Cardiac Rehab (Updated) Flashcards
What are the phases of cardiac rehabilitation?
→ 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
List the indications for initiating primary and secondary cardiac rehabilitation.
→ 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
What are the contraindications for both inpatient and outpatient cardiac rehab?
→ 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
What are the goals of inpatient cardiac rehab?
→ Prevent another CAD event (e.g., DVT, atherosclerosis)
→ Optimize lifestyle factors and behaviors
→ Reduce morbidity and mortality
→ Recover from the cardiovascular event
What are the criteria for advancing ambulation/activity in inpatient CR?
→ 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
What are the abnormal responses to physical activity during inpatient CR?
→ 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
How do you identify cardiovascular disease (CVD) risk factors?
→ Smoking
→ Hypertension
→ Diabetes mellitus
→ Obesity
→ Sedentary lifestyle
What are the main elements of patient assessment during inpatient CR?
→ Patient Interview
→ Chart review
→ Preparation for treatment
→ Physical Assessment
What are the vital sign guidelines for advancing mobility in post-MI patients?
→ 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
What are the vital sign guidelines for advancing mobility in post-CABG patients?
→ 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
What are the monitoring requirements for safety during aerobic exercise in Phase I CR?
→ 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
Abnormal reponses to IP physical activty with CR?
→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
Describe the sternal precautions for patients post-CABG.
→ Avoid heavy lifting > 5-10 lbs
→ No overhead activities for 6-10 weeks
→ Minimize excessive sternal movement or pain
What are the discharge requirements for inpatient CR?
→ 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
What are the expected outcomes of Phase I CR?
→ 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
What is the clinical pathway for Phase I CR?
→ Mobilization, aerobic exercise, and progression of intensity
→ Focus on self-care and early recovery
What are the types of aerobic activities recommended in Phase I CR?
→ Bed mobility, transfers, and walking
→ Light stretching and seated exercises
What are the education components in Phase I CR?
→ Self-monitoring techniques
→ Disease education and management
→ Risk factor modification
What is the role of the PT in CR?
→ Assess patient’s ability to perform ADLs safely
→ Communicate with healthcare team about patient responses
→ Educate about risk factors and disease management
What are the discharge considerations for a patient post-PCI?
→ Monitor access site (e.g., transfemoral or transradial approach)
→ Antiplatelet medication education
→ Clearance for early mobility
Describe the initial treatment approach for a patient with acute coronary syndrome (ACS).
→ Focus on early evaluation, treatment, and discharge
→ Emphasis on exercise testing when stable
How does recovery differ between PCI and CABG?
→ PCI: Quicker recovery, immediate exercise clearance after uncomplicated discharge
→ CABG: Longer recovery (6-10 weeks), requires sternal precautions
What are the mobility goals for patients in Phase I CR?
→ Ability to ambulate at least 250 feet
→ No chest pain, dizziness, or marked dyspnea during ambulation
What is the role of education in discharge planning for CR patients?
→ Discuss long-term CVD risk factor modification
→ Provide self-care and monitoring guidelines
What are the main CVD risk factors to educate patients on?
→ Smoking, diet, exercise, obesity, hypertension
How does the PT determine a patient’s readiness to be discharged from Phase I CR?
→ Based on mobility progress, vital sign stability, and patient understanding
What vital signs should be monitored before and after CR activities?
→ Heart rate, blood pressure, EKG changes, respiratory rate
What are the primary reasons for discontinuing exercise during Phase I CR?
→ Arrhythmias, significant EKG changes, or marked dyspnea
What are the main barriers to participation in a formal CR program?
→ Lack of patient knowledge
→ Transportation or financial issues
What are the common medications prescribed in Phase I CR?
→ Beta-blockers, antiplatelets, and nitroglycerin
What are the lab values to monitor during CR?
→ Troponin, creatine kinase, and hemoglobin
How should the EKG be interpreted during CR?
→ Look for signs of ischemia, arrhythmias, or heart block
What are the safety precautions for bed mobility and transfers in CR?
→ Use assistive devices as needed
→ Monitor for dizziness or instability
What are the goals of early mobility in Phase I CR?
→ Promote independence
→ Improve cardiopulmonary endurance
