cardiac rehab Flashcards
definition of cardiac rehab
The coordinated sum of activities required to influence favourably the underlying cause of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that the patients may, by their own efforts, preserve or resume optimal functioning in their community and through improved health behaviour, slow or reverse progression of disease - BACR British association for cardiovascular prevention and rehab
core components of cardiac rehab
physical exercise
smoking cessation
optimization of BP, lipid levels and glycemic control
regulation of body weight
education on risk factors and lifestyle
nutritional advice
psychosocial support
describe phase 1 of cardiac rehab
period of hospitalisation following an acute cardiac event.
risk assessment and risk stratification
receiving info on their dx, risk factors, meds, work/social issued
early mobilisation and discharge planning
describe phase II of cardiac rehab
immediate post discharge period
lasts 4-6 weeks
health education
resumption of physical activity.
Week one post discharge:Aim to walk for five minutes each day. If you find that this is very easy, you can do twofive-minute walks in the one day before increasing your walking time.
Week Two:Aim to walk for 10 minutes non-stop each day, as it becomes easier, you may increase the time by aminute or two.
Week Three:Aim to walk for 15-20 minutes non-stop each day.
Week Four:Aim to walk for 20-25 minutes non-stop each day.
Week Five:Aim to walk for 25-30 minutes non-stop each day.
Week Six:Aim to walk for 30-40 minutes non-stop each day.
describe phase III of cardiac rehab
Incorporates exercise training in combination with on-going education and psychosocial and vocational interventions
last 6-8 weeks
pts attend CR unit 2-3 times weekly
what occurs in phase IV of cardiac rehab
Need to have a plan before the end of the programme
Need to think of barriers to exercise
Need to start before the end of the programme
NYAH classification class I
Have cardiac disease w/o limitations of PA
normal PA does not cause fatigue, dyspnea, palpitation or anginal pain
NYAH classifcation II
Have cardiac disease w slight limitations of PA
normal PA does cause fatigue, dyspnea, palpitation or anginal pain
NYAH classification III
Have cardiac disease w/ marked limitations of PA. Comfortable at rest/
Less than normal PA does not cause fatigue, dyspnea, palpitation or anginal pain
NYAH classification IV
Unable to carry any PA w/o discomfort
symptoms of cardiac insufficiency or anginal syndrome may be present at rest
list atheresclerotic CVD risk factors
age men > 45 women>55
Hamily hx - MI, coronary revascularisation, sudden death before 55
smoking hx
physical inactivity - at least 30 min moderate 40-59% VO2R on at least 3d of the week
obesity - BMI > 30kg.m, waist girth > 102cm me, >88cm women
hypertension - SBP >140 mmHg, DBP >90 mmHg on at least 2 occasions or on at least
antihypertensive meds,
dyslipidemia - low density lipoprotein cholesterol > 130mg. dL high density lipoprotein cholestrol <40mg.dL, total serum cholesterol > 200 mg
diabetes - fasting plasma glucose 126 mg. dL
What medications to be cautious of during CR
Beta Blockers
ACE inhibitors
Angiotensin receptor blockers
Anticoagulants
Anti-platelet
Diuretics
Lipid lowering drugs
Why to be cautious of beta blockers in CR
Postural HTN
Attenuated HR response
Take 20-30bpm off target HR
Why be cautious of ACE inhibitors
Increase exercise capacity with heart failure
Postural HTN
Why be cautious of ACE inhibitors
Increase exercise capacity with heart failure
Postural HTN
why be cautious of angiotensin receptor blockers
postural HTN
Why be cautious of anticoagulants
Increased risk of bleeding. Ensure environmental safety
why be cautious of anti-platelet
breathing difficulties
why be cautious of diuretics
Dehydration
Postural HTN
Compliance with attending class (frequent mituration)
why be cautious of lipid lowering drugs
Possible aching in legs
describe ACCPVR risk stratifcation
low risk - functional capacity > 7 METS and EF > 50%
moderate risk - functional capacity < 5METs and EF 40%-60%, presence of angina and symptoms at >7METS
high risk - Presence of angina at < METS, EF <40%
purpose of bruce protocol treamill test
functional capacity exercise test
help identify persons level of aerobic endurance
gradual increase in treadmill speed and inclination for 3 mins
describe chester step test
step on and off low step at special rate
every 2 mins the HR and RPE checked and recorded
stepping rate increases
progress until subject reaches 80%HRMax or reports RPE =14
How to calculate 80%HRMax
(220-age) x 0.8)
how long is monitored for patients at low risk according to AACVPR
Direct staff supervision of exercise for min 6-18 exercise sessions
continuous ECG monitoring and decrease intermittent ECG monitoring
must maintain normal hemodynamic findings - no development of abnormal signs to remain at low risk
how long is monitored for patients at medium risk according to AACVPR
Direct staff supervision of exercise should occur for a minimum of 12-24 exercise sessions beginning with continuous ECG monitoring and decreasing to intermittent ECG monitoring as appropriate
how long is patient monitored during CR at high risk according to AACVPR
supervision for at least 18-36 exercise sessions
screening before CR class
symptomatic hypotension - SBP <90 or DBP <60
Symptomatic hypertension SBP > 180, DBP > 100
Tachycardia at rest > 100bpm
unstable arrhythmia
unstable heart failure
unstable diabetes
febrile illness
unstable angina
benefits of CR
Improved exercise capacity
improved HRQoL
Decreased hospitalisation
increased independence
decreased depression.
6 Core Components of Cardiovascular Disease Prevention and Rehab
- Health behaviour change and education;
- Lifestyle risk-factor management (including physical activity and exercise training, diet, smoke cessation);
- Psychosocial health; - social support
- Medical risk-factor management; - medication, beliefs on medication and adherence
- Long-term strategies;
- Audit and evaluation
6 Core Components of Cardiovascular Disease Prevention and Rehab
- Health behaviour change and education;
- Lifestyle risk-factor management (including physical activity and exercise training, diet, smoke cessation);
- Psychosocial health; - social support
- Medical risk-factor management; - medication, beliefs on medication and adherence
- Long-term strategies;
- Audit and evaluation
