 15 point scale, where as the modified borg scale consists of 10 points from no exertion to maximal exertion. Patient should be maintained on moderate exertion during the first two phases of cardiac rehab.

Question 22

Why is cooldown important in cardiac rehabilitation?

Answer 22

Patients undergoing cardiac rehabilitation are at a higher risk for post exercise hypotension or even syncope if a slow cooldown phase is not incorporated into the exercise regimen. The heart continues to generate a higher cardiac output based on the increased demand during the conditioning phase and an abrupt stop in exercise may result in a drop in blood pressure causing hypotension.