Cardiac Rehab (Updated)

Question 1

What are the objectives of cardiac rehab (CR) in terms of physical therapy?

Answer 1

→ Understand the role of the physical therapist in CR → Determine when CR is indicated/contraindicated → Know the phases of CR

Question 2

What are the phases of cardiac rehabilitation?

Answer 2

→ Phase 1: Inpatient CR → Phase 2: Outpatient CR → Phase 3: Maintenance program

Question 3

List the indications for initiating cardiac rehabilitation.

Answer 3

→ Post myocardial infarction (MI) → Post coronary artery bypass graft (CABG) → Post percutaneous coronary intervention (PCI) → Chronic stable angina or heart failure

Question 4

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

Answer 4

→ Unstable angina or acute MI → Resting SBP > 200 mmHg or diastolic > 110 mmHg → Orthostatic BP drop > 20 mmHg with symptoms → Critical aortic stenosis or uncontrolled arrhythmias → Active pericarditis/myocarditis or recent embolism

Question 5

What are the goals of inpatient cardiac rehab?

Answer 5

→ Prevent another CAD event (e.g., DVT, atherosclerosis) → Optimize lifestyle factors and behaviors → Reduce morbidity and mortality → Recover from the cardiovascular event

Question 6

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

Answer 6

→ 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 7

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

Answer 7

→ 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 8

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

Answer 8

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

Question 9

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

Answer 9

→ Chart review and patient interview → Evaluation of vitals, mobility, and self-care abilities → Review of CVD risk factors and readiness to learn

Question 10

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

Answer 10

→ 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 11

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

Answer 11

→ 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 12

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

Answer 12

→ Report any chest discomfort, dyspnea, dizziness, or faintness → Discontinue exercise if HR exceeds max HR range → Stop exercise if DBP ≥ 110 mmHg or SBP > 210 mmHg

Question 13

What should be the response to signs of activity intolerance during CR?

Answer 13

→ Discontinue exercise immediately → Monitor for angina, marked dyspnea, or EKG changes suggestive of ischemia

Question 14

Describe the sternal precautions for patients post-CABG.

Answer 14

→ Avoid heavy lifting > 5-10 lbs → No overhead activities for 6-10 weeks → Minimize excessive sternal movement or pain

Question 15

What are the discharge requirements for inpatient CR?

Answer 15

→ 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 16

What are the expected outcomes of Phase I CR?

Answer 16

→ Increased knowledge of disease management → Ability to return to ADLs → Reduced CVD risk factors through modifications

Question 17

What is the clinical pathway for Phase I CR?

Answer 17

→ Mobilization, aerobic exercise, and progression of intensity → Focus on self-care and early recovery

Question 18

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

Answer 18

→ Bed mobility, transfers, and walking → Light stretching and seated exercises

Question 19

What are the education components in Phase I CR?

Answer 19

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

Question 20

What is the role of the PT in CR?

Answer 20

→ Assess patient’s ability to perform ADLs safely → Communicate with healthcare team about patient responses → Educate about risk factors and disease management

Question 21

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

Answer 21

→ Monitor access site (e.g., transfemoral or transradial approach) → Antiplatelet medication education → Clearance for early mobility

Question 22

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

Answer 22

→ Focus on early evaluation, treatment, and discharge → Emphasis on exercise testing when stable

Question 23

How does recovery differ between PCI and CABG?

Answer 23

→ PCI: Quicker recovery, immediate exercise clearance after uncomplicated discharge → CABG: Longer recovery (6-10 weeks), requires sternal precautions

Question 24

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

Answer 24

→ Ability to ambulate at least 250 feet → No chest pain, dizziness, or marked dyspnea during ambulation

Question 25

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

Answer 25

→ Discuss long-term CVD risk factor modification → Provide self-care and monitoring guidelines

Question 26

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

Answer 26

→ Smoking, diet, exercise, obesity, hypertension

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

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

Answer 29

→ Arrhythmias, significant EKG changes, or marked dyspnea

Question 30

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

Answer 30

→ Lack of patient knowledge → Transportation or financial issues

Question 31

What are the common medications prescribed in Phase I CR?

Answer 31

→ Beta-blockers, antiplatelets, and nitroglycerin

Question 32

What are the lab values to monitor during CR?

Answer 32

→ Troponin, creatine kinase, and hemoglobin

Question 33

How should the EKG be interpreted during CR?

Answer 33

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

Question 34

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

Answer 34

→ Use assistive devices as needed → Monitor for dizziness or instability

Question 35

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

Answer 35

→ Promote independence → Improve cardiopulmonary endurance