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CD Flashcards

1
Q

Acute response to exercise

Hemodynamic factors: HR (3)

A
  1. Chronotropic Incompetence
  2. Blunted HR response in patient taking B-blocker, Ca-channel blocker
  3. Delayed HR recovery
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2
Q

Acute response to exercise

Hemodynamic factors: SBP, DBP (3)

A
  1. Hypertensive response
  2. Hypotensive response
  3. Blunted BP response (variable) in patients taking vasodilator, Ca-channel blocker, ACE inhibitors, and alpha or B-blocker.
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3
Q

Acute response to exercise

Electrocardiogram (13)

A
  1. ST segment depression
  2. ST segment elevation
  3. Uninterpretable ST segment in patient with LBBB
  4. ST segment interpretability only in lead II, III, aVF, V4, V5, V6, in patient with RBBB
  5. Isolated premature atrial contraction
  6. Atrial flutter or fibrillation
  7. Sustained supraventricular tachycardia
  8. Isolated premature ventricular contractions (PVCs)
  9. Multifocal PVC or triplets of PVCs
  10. Sustained ventricular tachycardia
  11. Potential FP test in patient taking cardiac glycosides (digitalis, digoxin), diuretics if hypokalemia occurs, and hormone replacement therapy
  12. Potential change in ECG, FP or FN test in patients taking certain antiarrhythmic agents
  13. Increased likelihood of PVCs in patients taking diuretics
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4
Q

Acute response to exercise

Signs & Symptoms (4)

A
  1. Angina
  2. Nervous system symptoms (dizzy, near syncope)
  3. Signs of poor perfusions in CHF (cyanosis, pallor)
  4. Fatigue, dyspnea, wheezing, leg cramps, claudication
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5
Q

Acute response to exercise

Gas exchange and ventilation (7)

A
  1. Reduced VO2/WR slope (inconsistent finding)
  2. Low O2 pulse (CHF)
  3. Markedly reduced VO2peak (20-50%) compared to age- and sex-matched individuals; depends on severity of disease (CHD vs. CHF)
  4. Increased VE at submaximal VO2
    - More prevalent in CHF than in CHD patients
  5. Increased fB and reduced VT are frequent in CHF
  6. Reduced ventilatory threshold
  7. However, usually not ventilatory limited
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6
Q

Acute response to exercise

Blood gases and saturation (3)

A
  1. Usually no atrial desaturation or drop in PaO2 during exercise
  2. If desaturation and/or ventilatory limitation may suggest concurrent CV and respiratory limitation
  3. Reminder; significant desaturation = Change in SpO2 more/e 5%
    severe desaturation = SpO2 less 80%
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7
Q

Benefits of aerobic training (9)

A
  1. Cardiovascular adaptation with regular PA/ ET
  2. Improvement in max capacity due to peripheral adaptations
  3. Decrease in HR and BP for given level of submax effort
    • Means ischemic/angina level are delayed
  4. Stabilization, slowing or reversal of the atherosclerotic process when combined with risk factor modification
  5. Reduction in inflammation
  6. Partial reversal of autonomic dysfunction
    • Improvement in HR variability
    • Reduction in resting and exercise levels of norepinephrine
  7. Improvement in haemostatic profile
    • Increase in fibrinolytic activity
    • reduction in erythrocyte rigidity
    • reduction in platelet adhesiveness and aggregation
  8. Improvement in risk factor profile
    • Increase in HDL and decrease in serum trigglycerides
    • Reduction in resting SBP and DPB
    • Improved glucose tolerance
    • Reduced total body fat and intra-abdominal fat (comprehensive program)
  9. Reduction in CV and all-cause mortality
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8
Q

Benefits of resistance training (7)

A
  1. Improvement in muscular strength and endurance
  2. Decrease in cardiac demands of muscular work during daily activities
  3. Prevention and treatment of other diseases and conditions (osteo, Type II D, obesity)
  4. Increase in ability to perform ADLs
  5. Improve in self confidence
  6. Maintenance of independence
  7. Slowing of age and disease related declines in muscle strength and mass
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9
Q

Exercise testing (3)

A
  1. Recommended, but guidelines also give recommandation for ET intensity in the absence of prior CET
  2. When used, test should be symptom limited
    • Standard Bruce protocol = most popular in this clientele. Very “practical” b/c familiar, easy to interpret and quick. However, not ideal for individuals that are older, deconditioned or have CHF b/c increments are too high. Can overestimate maximal capacity.
  3. Evaluate patients when stable and consider timing of meds and training sessions
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10
Q

Precautions

Patients with ischemia/angina (10)

A
  1. Exercise can be inappropriate for patients who have angina at 
≤ 3 METs
  2. Teach patients to recognize their angina symptoms
  3. Interrupt session or at least decrease intensity if moderate angina, i.e. 2 on a 1-4 scale
  4. Prolong w/u and c/d (10 minutes) b/c have anti-angina effect. For w/u, objective is to progressively increase HR 10-20 b/min from lower limit of target HR
  5. HR should stay at least 10 b/min below angina or ischemic threshold
  6. Possibility of symptom exacerbation if exercise in cold
  7. Upper-body exercise can precipitate angina quicker than lower-body exercise (more pronounced pressor response)
  8. Certain patients benefit from prophylactic use of nitroglycerin (pre-exercice). Under proper medical supervision. Evaluate BP before and after b/c risk of hypotensive response
  9. Any increase or change in angina symptoms should be noted and should receive medical attention
  10. If symptoms of angina are not relieved by exercise termination or by 3 nitro tablets (1 every 5 minutes), patient should be taken to closest emergency
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11
Q

Precautions

Post-angioplasty patients (3)

A
  1. Exercise training can start almost immediately after intervention if catheter entry site heals well
  2. Possibility of faster progression than other cardiac sub-populations b/c often no myocardial injury and shorter inactivity period before and after intervention
  3. Less re-stenosis today than before (with stents and aggressive pharmacological interventions), but should still closely check these patients for possible recurrence of signs and symptoms of angina
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12
Q

Precautions

Post-sternotomy patients (5)

A
  1. Caution in developing exercise program within first 8-12 weeks post-surgery. Routinely evaluate sternal wound for infection, healing, and stability.
  2. Avoid upper-body movements that would exert tension on the the sternal wound
  3. Because of inter-individual differences in initial strength and healing process, no universal standard weight limits can be recommended; often set at 5- to 10-lb limit for 10-12 weeks
  4. ROM exercises and other activities involving sternal muscle can be gradually introduced and progressed as long as no sign of sternal instability
  5. Insist on importance of lifestyle modifications b/c may have impression that are “fixed”
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13
Q

Precautions

Patients with pacemaker or implantable defibrillator (5)

A
  1. Know type, mode, and setting of the device
  2. Exercise testing should be used to evaluate HR and rhythm response
  3. For patients with ICD, know programmed threshold for pacing and defibrillation. Keep HR at least 10-15 bpm below this threshold during exercise test and training
  4. After the first 24 hrs following device implantation, mild upper extremity ROM activities can be performed
  5. Avoid rigorous upper-extremity activities for 3-4 weeks after implant (lower extremity activities are permitted)
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14
Q

Precautions

Patients with chronic heart failure (CHF) (9)

A
  1. Should be stable, treated and have no absolute contraindications (especially decompensated CHF or threatening arrhythmias)
  2. Should have an exercise capacity > 3 METs
  3. If possible, directly measure VO2peak b/c aerobic capacity can be markedly overestimated from exercise time in this clientele
  4. Many will be taking multiple meds: digoxin, diuretics, vasodilators, ACE inhibitors, B-blockers, and anti-arrhythmic agents. Consider effects on exercise response.
  5. Supervisory staff should be extra vigilant of any worsening signs or symptoms (increasing fatigue, dyspnea or angina on exertion, edema, sudden weight gain, malignant ventricular arrhythmias)
  6. Chronotropic response to exercise can be impaired, so RPE and dyspnea may be used preferentially over HR or work rate
  7. W/u and c/d duration should be increased to 15 min each
  8. Consider resistance training in stable patients who have adjusted and are tolerating aerobic training (usually requires at least 4 weeks)
  9. Avoid isometric exertion
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15
Q

Precaution

Patients after cardiac transplantation

A
  1. Immunosuppression therapy can lead to bone loss, DM, and hypertension. Regular aerobic and RT can play an important role in the managing of these metabolic disorders
  2. HIIT can be used
  3. ROM, activities and exercises involving upper limbs should be restricted for up to 12 wk.
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EXCI 450 (7 decks)

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