Cardiac Rehab Flashcards
When a patient is unable to undergo graded exercise testing, what is the secondary option?
ETT with radionuclide perfusion
What are the two testing modes for cardiac rehab?
1) treadmill or cycle ergometry
2) step test
What should your facility have if you’re completing maximal ETT?
advanced cardiac life support
ETT = exercise tolerance testing
What is Karvonen’s formula, and what’s it for?
predicting target HR range
.6 (HR max - resting HR) + resting HR = low target
.8 HR max - resting HR) + resting HR = high target
What is a continuous ETT?
workload is continually progressed (step test, ramp test) so that pt doesn’t reach steady state
What does a positive ETT mean?
myocardial oxygen supply doesn’t meet demand, positive for ischemia
You have a cardiac patient in your outpatient clinic with no means to perform a graded exercise test. You want to get an idea about their cardiac ability and VO2 max though, so what test do you want to use?
6 minute walk; highly correlated with VO2 max and ETT
What might be some signs you would look for in your patient doing the 6MWT that would indicate exertional intolerance?
1) persistent dyspnea
2) dizziness/confusion
3) angina
4) several leg claudication
5) excessive fatigue
6) palor, cold sweat
7) ataxia, incoordination
8) pulmonary rales
Your patient is doing an ETT and their BP rises from 120/80 to 135/93. Is this typical?
No, only systolic should rise
What is RPP?
rate pressure product: systolic BP x HR
- often used as index of MVO2 (myocardial o2 consumption)
T/F: Increased coronary blood flow increases RPP.
true
What are the values of the Borg scale, and what are cut off ranges?
borg is 6-20
7 = very light 13 = somewhat hard 19 = very very hard
You are monitoring the ECG of your patient undergoing an ETT. You see a reduced R wave while there is an increased Q wave. There’s also ST segement depression >1mm below baseline. Are these all normal?
no - ST segment should be depressed only <1mm. >1mm indicates MI
others are correct: reduced R wave, increased Q
What is a MET?
amount of O2 consumed at rest (3.5ml/kg per minute
Walking at a slightly faster pace (3.5mph) would use how many METS?
4-5 METS
T/F: When assessing you patient using an arm ergometer, you would expect to see a higher HR, SV, and BP as compared to leg ergometer.
false
higher: HR, BP
lower: SV
Your early-phase cardiac rehab patient needs exercise prescription for home regarding duration. What do you tell her?
need to have discontinuous (interval) training first - work up to continuous later
What should ALWAYS be implemented in any cardiac rehab program?
warm up/cool down phases
- kept consistent at 5-10 minutes each
What should you use to monitor response to resisted exercise training in your later-stage patients with cardiac rehab?
RPP (uses BP, so it’s safer than just heart rate)
- systolic BP x HR
What is the typical training intensity used? (as a % of functional capacity?
60-80%, but can dip to 40% depending on initial level of fitness
How can you measure the intensity of an exercise?
1) HR (using 208 -.7 x age), Karvonen’s range
2) Borg
3) METs
Why can we not always simply rely on HR to measure intensity?
- effect of meds
- environmental extremes can vary HR/BP (heavy arm work, isometrics, valsalva)
- pacemaker (can affect ability of HR to rise in response to exercise stress if it’s fixed-rate)
What is the average duration for moderate-intensity exercise?
20-30min
What are the different things to consider when doing exercise prescription?
type (modality) intensity duration frequency progression
What MET level should you tell your patient to work at if you want them to work at a moderate intensity?
5 METs
With low intensity activities (<5METs), what frequency should you prescribe?
daily
With moderate intensity activities (>5METs), what frequency should you prescribe?
3-5/wk
Your patient is exercising on the treadmill and you increase his speed of walking. You notice his BP drops from 120/80 to 108/78. What should you do?
stop exercise immediately
- absolute CONTRAINDICATION to exercise = >10mmHg drop in systolic with increase in workload
What are absolute indications to stop exercise in your patient in cardiac rehab?
1) dizziness/ ataxia, near syncope
2) signs of poor perfusion
3) drop in BP >10mmHg with increased workload
4) moderate to severe angina
5) patient’s desire to stop
6) unable to monitor ECG/BP
7) sustained VT
8) ST elevation >1mm
If your patient completing part of his cardia exercise program begins to complain of claudication pain and is short of breath, what should you do?
these are relative indications to stop exercise, so consider stopping if worsening
What arrythmia is an absolute indication to stop exercise?
sustained v-tach
Your patient has just undergone a PTCA. Should you wait to exercise?
no, walking can be done immediately
- but wait 2 weeks for vigorous exercise to allow inflammatory process to subside
- use post-PTCA ETT to prescribe exercise
Your patient has just undergone a CABG. What precautions should you take with exercise prescription?
sternal precautions
- no lifting, pushing, pulling for 4-6wks
limit UE exercise with sternal incision healing
Your patient has a high degree atrioventricular block. Should they be added to cardiac rehab?
they can, it’s just a relative contraindication
Your pt has uncontrolled cardiac arrythmias causing symptoms. Should they be added to cardiac rehab?
no; absolutely contraindicated
Your pt with a history of DVT is exhibiting chest pain, diaphoresis, anxiousness in your clinic. Should you exercise him?
no, could have an acute PE and that’s an absolute contraindication
Your patient has a diagnosis of L main coronary a. stenosis. Should they be added to cardiac rehab?
they can, just a relative contraindication
T/F: Cardiac training/rehab results in a decrease of lipoproteins.
true (cholesterol, triglycerides)
