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Cuccurullo 3rd Edited > Ch 9 - Cardiac Rehabilitation > Flashcards

Ch 9 - Cardiac Rehabilitation Flashcards

1
Q

What should all MI survivors receive?

A

Cholesterol lowering agent
Aspirin
Beta-blocker

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2
Q

What does aspirin reduce the risk of?

A

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

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3
Q

What do Beta-blockers reduce the risk of?

A

Reduce mortality

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

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4
Q

What are non modifiable risk factors of heart disease?

A

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

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5
Q

What are modifiable risk factors of heart disease?

A 
Hypertension
Cigarette smoking
Hyperlipidemia
Diabetes mellitus
Obesity
Sedentary lifestyle
Type A personality
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6
Q

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

A

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

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7
Q

What age do most MI’s occur?

A

50% of MI occurs in people under age 65

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8
Q

Describe phase I of cardiac rehab.

A

During acute inpatient hospitalization

Can last 1-14 days

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9
Q

Describe phase II of cardiac rehab.

A

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

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10
Q

Describe phase III/IV of cardiac rehab.

A

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

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11
Q

What is the most closely monitored phase of cardiac rehabilitation?

A

Phase II

Immediate outpatient period

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12
Q

What are the two components of phase III cardiac rehab?

A

Intermediate and maintenance.

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13
Q

Describe the intermediate stage of cardiac rehab.

A

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

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14
Q

What does Total oxygen consumption (VO2) represent?

A

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

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15
Q

What is Aerobic capacity (VO2 max)?

A

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)

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16
Q

How can Aerobic capacity (VO2 max) be tested?

A

Treadmill or leg cycle ergometer testing

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17
Q

What is Myocardial oxygen consumption (MVO2)?

A

Actual oxygen consumption of the heart measured directly with cardiac catheterization

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18
Q

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

A

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

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19
Q

What is a Metabolic equivalent (MET)?

A

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

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20
Q

What does 1 Metabolic equivalent (MET) equal?

A

3.5 mL O2 consumed/kg of body weight/minute

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

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21
Q

What are outcomes of cardiac rehab?

A
  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
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22
Q

When should patients be mobilized after cardiac surgery?

A

As rapidly as possible to prevent decubitus,

pneumonia, and thromboembolism

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23
Q

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

A

Activities of very low intensity (1 to 2 METs)

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24
Q

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

A

Activities or exercises of intensity (3 to 4 METs)

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25
Q

What is the energy cost of low grade ambulation?

A

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

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26
Q

What is Graded Exercise Testing (GXTs)?

A

Tests assess the patient’s to tolerate increased physical stress

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27
Q

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

A
  • Functional rather than diagnostic tools
  • Risk stratification
  • Limits and guidelines for exercise therapy
  • Assess change over time
28
Q

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

A

<4 MET

29
Q

What exercise testing protocol is used for Lower extremity amputees?

A

Arm ergometers

30
Q

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

A

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

31
Q

What are advantages of a cycle ergometer?

A

Less space
Less expensive
Better quality EKG and BP monitoring

32
Q

What exercise testing protocol is appropriate for

high-risk patients with functional capacity of <7 METs?

A

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

33
Q

What exercise testing protocol is appropriate for

low to intermediate risk patients with functional capacity of >7 METs?

A

Bruce protocol with metabolic demands of >2 METs per stage

34
Q

When is Bruce protocol used?

A

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

35
Q

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

A

Evaluate ischemia

Cannot be used in exercise presumption

36
Q

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

A

2-3 METs

37
Q

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

A

3-4 METs

38
Q

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

A

4-5 METs

39
Q

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

A

5-6 METs

40
Q

What is the MET of Sexual intercourse?

A

3-4 METs

41
Q

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

A

7 METs

42
Q

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

A

9 METs

43
Q

What is the MET of mopping the floor?

A

2-4 METs

44
Q

What is the MET of Pushing a power lawn mower?

A

4 METs

45
Q

What is the MET of Golf?

A

2-5 METs

46
Q

What is the MET of Bowling?

A

4-5 METs

47
Q

What is the MET of Volleyball?

A

3-4 METs

48
Q

What is the MET of Ping pong?

A

3-6 METs

49
Q

What is the MET of Tennis?

A

4-7 METs

50
Q

What is the MET of Roller-skating?

A

5-6 METs

51
Q

When is sexual intercourse not recommended after MI?

A

2 weeks post MI

52
Q

What is target HR?

A

70% to 85% of the maximum HR

53
Q

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

A

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

54
Q

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

A

– 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

55
Q

What is an Orthotopic heart transplantation (OHT)?

A

■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

56
Q

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

A

99%

57
Q

What is a Heterotopic transplantation?

A

Recipient heart is left in place to assist the donor heart

58
Q

What does a transplanted heart lack?

A

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

59
Q

What are physiologic changes after heart transplant?

A
  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
60
Q

How does exercise improve PAD and walking economy?

A

Increasing biomechanical and metabolic efficiency

61
Q

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

A

ASA 325 mg

62
Q

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

A 
–Poorer neuro and functional outcomes
–Higher mortality
–Longer hospital stays
–Lower discharge rates to home
–Poorer outcome
63
Q

Describe sedentary work.

A

Lifting <10 lbs

Walking/standing occasional

64
Q

Describe light work.

A

Lifting <20 lbs

Fair amount of walking/standing

65
Q

Describe Medium work.

A

Lifting <50 lbs

Frequent carrying up to 25 lbs

66
Q

Describe Heavy work.

A

Lifting <100 lbs

Frequent carrying up to 50 lbs

67
Q

Describe Very Heavy work.

A

Lifting >100 lbs

Frequent carrying >50 lbs

Cuccurullo 3rd Edited (91 decks)

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