Cardiac Rehabilitation - Phase 2

Question 1

Phase 2

Answer 1

¬	Education
o	Diet
o	Medications
o	Disease process, symptoms
o	Action plans for angina
o	How to  risk factor
¬	Exercise
¬	OT
o	Relaxation, stress reduction
o	Occupational assessment, ADL’s
o	Psychological issues
o	Sexual activity

Question 2

Comments

Answer 2

• Programs now aimed at:
o Lifestyle changes, fitness
o in risk factors
• Most studies based on middle age, middle class, middle weight, white males
• Older studies completed when patients had bed rest
• Effects differ with gender, weight, race, +/- diabetes

Question 3

Heart Health

Answer 3

• Initiative by National Heart Foundation
• Everyone should have cardiac health evaluated
• Encourage at-risk patients to be screened, to change behaviours
• Will change economics of cardiac rehabilitation

Question 4

Effects

Answer 4

•	Hospital, community, GP practice
•	Define activity guidelines
•	inc. Return to existing activities
•	 inc. Confidence
•	 inc. Self-esteem & mastery
•	 dec. Depression
•	inc.  QOL
•	Changes in lipoprotein metabolism
o	inc.  Synthesis of HDL, dec. Se Cholesterol, dec. LDL
•	Improved insulin sensitivity
•	dec. Catecholamine response to stress
•	dec. Thromboembolic response
•	dec. Double product 
•	dec. Fat mass,  lean body mass

Question 5

Peripheral changes (if able to exercise at appropriate intensity)

Answer 5

• inc. No. & size of mitochondria
• inc. Oxidative enzyme capacity
• inc. Capillarisation
• inc. Myoglobin
• > VO2max* If able to exercise at appropriate intensity
• dec. Hypertension
• dec. Cardiac dysrhythmias
• dec. Decrease of subsequent MI by 25-30%
• dec. Sudden death (25-35% survival advantage)
• dec. Fatal reinfaction
• dec. All cause mortality
• inc. Collateral circulation* In those who can exercise at very high intensity

Question 6

Components

Answer 6

¬	4/52 AMI or >4-6/52 post surgery
¬	Post angioplasty +/= > 2/52
¬	Outpatient setting
¬	Initial test
¬	Individual prescription

Question 7

Indications to Cease Test (or exercise)

Answer 7

•	ST depression, arrhythmia
•	≥ Maximal heart rate
•	Angina
•	Dizziness, syncope
•	Pallor
•	 ≥10mmHg DAP
•	 or  SAP
•	White streak down back (vasoconstriction)
•	Stumble, incoordination
Extreme dyspnoea or exhaustion

Question 8

Considerations in Designing Programme

Answer 8

• Patients own wishes & goals, age, occupation, activity
• Location of infarction
• STEMI or NSTEMI
• Level of enzymes
• Type of surgery (e.g. MVR, AVR)
• Resting BP, HR
• LVEF

Also Consider:
• Arrhythmias, pacemaker, heart block
• Ejection fraction, LV Dyskinesia
Other conditions (e.g. PVD, Diabetes, COPD)

Question 9

Interview

Answer 9

Important for goal-setting:
•	Occupation  hours, division of labour, actual tasks
•	Stress
•	Recreation, how often, level
•	Relaxation, home, social
•	Smoking
•	Sleep
•	Digestion
•	Depression?

Question 10

Activity Counselling

Answer 10

¬	Motivational interviewing
o	Patient does the talking
o	Open questions, reflective listening
o	Guide the conversation
o	No expert behaviour
o	Identify barriers
o	Set realistic goals
¬	Follow-up and reinforcement
¬	Feedback on objective measurements