Cardiac rehab

Question 1

what are the rules with cardiac rehab billing?

Answer 1

-you CANNOT bill the cardiac rehab codes and typical PT codes at the same time

Question 2

what can cardiac rehab improve?

Answer 2

3 months of exercise trainig can improve:

lipids, exercise capacity, obesity parameters

Question 3

what are the benefits of cardiac rehab?

Answer 3

• increased peak vo2
• increased peak anerobic threshold
• reductions in submax HR and RPP
• decresaed myocardial oxygen demand at submax workloads
• improved cholesterol profiles
• decreases markers of inflammation
• mental health
• mortality
• medication adherence

Question 4

what are some exlusions for cardiac rehab?

Answer 4

• unstable angina
• class IV HF
• uncontrolled sustained tachy or brady rhytyhms
• symptomatic aortic or mitral stenosis
• severe pulm hypertension

Question 5

what are some symptoms that could be aggravated by exercise?

Answer 5

• uncontrolled HTN (SBP >200, DBP >100
• suspected myocarditis or pericarditis
• recent DVT or pulm emb
• active infection

Question 6

When does Phase I occur?

Answer 6

acute phase
begins when patient admitted into hopsital and continues until discharge
-often 24-48 hours after cardiac event/surgery

Question 7

when does Phase II occur?

Answer 7

outpatient

subacute that begins as easrly as 24 hours after discharge but usually 1-3 weeks after discharge

Question 8

when does phase III occur?

Answer 8

maintenance phase with emphasis on patient independence

patient consults wtih PT occassioanyl

Question 9

when does phase IV occur?

Answer 9

maintanance

think health and wellness

Question 10

explain phase I

Answer 10

goals: evaluate physiologic responses to self-care and ambulation activities

• achieve 3-5 METs activites and assess vital signs
• documentation provides assessment to phusician and other team members
• provides guidance for safe progression of activity during recovery

include patient and family education, risk factor modication, self monitoring techniques and activity guidelines

Question 11

give exercise prescription for phase I

Answer 11

F: daily
I: HR rest+ 20-50 bpm
or maintain HR <75% APMHR
T: progress to > 150 min/week of light to mod
T: AROM with prgoression to light intesnity resistance exercises +WU +CD
progressive mobilization/ADL retraining (bed mod, stairs, gait, transfers)

Question 12

explain Phase II

Answer 12

“comprehensive cardiac rehab:
36 session, generally 2-3x a week for 12 weeks
-ECG monitoring
-supervised ex program
-structured education series
-comprehensive medical eval: cardiac risk factor modification, prescribed exercise,e ducation session, counseling

Question 13

what are indications for comprehensive cardiac rehab?

Answer 13

acute MI (<12 months ago)
stable angina
heart transplanet
valve repair/replacement
stenting
HF- NOW covered if EF <35%

Question 14

give exercise prescription for phase II

Answer 14

F: 3-5x a week
I: based on HR or VO2 or RPP
use Karvonen method for HRR 
or % peak HR
or APMHR
RPE
T: goal >150 min/week of mod intensity
T: aerobic and resistance

Question 15

if workload is the same; what happens with UE vs LE CV responses?

Answer 15

UE>LE for BP and HR

Question 16

what is RPP

Answer 16

rate pressure product
-measure of stress put on cardiac muscle based on HR and arterial BP that its pumping against (SBP)

-direct indication of energy demand of heart and a good measure of myocardial oxygen demand of heart

RPP= HRx SBP

Question 17

what are the 4 elements of myocardial oxygen demand?

Answer 17

• HR
• afterload (SBP)
• preload
• contractility

Question 18

explain Phase III

Answer 18

• provides ongoing supervised exercise conditioning program
• incentives for lifelong habits of exericse, risk factor reduction, ongoing education
• goal is increasing patient independence with exercise progression

Question 19

explain phase IV

Answer 19

• long term, open ended
• community based
• patient independent with all aspects of program
• no clinical superivsion