Ch 9 - Cardiac Rehabilitation

Question 1

What should all MI survivors receive?

Answer 1

Cholesterol lowering agent
Aspirin
Beta-blocker

Question 2

What does aspirin reduce the risk of?

Answer 2

Subsequent MI, stroke, and death from cardiovascular causes by about 25%

Question 3

What do Beta-blockers reduce the risk of?

Answer 3

Reduce mortality

and reinforce after MI and may be more effective in women than in men

Question 4

What are non modifiable risk factors of heart disease?

Answer 4

Age
Male gender
Family history of CAD
Past history of CAD, PVD, CVA

Question 5

What are modifiable risk factors of heart disease?

Answer 5

Hypertension
Cigarette smoking
Hyperlipidemia
Diabetes mellitus
Obesity
Sedentary lifestyle
Type A personality

Question 6

Describe the 3 year survival rate post-MI in patients who do cardiac rehab vs those who do not.

Answer 6

Rehab: 95%
None: 65%
28% red in recurrent MI

Question 7

What age do most MI’s occur?

Answer 7

50% of MI occurs in people under age 65

Question 8

Describe phase I of cardiac rehab.

Answer 8

During acute inpatient hospitalization

Can last 1-14 days

Question 9

Describe phase II of cardiac rehab.

Answer 9

Supervised outpatient cardiac rehab lasting 3 to 6 months, length determined by risk stratification

Question 10

Describe phase III/IV of cardiac rehab.

Answer 10

Maintenance phase in which physical fitness and risk factor reduction are accomplished in a minimally supervised or unsupervised setting

Question 11

What is the most closely monitored phase of cardiac rehabilitation?

Answer 11

Phase II

Immediate outpatient period

Question 12

What are the two components of phase III cardiac rehab?

Answer 12

Intermediate and maintenance.

Question 13

Describe the intermediate stage of cardiac rehab.

Answer 13

Follows immediate outpatient cardiac rehabilitation when the patient is not intensely monitored and/or supervised but is still involved in regular endurance exercise training and lifestyle change

Question 14

What does Total oxygen consumption (VO2) represent?

Answer 14

Oxygen consumption of the whole body and corresponds to the work of the peripheral skeletal muscles rather than myocardial muscles

Question 15

What is Aerobic capacity (VO2 max)?

Answer 15

Measure the maximum oxygen consumption that an individual can achieve during exercise expressed the milliliters of O2 consumed per kilogram of body weight per minute (mL O2/kg/min)

Question 16

How can Aerobic capacity (VO2 max) be tested?

Answer 16

Treadmill or leg cycle ergometer testing

Question 17

What is Myocardial oxygen consumption (MVO2)?

Answer 17

Actual oxygen consumption of the heart measured directly with cardiac catheterization

Question 18

How can Myocardial oxygen consumption (MVO2) be estimated in a clinical setting?

Answer 18

Estimated MVO2 = rate pressure product (RPP) = SBP × HR

Question 19

What is a Metabolic equivalent (MET)?

Answer 19

Ratio of working metabolic rate to basal (resting) metabolic rate

Question 20

What does 1 Metabolic equivalent (MET) equal?

Answer 20

3.5 mL O2 consumed/kg of body weight/minute

1 MET = Energy consumption while at basal metabolic rate (seated rest)

Question 21

What are outcomes of cardiac rehab?

Answer 21

1. Improved Exercise Tolerance
2. Improved Sx
3. Improved Blood Lipid Levels
4. Red Cigarette Smoking
5. Improved Psychosocial Well-Being and Stress Red
6. Red Mortality
7. Safety

Question 22

When should patients be mobilized after cardiac surgery?

Answer 22

As rapidly as possible to prevent decubitus,

pneumonia, and thromboembolism

Question 23

What MET should rehab be during the acute period in coronary care unit?

Answer 23

Activities of very low intensity (1 to 2 METs)

Question 24

What MET should rehab be during the subacute period in telemetry unit/medical ward?

Answer 24

Activities or exercises of intensity (3 to 4 METs)

Question 25

What is the energy cost of low grade ambulation?

Answer 25

– 1 mph (slow stroll) = 1.5 to 2 METs –2 mph (regular slow walk) = 2 to 3 METs –Propelling wheelchair = 2 to 3 METs

Question 26

What is Graded Exercise Testing (GXTs)?

Answer 26

Tests assess the patient’s to tolerate increased physical stress

Question 27

How do cardiac rehab professionals use Graded Exercise Testing (GXTs)?

Answer 27

* Functional rather than diagnostic tools * Risk stratification * Limits and guidelines for exercise therapy * Assess change over time

Question 28

What MET do most ADL's in the home environment require?

Answer 28

<4 MET

Question 29

What exercise testing protocol is used for Lower extremity amputees?

Answer 29

Arm ergometers

Question 30

What exercise testing protocol provides a common form of physiologic stress?

Answer 30

Treadmill testing subjects are likely to attain a higher VO2 max and peak heart rate than cycle ergometer

Question 31

What are advantages of a cycle ergometer?

Answer 31

Less space Less expensive Better quality EKG and BP monitoring

Question 32

What exercise testing protocol is appropriate for | high-risk patients with functional capacity of <7 METs?

Answer 32

Balke-Ware protocols that increase metabolic demands by 1 MET per stage

Question 33

What exercise testing protocol is appropriate for | low to intermediate risk patients with functional capacity of >7 METs?

Answer 33

Bruce protocol with metabolic demands of >2 METs per stage

Question 34

When is Bruce protocol used?

Answer 34

Bruce Protocol of 2 to 3 METs per stage is useful with stable patients with functional capacities of 10 METs

Question 35

What can Pharmacologic stress testing in debilitated patients for whom exercise testing cannot be performed be used for?

Answer 35

Evaluate ischemia | Cannot be used in exercise presumption

Question 36

What is the MET of a slow walk (2 mph)?

Answer 36

2-3 METs

Question 37

What is the MET of a regular speed walk (3 mph)?

Answer 37

3-4 METs

Question 38

What is the MET of a brisk walk (3-5 mph)?

Answer 38

4-5 METs

Question 39

What is the MET of a very brisk walk (4 mph)?

Answer 39

5-6 METs

Question 40

What is the MET of Sexual intercourse?

Answer 40

3-4 METs

Question 41

What is the MET of Outdoor work—shovel snow, spade soil?

Answer 41

7 METs

Question 42

What is the MET of jog, walk (5 mph)?

Answer 42

9 METs

Question 43

What is the MET of mopping the floor?

Answer 43

2-4 METs

Question 44

What is the MET of Pushing a power lawn mower?

Answer 44

4 METs

Question 45

What is the MET of Golf?

Answer 45

2-5 METs

Question 46

What is the MET of Bowling?

Answer 46

4-5 METs

Question 47

What is the MET of Volleyball?

Answer 47

3-4 METs

Question 48

What is the MET of Ping pong?

Answer 48

3-6 METs

Question 49

What is the MET of Tennis?

Answer 49

4-7 METs

Question 50

What is the MET of Roller-skating?

Answer 50

5-6 METs

Question 51

When is sexual intercourse not recommended after MI?

Answer 51

2 weeks post MI

Question 52

What is target HR?

Answer 52

70% to 85% of the maximum HR

Question 53

What is the Borg Rating of Perceived Exertion (PRE) Scale?

Answer 53

Linear scale of rating from 6 to 20 of physical exertion and correlates linearly with HR, ventricular O2 consumption, and lactate levels

Question 54

What is the duration and frequency of exercise recommended by ACSM?

Answer 54

– Moderate cardio exercise for >30 min for >five days/week – Vigorous cardio exercise >20 minutes for >5 days/week or combo to achieve a total energy expenditure of 500- 1,000 MET min/week –Resistance and neuromotor exercise involving balance, agility, and coordination 2-3 days/week

Question 55

What is an Orthotopic heart transplantation (OHT)?

Answer 55

■Donor heart excised w/ intact RA and a long segment of SVC ■Donor LA is sutured to the stump of 4 pulmonary veins in the recipient ■Superior and inferior venae cavae are sutured to the recipient atrial cuff and great arteries are anastomosed

Question 56

What % of cardiac transplants are Orthotopic heart transplantation (OHT)?

Answer 56

99%

Question 57

What is a Heterotopic transplantation?

Answer 57

Recipient heart is left in place to assist the donor heart

Question 58

What does a transplanted heart lack?

Answer 58

Vagal innervation (PNS tone) from the body and vagal inhibition to the sinoatrial (SA) node

Question 59

What are physiologic changes after heart transplant?

Answer 59

1. High resting HR d/t PNS denervation 2. Lower peak exercise HR 3. Resting HTN d/t renal effects of anti-rejection medications 4. Slower return to resting HR postexercise 5. Lower work capacity, CO, SBP, and the total O2 consumption (VO2) at max effort 6. Pretransplantation rehab strength training may enhance preop and postop recovery 7. 5- and 10-year survival ~85% and 75% 8. Accelerated atherosclerosis

Question 60

How does exercise improve PAD and walking economy?

Answer 60

Increasing biomechanical and metabolic efficiency

Question 61

What can be used instead of anti-coagulation if risk of hemorrhage is high in non-valvular Afib?

Answer 61

ASA 325 mg

Question 62

Describe the results of the 1996 Copenhagen Stroke Study that measured the consequences of stroke with AF compared to those with sinus rhythm.

Answer 62

``` –Poorer neuro and functional outcomes –Higher mortality –Longer hospital stays –Lower discharge rates to home –Poorer outcome ```

Question 63

Describe sedentary work.

Answer 63

Lifting <10 lbs | Walking/standing occasional

Question 64

Describe light work.

Answer 64

Lifting <20 lbs | Fair amount of walking/standing

Question 65

Describe Medium work.

Answer 65

Lifting <50 lbs | Frequent carrying up to 25 lbs

Question 66

Describe Heavy work.

Answer 66

Lifting <100 lbs | Frequent carrying up to 50 lbs

Question 67

Describe Very Heavy work.

Answer 67

Lifting >100 lbs | Frequent carrying >50 lbs