Cardiac Rehabilitation and Interventions Flashcards
What is the purpose of exercise stress testing?
Used to assess the patient’s ability to tolerate increasing intensity of exercise while ECG, BP, HR and symptoms are monitored.
Exercise stress testing can be used to detect the presence of ______.
Myocardial ischemia
What does an exercise stress test involve?
Patient is required to exercise at progressively greater increments of work, by varying the speed and grade of the treadmill, or the speed and resistance of pedaling an UE or cycle ergometer
List 6 absolute indications for terminating an exercise test.
- Drop in SBP > 10 mmHg from baseline despite increase in workload with other evidence of ischemia
- Moderately severe angina
- Dizziness, ataxia
- Signs of poor perfusion (cyanosis, pallor)
- Sustained ventricular tachycardia
- 1.0 mm ST elevation in leads without diagnostic Q waves
What does a positive exercise stress test indicate?
High probability of coronary artery disease and ischemia
What does a negative exercise stress test indicate?
Low probability of coronary artery disease with balanced oxygen supply and demand
Ratings of perceived exertion (RPE) are important to use with patients taking ____. Why?
Beta blockers
Why?: these patients do not exhibit a typical rise in HR with exercise
Describe the category RPE scale.
Rates exercise intensity from 6 to 20
Very, very light (7)
Somewhat hard (13)
Very, very hard (19)
Describe the category-ratio (Borg) RPE scale.
Rates exercise intensity from 1 to 10
Nothing at all (0) Very weak (1) Moderate (3) Strong (5) Extremely strong (10)
List the ECG changes that occur in healthy adults during exercise (5).
- Tachycardia (proportionate with exercise intensity)
- Rate related shortening of QT interval
- ST segment depression, upsloping, less than 1 mm
- Reduced R wave, increase Q wave
- Exertional arrhythmias: rare, single PVCs
List the ECG changes that occur in adults with myocardial ischemia/CAD during exercise (3).
- Significant tachycardia
- Exertional arrhythmias
- ST segment depression ( > 1 mm)
What is a metabolic equivalent (MET)?
MET = the amount of oxygen consumed at rest (sitting); equal to 3.5 mL/kg per minute.
List 5 adverse responses to inpatient exercise that lead to exercise termination.
- Diastolic BP equal to or > 110 mmHg
- Decrease in systolic BP > 10 mm Hg during exercise
- Significant atrial/ventricular arrhythmias with or without associated symptoms
- Second or third degree heart block
- Symptoms of exercise intolerance (angina, dyspnea, ECG changes suggestive of ischemia)
Where does phase 1 of cardiac rehab take place?
Inpatient acute care hospital
How long does phase 1 of cardiac rehab typically last?
Length of hospital stay is typically 3-5 days for uncomplicated MI
List 5 exercise/activity goals and outcomes of phase 1 of cardiac rehab.
- Initiate early return to independence in ADLs
- Counteract negative effects of bed rest (reduce risk for DVT, maintain ROM, reduce orthostatic hypotension)
- Help allay anxiety and depression
- Provide medical surveillance
- Provide patient and family education
List 5 exercise/activity guidelines to consider for phase 1 of cardiac rehab.
- Program components: ADLs, selected arm/leg exercises, early supervised ambulation
- Initial activities: Low intensity (2-3 METS) progression to > 5 METs by discharge
- Post MI: limited to 70% max HR and/or 5 METs until 6 weeks post MI
- Short exercise sessions, 2-3 times a day
- Post surgical patients: lifting activities are restricted to ~ 6 weeks
Where does phase 2 of cardiac rehab take place?
Outpatient cardiac rehabilitation (subacute phase)
List 3 exercise/activity goals and outcomes of phase 2 of cardiac rehab.
- Improve functional capacity
- Progress towards full resumption of ADLs, habitual and occupational activities
- Encourage activity pacing, energy conservation; stress importance of taking proper rest periods
List 6 exercise/activity guidelines to consider for phase 2 of cardiac rehab.
- Patients benefit from ECG monitoring during exercise
- Frequency: 2-3 sessions/week
- Duration: 30-60 minutes with 5-10 minutes of warm up and cool down
- Programs may offer single or multiple modes of training
- Patients are weaned from continous monitoring to spot and self monitoring
- Suggested exit point: 9 MET functional capacity
____ MET capacity is needed for safe resumption of most daily activities.
5 METS
What are the strength training guidelines for phase 2 of cardiac rehab?
- Guidelines: after 3 weeks of cardiac rehab; 5 weeks post MI, or 8 weeks post CABG
- Begin with use of elastic bands and light hand weights (1-3lb)
- Progress to moderate loads, 12-15 comfortable repetitions
Where does phase 3 of cardiac rehab take place?
Community centers, YMCA or clinical facilities
List 3 exercise/activity goals and outcomes of phase 3 of cardiac rehab.
- Improve/maintain functional capacity
- Promote self-regulation of exercise programs
- Promote life-long commitment to risk factor modification
List 3 entry level criteria needed to initiate phase 3 of cardiac rehab.
- Functional capacity of 5 METs
- Clinically stable angina
- Medically controlled arrhythmias during exercise
List 4 exercise/activity guidelines to consider for phase 3 of cardiac rehab.
- Progression from supervised to self regulation of exercise
- Progression to 50-85% of functional capacity, 3-4 times/week, 45 minutes or more/session
- Regular medical check ups and periodic EST required
- Discharge typically in 6-12 months
What are the resistance training guidelines for a patient post MI?
Resistance training permitted if remain under 70% max HR or 5 METs for 6 weeks post MI, be cautious of Valsalva
What are the resistance training guidelines for a patient post cardiac surgery?
LE resistance training can be initiated immediately, in the absence of preoperative MI
UE resistant training should be avoided until soft tissue and bony healing has occurred (6-8 weeks)
