Cardiac Rehab

Question 1

Who is eligible for cardiac rehab?

Answer 1

stable MI patients

compensated HF

Heart transplant

stable angina

key is hemodynamic stability and rhythm stability

Question 2

What are the Four phases of cardiac Rehab?

Answer 2

I. Acute/inpatient hospital phase (3-5 days uncomp. MI)

2. Outpatient with intensive monitoring phase (6-12 weeks)
3. training and maintenance (does not require continuous telemetry)
4. High-risk patients in a disease prevention program (not offered everywhere)

Question 3

On average, with an uncomplicated CABG procedure the patient is ambulating by when?

Answer 3

Post op day #1

Question 4

What does it mean to have an uncomplicated MI or CABG?

Answer 4

No angina post MI

no malignant arrhythmias

no sx of HF

Question 5

Who needs telemetry (continuous)?

Answer 5

1. LEF <30%
2. complex ventricular arrhythmias at rest
3. Decreased BP with exercise (10-20 mmHg)
4. survivors of sudden death
5. following complicated MI
6. severe CAD and marked exercise-induced ischemia
7. inability to monitor self

Question 6

What are the contraindications for rehab for acute care cardiac pts?

Answer 6

1. unstable angina
2. resting SBP >200 or DBP >110
3. orthostatic drop of >20
4. uncontrolled atrial or ventricular arrhythmias or Afib >170
5. uncontrolled sinus tach >120 bpm
6. s/p aortic dissection repair
7. critical aortic stenosis (with qualifiers)
8. acute systemic illness/fever
9. Uncompensated CHF
10. 3rd degree AV block, no pacemaker
11. <48 hours after PE
12. High or low glucose
13. hyperthyroid
14. hyperkalemic/hypokalemic (K+ pills)

Question 7

What is the dyspnea scale?

Answer 7

+1 mild, noticeable to patient, not to observer

+2 mild, some difficulty, noticeable to observer

+3 moderate, difficult, but can continue

+4 severe difficulty, patient can not continue [never here in rehab]

Question 8

What is the stages of stable angina scale?

Answer 8

1. initial perception of discomfort
2. increase in intensity level or radiation to other areas
3. relief obtained only through cessation of activity
4. infarction pain [never have rehab patients here]

Question 9

What is the BORG scale of Rating of Perceived Exertion

(RPE)?

Answer 9

6-20

6 nothing at all

20 is maximal exertion (11-13 is where we want rehab patients)

sometimes given as 1-10 (2-3)

Question 10

What do you want to increase first, duration or intensity?

Answer 10

Duration. Never increase both at the same time.

Question 11

What is the ideal exertion for cardiac rehab?

Answer 11

5 METS = 2 flights of stairs

Question 12

What are post-MI and post-CABG rates?

Answer 12

RHR + 20 or less than 120 overall

RHR+30