Cardiac Rehab Lecture

Question 1

Indications for Cardiac Rehab

Answer 1

Medically stable post-MI
Stable angina
CABG
PTCA
Compensated, controlled HF
Cardiomyopathy
Heart txp
Valve or PM surgery
PAD
High-risk CV disease, ineligible for surgery
ESRD

HF - new category
Stable, EF < 35%, NYHA Classes II-IV despite being on optimal HF meds for 6 wks

Question 2

Contraindications to cardiac rehab

Answer 2

If pt is unstable:

Unstable angina
Resting SBP > 180mmHg or resting DBP > 110mmHg
Orthostatic BP drop > 20mmHg w/ sx
Critical AS
Acute systemic illness or fever
Uncontrolled dysrhythmias
Uncontrolled sinus tachycardia (> 120bpm)
Uncontrolled DM
Uncompensated CHF
3rd degree heart block w/o PM
Active pericarditis or myocarditis
Thrombophlebitis
Resting ST displacement (> 2mm) or > 3mm if on digitalis
Orthopedic problems that would prohibit exercise

Question 3

Phase I CR

Answer 3

F: multiple bouts, short duration –> 1-2 bouts of longer duration
I:
- post MI: HR < 120bpm or HR rest + 20bpm
- post-surgery: HR rest + 30bpm
- post txp: RPE 9-11/20
T: short bouts progressing to 10-15 min based on pre-morbid activity levels
T: walking, LE biking, TM

Question 4

Phase I d/c

Answer 4

HEP
Monitoring
Referral to CR (< 30% eligible candidates participate in CR)
Lifestyle changes
Family and pt support

Question 5

Phase II CR

Answer 5

2-6 wks if covered by insurance
Goal: meet AHA guidelines
Pt education on lifestyle changes
Assist/accelerate RTW
Promotion of psychological, behavioral, and educational improvement
Medical supervision w/ cardiologist on-site
Monitored via telemetry 
Ex rx based on GXT
Lifestyle modification classes

Question 6

1st degree heart block

Answer 6

Prolonged PRI

Question 7

2nd degree heart block type I

Answer 7

Progressively prolonged PRI until 1 QRS dropped

Question 8

2nd degree heart block type II

Answer 8

normal PRI w/ 1 dropped QRS

Question 9

3rd degree heart block

Answer 9

P waves have no relationship to QRS

Question 10

Low-intensity (comparison chart)

Answer 10

HRR: 40-60%
Borg: 9-11
RPE: 1-2

Question 11

Mod-intensity (comparison chart)

Answer 11

HRR: 50-70%
Borg: 12-14
RPE: 3-4

Question 12

High-/vigorous-intensity (comparison chart)

Answer 12

HRR 71-85%
Borg 15+
RPE 5+

Question 13

Absolute contraindications to ST

Answer 13

Unstable CHD
Decompensated HF
Uncontrolled arrhythmias
Severe pulmonary hypertension (mean pulmonary arterial pressure 55mmHg)
Severe and symptomatic aortic stenosis
Acute myocarditis, endocarditis, or pericarditis
Uncontrolled hypertension (180/110mmHg)
Aortic dissection
Marian syndrome
High-intensity RT (80% to 100% of 1RM) in pt’s w/ active proliferative retinopathy or moderate or worse nonproliferative diabetic retinopathy

Question 14

Relative contraindications to ST

Answer 14

Major RFs for CHD
DM @ any age
Uncontrolled HTN (160/100mmHg)
Low functional capacity (4 METs)
Musculoskeletal limitations
Individuals who have implanted PMs or defibrillators

Question 15

Things to keep in mind w/ ST for the cardiac pt in cardiac rehab…

Answer 15

Sternal precautions
5 wks s/p MI or cardiac surgery AND participating in supervised aerobic program
3 wks s/p PTCA (if stable)

Question 16

Considerations for ST w/ HF

Answer 16

Borg 11-14/20 ==> chronotropic abnormalities
10 min WU/CD
Monitor ECG, BP, body weigh during 1st 1-2 mo

Question 17

Warning signs when ST w/ HF

Answer 17

Decrease in exercise tolerance
Increased fatigue
Increase in dyspnea ratings
Increased weight
Angina
Edema
Change in rhythm