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BOARDS: Cardiology > Cardiac Rehab > Flashcards

Cardiac Rehab Flashcards

1
Q

When a patient is unable to undergo graded exercise testing, what is the secondary option?

A

ETT with radionuclide perfusion

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2
Q

What are the two testing modes for cardiac rehab?

A

1) treadmill or cycle ergometry

2) step test

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3
Q

What should your facility have if you’re completing maximal ETT?

A

advanced cardiac life support

ETT = exercise tolerance testing

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4
Q

What is Karvonen’s formula, and what’s it for?

A

predicting target HR range
.6 (HR max - resting HR) + resting HR = low target
.8 HR max - resting HR) + resting HR = high target

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5
Q

What is a continuous ETT?

A

workload is continually progressed (step test, ramp test) so that pt doesn’t reach steady state

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6
Q

What does a positive ETT mean?

A

myocardial oxygen supply doesn’t meet demand, positive for ischemia

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7
Q

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?

A

6 minute walk; highly correlated with VO2 max and ETT

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8
Q

What might be some signs you would look for in your patient doing the 6MWT that would indicate exertional intolerance?

A

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

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9
Q

Your patient is doing an ETT and their BP rises from 120/80 to 135/93. Is this typical?

A

No, only systolic should rise

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10
Q

What is RPP?

A

rate pressure product: systolic BP x HR

- often used as index of MVO2 (myocardial o2 consumption)

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11
Q

T/F: Increased coronary blood flow increases RPP.

A

true

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12
Q

What are the values of the Borg scale, and what are cut off ranges?

A

borg is 6-20

7 = very light
13 = somewhat hard
19 = very very hard
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13
Q

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?

A

no - ST segment should be depressed only <1mm. >1mm indicates MI

others are correct: reduced R wave, increased Q

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14
Q

What is a MET?

A

amount of O2 consumed at rest (3.5ml/kg per minute

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15
Q

Walking at a slightly faster pace (3.5mph) would use how many METS?

A

4-5 METS

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16
Q

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.

A

false

higher: HR, BP
lower: SV

17
Q

Your early-phase cardiac rehab patient needs exercise prescription for home regarding duration. What do you tell her?

A

need to have discontinuous (interval) training first - work up to continuous later

18
Q

What should ALWAYS be implemented in any cardiac rehab program?

A

warm up/cool down phases

- kept consistent at 5-10 minutes each

19
Q

What should you use to monitor response to resisted exercise training in your later-stage patients with cardiac rehab?

A

RPP (uses BP, so it’s safer than just heart rate)

  • systolic BP x HR
20
Q

What is the typical training intensity used? (as a % of functional capacity?

A

60-80%, but can dip to 40% depending on initial level of fitness

21
Q

How can you measure the intensity of an exercise?

A

1) HR (using 208 -.7 x age), Karvonen’s range
2) Borg
3) METs

22
Q

Why can we not always simply rely on HR to measure intensity?

A
  • 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)
23
Q

What is the average duration for moderate-intensity exercise?

A

20-30min

24
Q

What are the different things to consider when doing exercise prescription?

A 
type (modality)
intensity
duration
frequency
progression
25
Q

What MET level should you tell your patient to work at if you want them to work at a moderate intensity?

A

5 METs

26
Q

With low intensity activities (<5METs), what frequency should you prescribe?

A

daily

27
Q

With moderate intensity activities (>5METs), what frequency should you prescribe?

A

3-5/wk

28
Q

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?

A

stop exercise immediately

- absolute CONTRAINDICATION to exercise = >10mmHg drop in systolic with increase in workload

29
Q

What are absolute indications to stop exercise in your patient in cardiac rehab?

A

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

30
Q

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?

A

these are relative indications to stop exercise, so consider stopping if worsening

31
Q

What arrythmia is an absolute indication to stop exercise?

A

sustained v-tach

32
Q

Your patient has just undergone a PTCA. Should you wait to exercise?

A

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
33
Q

Your patient has just undergone a CABG. What precautions should you take with exercise prescription?

A

sternal precautions
- no lifting, pushing, pulling for 4-6wks

limit UE exercise with sternal incision healing

34
Q

Your patient has a high degree atrioventricular block. Should they be added to cardiac rehab?

A

they can, it’s just a relative contraindication

35
Q

Your pt has uncontrolled cardiac arrythmias causing symptoms. Should they be added to cardiac rehab?

A

no; absolutely contraindicated

36
Q

Your pt with a history of DVT is exhibiting chest pain, diaphoresis, anxiousness in your clinic. Should you exercise him?

A

no, could have an acute PE and that’s an absolute contraindication

37
Q

Your patient has a diagnosis of L main coronary a. stenosis. Should they be added to cardiac rehab?

A

they can, just a relative contraindication

38
Q

T/F: Cardiac training/rehab results in a decrease of lipoproteins.

A

true (cholesterol, triglycerides)

BOARDS: Cardiology (13 decks)

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