Cardio I - Values & Rehab Phases

Question 1

Cardio Rehab Phase I

Answer 1

• Inpatient
• Process of 3-5 days
• Ambulation, bathing, continence, dressing, toileting, and transfers
• As a PT, we need to be worried about a recurrent MI within first 4 weeks after initial injury so we need to be careful not to overwork the patient
• UE exercises avoided for 6-8 weeks after CABG and 5 weeks for MI
• </= 70% maxHR, 5-10 mins progressing for 2-4x/day
• Exercise discontinuation criteria — diastolic BP >/= 110, decreased in SBP >/= 10, significant ventricular or atrial arrhythmias, second or third degree heart blocks, or signs of exercise intolerance (angina, marked SOB, ECG changes related to ischemia, or >1mm depression)

Question 2

Cardio Rehab Phase II

Answer 2

• Outpatient
• Process lasts weeks to months
• Prior to entering this phase, recommended to have symptom limited ETT at 4-6 week mark
• Keep RPP below ischemic threshold (RPP = SBP x HR so stay >/= 10 beats below ischemic threshold)
• 70-85% maxHR, 20-60mins for 2-3x/week, 5-9 METS
• Resistance avoided until 5 weeks post MI and 9 weeks post CABG

Question 3

Cardio Rehab Phase III

Answer 3

• Maintenance, community centers
• Process is indefinite, unsupervised maintenance in community exercise program
• Prior to entering this phase, patient must be able to complete 5 METS of activity without symptoms, have stable angina, and have medically controlled arrhythmias during exercise
• 50-80% functional capacity, aerobic and strengthening, 45-60 minutes, 3-5x/week

Question 4

Blood flow through the heart…

Answer 4

• Deoxygenated blood: blood comes from extremities, go through veins through IVC/SVC, goes into right atrium, through tricuspid valve, through right ventricle, through pulmonic semilunar valves, then pulmonary arteries to…
• Oxygenated blood: …lungs, to pulmonary veins, through left atrium, through mitral valve, to left ventricle, to aortic valve, to systemic arteries throughout the body

Question 5

Heart Rate (HR)

Answer 5

• Parasympathetic — rest and digest
• Sympathetic — fight and flight (epinephrine and norepinephrine)
• HR changes based on body’s oxygen demand

Question 6

Cardiac Output (CO)

Answer 6

• Amount of blood pumped out per minute
• CO = SV x HR
• SV — amount of blood pumped out per ventricular contraction

Question 7

Blood Pressure (BP)

Answer 7

• SBP = pressure on artery walls when ventricles contract
• DBP = pressure on artery walls when ventricles are relaxed

Question 8

VO2 Max

Answer 8

• Maximum oxygen consumption during incremental exercise
• Measuring efficiency of your muscles
• More O2 consumed —> more ATP that can be created —> longer patient can exercise
• Gold standard for endurance testing!!! (this is an outcome measure, determines improvement in endurance over time)

Question 9

Korotkoff Sounds

Answer 9

• Sounds heard when blood pressure cuff is used to determine BP
• Sounds produced when artery collapses and then reopens with each heartbeat, sounds are caused by sudden deceleration of arterial walls, and sounds are heard through stethoscope placed over brachial artery
• First sound indicates SBP
• DBP indicated when all sounds have stopped

Question 10

Korotkoff Sound Phases

Answer 10

• Phase 1: A sharp tapping sound that indicates systolic blood pressure
• Phase 2: A swishing or whooshing sound that indicates pulsing blood flow
• Phase 3: A thumping sound that indicates blood flow is still blocked by the cuff
• Phase 4: A soft, blowing, or muffled sound that gradually fades
• Phase 5: Silence that indicates diastolic blood pressure