Cardiac Rehab Flashcards
A resting ST segment depression or elevation greater than what is a contraindication for cardiac rehab?
> 2mm
Is uncompensated heart failure a contraindication for cardiac rehab?
YES
How long do phase 1 and phase 2 cardiac rehab last?
Phase I: 3-5 days
Phase 2: up to 12 weeks
Before beginning cardiac rehab a patient should have no new or reccurent chest pain or no new significant or abnormal heart rhythm or ECG changes in how long?
8 hours
Phase I cardiac rehab should be discontinued if the following are seen with…
- Heart Rate
- DBP
- SBP
- ventricular/atrial dysrhythmias
- heart block
- signs of ischmia
- > 130 BPM or >30 bpm above resting heart rate ****
- DBP >110
- decrease in SBP >10
- significant ventricular or atrial dysrhythmias
- 2nd or 3rd degree heart block
- angina, marked dyspnea, and ECG changes suggestive of ischemia
What MET level should a patient be exercising at in Phase I?
progressive level walking (2-3 METS)
or
waling up and down steps or treadmill walking (3-4 METS)
What should the RPE be during Phase I? What should heart rate be post infarction heart rate vs. post surgery heart rate during phase I exercises?
RPE <13 (6-20)
Post Infarction: heart rate <120 BPM or <20 bpm above rest
Post Surgery: <30 BPM above rest
Duration of phase I exercise?
bouts of 3-5 minutes progressing to 10-15
Frequency Phase I?
first 3 days: 3-4 times per day
After three days: 2x per day with increased duration
For low risk patients with known stable coronary artery disease how many sessions of ECG and BP monitoring and medical supervision are recommended?
6-12 sessions
For moderate to high risk patients with known stable coronary artery disease how many sessions of ECG and BP monitoring and medical supervision are recommended?
usually >12 sessions
A rating of what on the Angina scale is the recommended end point to cease activity during cardiac rehab?
What should the patient do at this point?
1
scale 1-4
patient should discontinue activity and rest in sitting or recumbent position and be encouraged to use medications as directed
When should a patient be transported to nearest medical center if angina is not relieved?
if angina not releived by termination of activity or by 3 sublingual nitroglycerin tablets (one taken every 5 minutes)
Exercise should be how BPM below the known ischemic or anginal threshold?
> 10 beats per minute below
Exercise should be discontinued during phase II cardiac rehab if the what happens to the following…
- HR
- SBP
- DBP
- ST segment
- heart block
- ventricular dysrhthmias
- angina
- plateau or decrease in HR with increased work
- SBP plateaus or falls withi increase work or SBP ?250
- DBP >115
- > 1mm ST segment depression
- 2nd or 3rd degree heart block
- ventricular dysrhythmias
- angina or other symptoms of cardiovascular insufficiency
How is upper and lower target heart rate calcuated using the Heart Rate Reserve (HRR) or Karvonen formula?
use 40% for low and 85% for high
Lower THR: [(HRmax-HRrest)x40%] + HR REST
Higher THR: [(HRmax-HRrest)x80%] + HR REST
How is HRmax calcuated?
220-age
What is 1 MET equivalent to?
1 MET is energy expended while sitting quietyly
AKA 3.5 mLO2/kg/min
How is a Lower and Upper MET level established?
SAME THING AS KARVONEN OR HERAT RATE RESERVE (HRR)
Lower MET: [(METmax-METrest)x40%] + HR REST
Higher MET: [(METmax-METrest)x80%] + HR REST
What are 3 major situations in which HR cannot be used to regulate intensity?
- After heart transplant
- patients taking beta blockers
- no exercise testing done prior to cardiac rehab
An RPE of what corresponds to a 40-85% of max capacity?
12 to 16 (somewhat hard to hard) corresponds to 40-85% of max capacity
What are appropriate RPE ranges early in rehab vs. later?
Early: 11 to 13
Late: 14 to 16
Duration of rehab during
- the first month
- 3 to 4 months
- after 6 months
- 15 to 20 minutes
- 25 to 30 minutes
- 40 minutes or longer
How many days per week during Phase II?
3 to 5 days
METs
- walking slowly
- walking 3 mph
- walking 4 mph
- walking 4.5 mph
- jogging 5 mph
- running 7 mph
- 2.0
- 3 mph: 3.0-4.0
- 4 mph: 4.7 -7.0
- 4.5 mph: 6.3
- 5 mph jogging: 8.0
- 6 mph running: 11.5
METS
- shoveling
- power lawn mowing
- 7.0
2. 5.5
METS
- cooking
- bathing
- 2-3
2. 2-3
METS
- light gardening
- sweeping, vacuuming
- 3.0-4.0
2. 3.0-3.5
METS
- Basketball shooting around
- sexual intercourse
- 4.5
2. 4.0-5.0
to maintain hydration in hot environments how much fluid should be drunk for each pound of body weight loss?
one pint of fluid
Exercise in the cold can do what to the angina threshold?
may lower it
Hypothermia is defined as a body termperature less than what?
less than 97 degrees
The decreased atmospheric pressure at >5,000 feet reduces the partial pressure of oxygen in the air whihc has what result on arterial oxygen levels?
decreased arterial oxygen
What is the immediate compensatory response to high altitude?
increase in ventilation and HR and decreased performance
DO YOU ADD OR SUBJECT HR REST FOR THE LAST PART OF CALCULATING TARGET HEART RATE USING THE HEART RATE RESERVE OR KARVONEN FORMULA?
ADD HR REST
