Cardiac Rehab

Question 1

Criteria to reduce or terminate ex:

Answer 1

1. Angina or other s. of intolerance
2. 10 pt DROP in systolic BP or
   rise in Systolic >240, Diastolic>110
   260/115 for ex test
3. > 1mm ST segment depression, horiz or downslope. >2mm upslope
4. Increased freq of ventricular arrhythmias
5. 2nd deg or 3rd deg AV block or other disturbance

Question 2

NYHA 4 levels of Heart Failure

cardiac rehab intensity levels

Answer 2

1. Asymptomatic (6.5 METS)
2. Symptomatic with mod exertion (4.5 METS)
3. Symptomatic with minimal exertion (3 METS)
4. Symptomatic at rest (1.5 METS)

Question 3

RPP

Answer 3

rate pressure product
HRxSBP
energy cost to myocardium

Question 4

What does Digitalis do to EKG?

Digitalis __HR and __contractility

Answer 4

depresses ST, flattens t-wave, shortens QT

decrease HR, increase contractility

Question 5

hyperkalemia or hypercalcemia can change the EKG how?

Answer 5

widen QRS

Question 6

Beta blockers ___ HR

Nitrates ___HR

Answer 6

decrease; increase

Question 7

MAP

Answer 7

mean arterial pressure

systolic+(diastolicx2) / 3

Question 8

types of angina

Answer 8

stable
unstable
variant (pretzmetals)
asymptomatic (diabetic)

Question 9

signs of MI

Answer 9

male: SOB, wkness, fatigue, chest discomfort
female: early warnings with sleep disturbance and unusual fatigue, SOB, wkness, only 30% experience chest discomfort

Question 10

ABI

red flag*

Answer 10

ankle pressure / brachial pressure
1 is normal
<.5 is no bueno!

Question 11

karvonnen

Answer 11

(220 - Age) – (Resting HR) = HRR

HRR x Training Intensity % + Rest HR = Train HR

Question 12

1 MET =

activity 1-10

Answer 12

1 met = 3.5mL/kg O2 REST
2-3 mets = slow walking
4-6 mets = ADLs, brisk walking, mod bike
8 mets = jog
10 mets = swim/run

Question 13

resistance training typically begins __ weeks after event

Answer 13

4-6

Question 14

RPE___ corresponds to 60% intensity

RPE___ corresponds to 85% intensity

Answer 14

12-13

16

Question 15

exercise begins __ after MI

__ weeks after for angioplasty

Answer 15

exercise begins 24 hrs after

2 weeks after for angioplasty

Question 16

cardiac rehab is CONTRAINDICATED if…

Answer 16

unstable angina, 200/110, orth hypotn w/ sx, aortic stenosis, fever, uncontrolled arrythmia, uncontrolled tachy 120+, uncompensated CHF, pericarditis/myocarditis, uncontrolled diabetes

Question 17

PHASE I cardiac rehab

Answer 17

ACUTE 3-5 days, 2-3x daily, short sessions

2-3 METS, 10-20 pt rise in HR

Question 18

PHASE II cardiac rehab

Answer 18

OP or SUBACUTE progressing to ADLs
3-4xwk w/ ECG monitoring (progress to self check)
end goal of 9 METS
30-60 min + WU/CD

Question 19

PHASE III cardiac rehab

Answer 19

COMMUNITY- may be supervised 6-12 months

50-80% 45min or more, 4x wk or more

Question 20

guidelines for CHF exercise

Answer 20

must be medically stable, >3 MET capacity, HR>115 contraindicated during exercise, use energy conservation, caution with supine as orthopnea is likely.

Question 21

2 red flags with lymphedema

Answer 21

1. avoid vasodilation (thermal)

2. compression should be NO higher than 45mmHg