Cardiac Rehab

Question 1

who is appropriate for cardiac rehab?

Answer 1

Post-CABG, stent placement
Post-PTCA
Post-cardiac surgery including transplants
Post-MI
Those with ID’ed heart disease
CHF, stable angina
Elderly
Asymptomatic, at-risk pts

Question 2

who is NOT a candidate for cardiac rehab? (“HUU’S CAR”)

Answer 2

Hemodynamic instability (SBP > 200, DBP > 100, Orthostatic fall > 20)
Unstable angina
Uncontrolled DM
Serious arrhythmias
Conduction abnormalities (2nd/3rd deg blocks)
Active infections
Resting ST segment depression

Question 3

when does Phase I (acute/IP) begin?

Answer 3

Immediately upon pt becoming stable (pt will be ECG monitored)

Question 4

when does Phase II (subacute) begin?

Answer 4

2-12 weeks after DC from hospital

Question 5

what are 3 big things to know about Phase II?

Answer 5

-Pt is ECG monitored for at least the beginning of this phase
-Frequency: 3x/wk for 6 wks
-Do NOT want peak SBP bc it can damage the repaired area

Question 6

what should the intensity be during Phase I?

Answer 6

< 120 bpm or < 20-30 bpm increase during exertion

Question 7

when should you STOP tx during Phase I?

Answer 7

-Unusual HR inc
-Inappropriate BP response (SBP > 210, DBP > 110)
-10+ drop in SBP with exercise
-Presence of symptoms

Question 8

what are the 3 main goals of Phase I?

Answer 8

-Initiate return to independence in ADLs
-Counteract deleterious effects of bed rest
-Provide medical surveillance during ADLs

Question 9

activities to consider during Phase I

Answer 9

Self care
UE/LE AROM
Very light weights
Independent transfers
Bedside sitting → ambulation → stairs

Question 10

by the time a pt is DC from Phase I, how many METs of activity should they be able to perform?

Answer 10

3-5 (< 17 ml/kg min or 5 METs defines disability and energy expenditure needed to complete ADL)

Question 11

how long will the pt typically be in Phase II?

Answer 11

8-12 weeks

Question 12

what are the goals of Phase II? (“PP RIPP”)

Answer 12

-Provide pt and family edu
-Prepare pt to return to work
-Risk factor reduction/secondary prevention strategies
-Improved exercise tolerance/functionality
-Promote psychological, behavioral and edu improvement
-Perform 3-5 METs (2-3 mph) for 30 min

Question 13

what is considered abnormal BP and HR response during Phase II?

Answer 13

SBP > 240 mmHg
DBP > 110 mmHg
> 20 bpm drop during activity

Question 14

when is it safe to begin resistance training after an MI?

Answer 14

5 weeks

Question 15

when is it safe to begin resistance training after a CABG?

Answer 15

8 weeks

Question 16

when is it safe to begin resistance training after a PTCA or stent?

Answer 16

2 weeks

Question 17

intensity of resistance training during Phase II

Answer 17

30-50% 1RM
1-2 sets x 8-10 or 10-12 reps
2-3x/wk with rest day in between
11-13 RPE (no straining or pain)
Start at 20 min and work up to 60 min

Question 18

when does Phase III (training or intensive OP rehab) begin?

Answer 18

3-6 mos post-event

Question 19

what does Phase III consist of?

Answer 19

HEP
YMCA
Pt may or may not be seen by staff
Self-monitoring, no ECG monitoring

Question 20

what are 3 goals for Phase III?

Answer 20

Achieve 50-80% of HRR on treadmill test (moderate activity)
3-4 exercise sessions/wk
> 45 min per session

Question 21

what does Phase IV (maintenance) consist of?

Answer 21

HEP
Self monitoring
Environmental concerns
Adherence