Cardiac Rehab (Updated)

Question 1

What are the phases of cardiac rehabilitation?

Answer 1

→ Phase 1: Acute or hospital phase
→ Phase 2: Early outpatient or intensive monitoring phase
→ Phase 3: Training or maintenance phase
→ Phase 4: Disease prevention program

Question 2

List the indications for initiating primary and secondary cardiac rehabilitation.

Answer 2

→ Primary CVD:

• Acute coronary syndrome
• MI
• CABG
• Heart or Lung transplant
• Heart valve repair
• HF

→ Secondary CVD:

History of:
* CAD,
* HF,
* MI

High risk for CVD with dx of:

• Diabetes,
• Dyslipidemia,
• HTN,
• Obesity,
• ESRD

Question 3

What are the contraindications for both inpatient and outpatient cardiac rehab?

Answer 3

→ Unstable angina or acute MI
→ Resting SBP > 200 mmHg or diastolic > 110 mmHg
→ Orthostatic BP drop > 20 mmHg with symptoms
→ Critical aortic stenosis
→ Active pericarditis/myocarditis
–> recent embolism
–> acute systemic illness or fever
–> uncontrolled atrial/ventricular arrythmias
–> third degree atrial ventrilar block without pacemaker
–> thrombophlebitis
–> resting ST segment depression or elevation > 2mm
–> uncompensated CHF
–> orthopedic or metabolic conditions that prohibit exercise

Question 4

What are the goals of inpatient cardiac rehab?

Answer 4

→ Prevent another CAD event (e.g., DVT, atherosclerosis)

→ Optimize lifestyle factors and behaviors

→ Reduce morbidity and mortality

→ Recover from the cardiovascular event

Question 5

What are the criteria for advancing ambulation/activity in inpatient CR?

Answer 5

→ No new/recurrent chest pain in the previous 8 hours
→ Stable or declining creatine kinase/troponin levels
→ No new signs of decompensated heart failure
→ No new significant EKG changes in the previous 8 hours

Question 6

What are the abnormal responses to physical activity during inpatient CR?

Answer 6

→ Decrease in SBP > 10 mmHg or increase > 40 mmHg
→ Heart rate exceeding max HR ranges
→ Significant arrhythmias, such as second/third-degree heart block
→ Signs of activity intolerance: angina, dyspnea, ischemia on EKG

Question 7

How do you identify cardiovascular disease (CVD) risk factors?

Answer 7

→ Smoking
→ Hypertension
→ Diabetes mellitus
→ Obesity
→ Sedentary lifestyle

Question 8

What are the main elements of patient assessment during inpatient CR?

Answer 8

→ Patient Interview

→ Chart review

→ Preparation for treatment

→ Physical Assessment

Question 9

What are the vital sign guidelines for advancing mobility in post-MI patients?

Answer 9

→ Heart rate increase should be ≤ 20 bpm above resting HR

→ HR should be < 120 bpm

→ SBP should not decrease by > 10 mmHg or increase by > 40 mmHg

Question 10

What are the vital sign guidelines for advancing mobility in post-CABG patients?

Answer 10

→ Heart rate increase should be ≤ 30 bpm above resting HR

→ HR should be < 120 bpm

→ SBP should not decrease by > 10 mmHg or increase by > 40 mmHg

Question 11

What are the monitoring requirements for safety during aerobic exercise in Phase I CR?

Answer 11

→ Report any chest discomfort, dyspnea, dizziness, or faintness

→ Outside of max HR ranges: hr > 120 bpm, Post-op: >30 bmp above resting HR, post MI: >20 bpm above resting HR

→ Stop exercise if DBP ≥ 110 mmHg or SBP > 210 mmHg
–>arrythmia changes: significant ventricular or atrial dysrhythmias, 2nd or 3rd degree heart block
–>s/s of including angina, marked
–>decrease in SBP >10mm HG or increase in > 40mmHG

Question 12

Abnormal reponses to IP physical activty with CR?

Answer 12

→abnormal BP changes including decrease in SBP > 10 mmHG, increase in SBP of >40mmHG
→HR outside of max HR ranges
→significant ventricular or atrial arrhythmias
→second or third-degree heart blocks
→s/s of actvity intolerance
- angina, marked dyspnea, or EKG changes suggestive of ischemia

Question 13

Describe the sternal precautions for patients post-CABG.

Answer 13

→ Avoid heavy lifting > 5-10 lbs

→ No overhead activities for 6-10 weeks

→ Minimize excessive sternal movement or pain

Question 14

What are the discharge requirements for inpatient CR?

Answer 14

→ Review activity guidelines and exercise prescription

→ Explain symptoms to monitor for and when to contact a physician

→ Refer to outpatient, subacute setting, or low-level exercise testing as needed

Question 15

What are the expected outcomes of Phase I CR?

Answer 15

→ Prevent harmful effects of bed rest during hospitalization

→ Walk 5-10 minutes continuously or 1000 feet 4x/day (~250’ each time

→ Walk up/down 1 flight of stairs independently

→ Know safe HR and RPE limits for exercise

→ Recognize abnormal signs and symptoms that suggest poor tolerance to activity

→ Promote a more rapid and safe return to ADLs

→ Prepare patient and home support system to optimize recovery following discharge

Question 16

What is the clinical pathway for Phase I CR?

Answer 16

→ Mobilization, aerobic exercise, and progression of intensity

→ Focus on self-care and early recovery

Question 17

What are the types of aerobic activities recommended in Phase I CR?

Answer 17

→ Bed mobility, transfers, and walking

→ Light stretching and seated exercises

Question 18

What are the education components in Phase I CR?

Answer 18

→ Self-monitoring techniques
→ Disease education and management
→ Risk factor modification

Question 19

What is the role of the PT in CR?

Answer 19

→ Assess patient’s ability to perform ADLs safely

→ Communicate with healthcare team about patient responses

→ Educate about risk factors and disease management

Question 20

What are the discharge considerations for a patient post-PCI?

Answer 20

→ Monitor access site (e.g., transfemoral or transradial approach)

→ Antiplatelet medication education

→ Clearance for early mobility

Question 21

Describe the initial treatment approach for a patient with acute coronary syndrome (ACS).

Answer 21

→ Focus on early evaluation, treatment, and discharge

→ Emphasis on exercise testing when stable

Question 22

How does recovery differ between PCI and CABG?

Answer 22

→ PCI: Quicker recovery, immediate exercise clearance after uncomplicated discharge

→ CABG: Longer recovery (6-10 weeks), requires sternal precautions

Question 23

What are the mobility goals for patients in Phase I CR?

Answer 23

→ Ability to ambulate at least 250 feet

→ No chest pain, dizziness, or marked dyspnea during ambulation

Question 24

What is the role of education in discharge planning for CR patients?

Answer 24

→ Discuss long-term CVD risk factor modification

→ Provide self-care and monitoring guidelines

Question 25

What are the main CVD risk factors to educate patients on?

Answer 25

→ Smoking, diet, exercise, obesity, hypertension

Question 26

How does the PT determine a patient’s readiness to be discharged from Phase I CR?

Answer 26

→ Based on mobility progress, vital sign stability, and patient understanding

Question 27

What vital signs should be monitored before and after CR activities?

Answer 27

→ Heart rate, blood pressure, EKG changes, respiratory rate

Question 28

What are the primary reasons for discontinuing exercise during Phase I CR?

Answer 28

→ Arrhythmias, significant EKG changes, or marked dyspnea

Question 29

What are the main barriers to participation in a formal CR program?

Answer 29

→ Lack of patient knowledge

→ Transportation or financial issues

Question 30

What are the common medications prescribed in Phase I CR?

Answer 30

→ Beta-blockers, antiplatelets, and nitroglycerin

Question 31

What are the lab values to monitor during CR?

Answer 31

→ Troponin, creatine kinase, and hemoglobin

Question 32

How should the EKG be interpreted during CR?

Answer 32

→ Look for signs of ischemia, arrhythmias, or heart block

Question 33

What are the safety precautions for bed mobility and transfers in CR?

Answer 33

→ Use assistive devices as needed

→ Monitor for dizziness or instability

Question 34

What are the goals of early mobility in Phase I CR?

Answer 34

→ Promote independence

→ Improve cardiopulmonary endurance