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Cardio-Pulmonary NPTE > Cardiac Rehabilitation > Flashcards

Cardiac Rehabilitation Flashcards

1
Q

What are the goals of cardiac rehabilitation?

A
  • limit the physiological and psychological effects of cardiac illness
  • reduce the risk of sudden death or re-infarction
  • control cardiac symptoms
  • stabilize or reverse the atherosclerotic process
  • enhance the psychosocial and vocational status of selected patients
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2
Q

What are the clinical indications for inpatient/outpatient cardiac rehab?

A
  • medically stable post-myocardial infarction
  • stable angina pectoris
  • coronary artery bypass surgery
  • percutaneous transluminal coronary angioplasty
  • compensated heart failure
  • cardiomyopathy
  • heart transplant
  • other cardiac surgeries
  • PAD
  • end stage renal disease
  • high risk of coronary artery disease with a diagnosis of DM2, dyslipidemia, hypertension, or obesity
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3
Q

What are the contraindications for inpatient/outpatient cardiac rehabilitation?

A
  • unstable angina
  • resting systolic BP over 200 or resting diastolic BP over 110
  • orthostatic blood pressure drop of over 20 mm Hg with symptoms
  • critical aortic stenosis
  • acute systemic illness or fever
  • uncontrolled atrial/ventricular arrythmias
  • 3rd degree atrial ventricular block w/o a pacemaker
  • active pericarditis or myocarditis
  • recent embolism
  • thrombophlebitis
  • resting ST segment depression or elevation over 2mm
  • uncompensated congestive heart failure
  • any other orthopedic or metabolic conditions that would prohibit exercise
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4
Q

What is the role of a PT in cardiac rehab?

A
  • develop an individualized exercise prescription considering mode, intensity, duration, and frequency
  • monitor heart rate, blood pressure, ECG, RPE, and signs/symptoms
  • supervise exercise and promote proper technique and breathing patterns
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5
Q

What is phase 1 of cardiac rehabilitation?

A

inpatient cardiac rehab

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6
Q

What does phase 1 of cardiac rehab consist of?

A
  • patient and family education
  • self care evaluation
  • continuous monitoring of vital signs
  • group discussions, and low-level exercise
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7
Q

How long does phase 1 of cardiac rehab usually last?

A

3-5 days

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8
Q

What is the procedure of the medical evaluation for phase 1 cardiac rehab?

A
  • no new or recurrent chest pain in eight hours
  • no new signs of uncompensated heart failures (i.e dyspnea at rest with bilateral basilar crackles)
  • no new significant, abnormal heart rhythm or ECG changes in eight hours
  • stable creatine kinase and troponin levels
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9
Q

When should phase 1 of cardiac rehab be discontinued for safety concerns?

A
  • HR over 130 bpm or over 30 bpm above resting HR
  • Diastolic BP over 110
  • decreased Systolic BP by 10
  • significant ventricular or atrial dysrhythmias
  • 2nd or 3rd degree heart block
  • signs or symptoms including angina, marked dyspnea, and ECG changes suggestive of ischemia
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10
Q

When can active upper and lower extremity begin after a bypass graft surgery and after a cardiac infarction?

A

24 hours after bypass graft surgery

2 days after infarction

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11
Q

How should active exercise progress during phase 1 of cardiac rehab?

A

from sitting to standing (1-4 METS)

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12
Q

What should the mode be for aerobic exercise in phase 1 of cardiac rehab?

A

progressive, supervised level walking (2-3 METs) to walking up and down step or treadmill walking (3-4 METs)

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13
Q

What should the Intensity be for aerobic exercise in phase 1 of cardiac rehab?

A
  • RPE under 13 (6-20 scale)
  • For post-infarction patients: HR under 120 bpm or under 20bpm above resting HR
  • For post-surgical patients: under 30bpm above resting HR
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14
Q

What should the Duration be for aerobic exercise in phase 1 of cardiac rehab?

A

intermittent bouts of 3-5 minutes, progressing to 10-15 minutes of continuous activity

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15
Q

What should the frequency be for aerobic exercise in phase 1 of cardiac rehab?

A

first three days: 3-4 times a day

After first 3 days: twice a day with increased duration

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16
Q

What should the progression be for aerobic exercise in phase 1 of cardiac rehab?

A

progress varies according to patient tolerance and risk stratification

-activity may be progressed provided there is an adequate increase in heart rate and systolic BP (10-40 mm HG), no new dysrhythmias or ST changes on the ECG, and no cardiac symptoms are observed (palpitations, dyspnea, angina, or excessive fatigue)

17
Q

What are the expected outcomes of phase 1 of cardiac rehab?

A
  • prevent harmful physiological and psychological effects of best rest during hospitalization
  • walk 5-10 minutes continuously or 1000ft, 4x daily
  • walk down and up one flight of stairs independently
  • know safe heart rate and RPE limits for exercise
  • recognize abnormal signs and symptoms suggesting intolerance to activity
  • promote a more rapid and safe return to ADLs within the limits imposed by their disease
  • prepare the patient and home support system to optimize recovery following discharge
18
Q

What is the second phase of cardiac rehab?

A

immediate outpatient rehabilitation with a comprehensive program that includes prescribed exercise, cardiac risk factor modification, education, and counseling about diet and disease management

19
Q

What can a patient begin phase 2 cardiac rehab? How long does it last?

A

immediately after hospitalization and lasts up to 12 weeks

20
Q

Why is an exercise test with ECG recommended before beginning phase 2 cardiac rehab?

A

used to asses:

  • HR and rhythm
  • signs and symptoms
  • ST segment changes
  • exercise capacity
  • risk stratification
  • target HR for exercise
  • initial level of work for exercise
21
Q

What should be included in a physical exam of a patient before beginning formal physical activity?

A
  • medical history
  • cardiovascular disease risk profile
  • BMI or waist-hip ratio
  • resting ECG and BP
  • auscultation of lung sounds
  • palpation and inspection of extremities for arterial pulses, edema, and skin integrity
22
Q

How many sessions should ECG and BP be monitored for when working with a low risk patient with known stable coronary artery disease?

A

6-12

23
Q

How many sessions should ECG and BP be monitored for when working with a moderate-high risk patient or patients unable to self-regulate/don’t understand recommended activty levels?

A

usually over 12 session

24
Q

When should you discontinue phase 2 of cardiac rehab for safety reasons?

A
  • plateau or decrease in HR with increase of work
  • SBP plateaus or falls with increase in work or rises over 250 mm Hg
  • diastolic BP over 115 mm Hg
  • ST segment depression over 1 mm
  • 2nd or 3rd degree heart block
  • ventricular dysrhythmias
  • angina or other symptoms of CV insufficiency
25
Q

What should the Mode be for aerobic exercise in phase 2 of cardiac rehab?

A

rhythmic activities that use large muscle groups and can be performed continuously and safely such as walking, jogging, bicycling, etc.)

26
Q

What should the HR Intensity be for aerobic exercise in phase 2 of cardiac rehab?

A
  • for patient who did not have an entry exercise test you can use resting HR + 20bpm
  • using a target heart rate range from 55-90% of MaxHR
  • using HR reserve (karvonen formula) with the range being between 40% and 85%
27
Q

What is the karvonen formula?

A

Way to measure Heart Rate Reserve

[(HRmax - HRrest) x THR%] + HRrest

28
Q

What does an RPE of 12-16 represent?

A

somewhat hard to hard

65-85% of maximal capacity

29
Q

What does an RPE of 11-13 represent?

A

fairly light to somewhat hard

appropriate upper limit during the initial phases of phase 2 cardiac rehab

30
Q

What is RPE specific to?

A

mode of exercise

31
Q

What should the duration be for aerobic exercise in phase 2 of cardiac rehab?

A
  • 15-20mins of continuous or intermittent exercise during the first month
  • 25-30mins during the next 3-4 months
  • 40+ minutes after 6 months

interval training may be appropriate for those who cannot do continuous exercise

32
Q

What is the equivalent of 1 MET (Metabolic Equivalents)?

A

energy expended while sitting quietly

33
Q

What should be the upper and lower range of METs during phase 2 cardiac rehab?

A

Lower: [(MaxMETs - RestMETs) x 40%] + RestMETs

Upper: [(MaxMETs - RestMETs) x 85%] + RestMETs

Cardio-Pulmonary NPTE (24 decks)

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