CV Rehab Management - HF, CAD, CR & DM

Question 1

What setting does Phase 1 Cardiac Rehab take place in?

Answer 1

Acute care or post-acute care (all inpatient).

Question 2

When does Phase 1 Cardiac Rehab occur in the patient’s timeline?

Answer 2

From Post-Operative Day (POD) 0 through discharge.

Question 3

What is the main aim of Phase 1 Cardiac Rehab?

Answer 3

To get patients to the next level of care or home.

Question 4

What setting does Phase 2 Cardiac Rehab take place in?

Answer 4

Outpatient setting

Question 5

When does Phase 2 Cardiac Rehab start?

Answer 5

As soon as possible after hospital discharge.

Question 6

How many sessions does Phase 2 Cardiac Rehab include?

Answer 6

36 sessions (3 times per week for 12 weeks).

Question 7

What components should the exercise program in Phase 2 Cardiac Rehab include?

Answer 7

combination of aerobic exercise training, resistance training, and flexibility.

Question 7

True or False: PTs primarily leads Phase 2 Cardiac Rehab?

Answer 7

False: Exercise physiologist

Question 8

What does “specificity” mean in the context of Phase 2 Cardiac Rehab exercise training?

Answer 8

Training should mirror the patient’s regular functional tasks

Question 9

What should the mode of exercise in Phase 2 Cardiac Rehab focus on?

Answer 9

Exercises should engage muscles used for regular functional tasks.

Question 10

True or False: In the Phase 2 Cardiac Rehab exercise program? Patient preferences should be taken into account if possible.

Answer 10

True

Question 11

Why is exercise intensity important in Phase 2 Cardiac Rehab?

Answer 11

If exertion is too intense, training can be hazardous; if not intense enough, training can be ineffective.

Question 12

At what percentage of HR max does aerobic training typically occur in Phase 2 Cardiac Rehab?

Answer 12

At 70-85% HR max, but can occur at 40-60% HR max in elderly or more compromised patients.

Question 13

What are the phases of an exercise session in Phase 2 Cardiac Rehab?

Answer 13

Warm-up, steady-state exercise, and cool-down.

Question 14

What tools are used to monitor exercise intensity in Phase 2 Cardiac Rehab?

Answer 14

HR max formulas and Rate of Perceived Exertion (RPE) scales.

Question 15

What can be used for patients who cannot yet tolerate long-duration aerobic activities?

Answer 15

Interval training.

Question 16

What is the effect of combining upper and lower body exercises in Phase 2 Cardiac Rehab?

Answer 16

produces a higher VO2 max consumption.

Question 17

What is the goal duration for continuous steady-state exercise in Phase 2 Cardiac Rehab?

Answer 17

45 minutes of continuous steady-state exercise.

Question 18

What is the typical frequency of Cardiac Rehab sessions in Phase 2?

Answer 18

3x per week.

Question 19

How should the exercise program be adjusted for more impaired patients in Phase 2 Cardiac Rehab?

Answer 19

start with low-intensity, short-duration, and high-frequency exercise if possible.

Question 20

When is resistance training initiated in Phase 2 Cardiac Rehab?

Answer 20

after aerobic exercise.

Question 21

What is the goal for resistance training intensity in Phase 2 Cardiac Rehab?

Answer 21

30-50% of 1 Rep Max (1RM), with 8-10 reps, 2-3 times per week for major muscle groups.

Question 22

How should weights be progressed in resistance training?

Answer 22

increase weights by 5-10 lbs when 12-15 reps become comfortable.

Question 23

What breathing technique should be used during resistance training, and why?

Answer 23

Exhale with exertion to avoid the Valsalva maneuver.

Question 24

What is the primary focus of Phase 3 Cardiac Rehab? How does supervision change in Phase 3 Cardiac Rehab?

Answer 24

It is the maintenance phase, focusing on lifelong exercise involvement. There is less individualized supervision, with larger exercise groups.

Question 25

Where do patients typically participate in Phase 3 Cardiac Rehab?

Answer 25

YMCA, senior centers, or private gyms.

Question 26

What is the impact of attending 36 sessions of Cardiac Rehab on mortality and MI risk?

Answer 26

decrease both mortality risk and myocardial infarction

Question 27

What is a major issue with patients benefiting from Cardiac Rehab?

Answer 27

Many patients who would benefit from Cardiac Rehab are not being referred.

Question 28

What is the greatest predictor of participation in Cardiac Rehab?

Answer 28

The strength of the physician’s (MD) recommendation.

Question 29

When should patients avoid exercise in relation to meal times?

Answer 29

Patients should avoid exercising within 1-2 hours after a meal.

Question 30

What types of exercises should be avoided during Cardiac Rehab?

Answer 30

Isometric exercises and breath-holding should be avoided.

Question 31

What showering practices should be followed to maintain safety in Cardiac Rehab?

Answer 31

shorter showers and avoid extreme temperatures to maintain normal blood/fluid distribution.

Question 32

How much can healthy lifestyle choices reduce the risk of myocardial infarction (MI)?

Answer 32

Healthy lifestyle choices reduce the risk of MI by 81-94%, pharmacotherapies alone result in a 20-30% reduction.

Question 33

What is the most effective treatment for cardiovascular disease (CVD)?

Answer 33

most effective treatment is a combination of lifestyle changes and pharmacologic management.

Question 34

What diet is recommended for the prevention and management of cardiovascular disease (CVD)?

Answer 34

Mediterranean diet.

Question 35

What should be increased in the diet to help prevent CVD? What types of foods should be limited to reduce the risk of CVD?

Answer 35

Increased intake of fruits and vegetables. Limit processed foods.

Question 36

What is a key characteristic of the Mediterranean diet?

Answer 36

It includes lots of fresh fruits and vegetables.

Question 37

What is the primary pharmacologic treatment required for Type 1 Diabetes Mellitus?

Answer 37

Type 1 DM requires insulin replacement.

Question 38

What is the pharmacologic treatment that is effective only for Type 2 Diabetes Mellitus?

Answer 38

Medications specifically designed for Type 2 DM. (metformin)

Question 39

What are some mechanisms of action used by medications to lower blood sugar in Type 2 DM?

Answer 39

Slow the rate of glucose release by the liver - Stimulate insulin secretion by β cells of the pancreas - Block glucose reabsorption in the kidneys - Enhance insulin sensitivity in peripheral tissues

Question 40

Do medications for Type 2 DM include insulin replacement?

Answer 40

No, artificial replacement of insulin is typically associated with Type 1 DM, though some Type 2 patients may eventually require insulin.

Question 41

What is one of the primary mechanisms of action of Metformin (Glucophage)?

Answer 41

Metformin slows the rate of glucose released by the liver.

Question 42

What is the risk of hypoglycemia when using Metformin alone?

Answer 42

very low risk of hypoglycemia when Metformin is used alone

Question 43

Does Metformin affect insulin secretion at the pancreas?

Answer 43

No, Metformin does not affect insulin secretion at the pancreas.

Question 44

What risk is associated with increased exercise while taking Metformin?

Answer 44

There is an increased risk of lactic acidosis with exercise.

Question 45

What are GLP-1 agonists?

Answer 45

Medications that mimic a gastrointestinal hormone released during digestion, stimulating the pancreas to produce and release insulin.

Question 46

What is one benefit of GLP-1 agonists besides insulin stimulation?

Answer 46

successful in promoting weight reduction.

Question 47

prevent the breakdown of GLP-1, allowing it to act on the pancreas to produce and release insulin.

Answer 47

function of DPP-4 inhibitors?

Question 48

How do sulfonylureas work?

Answer 48

directly stimulate the pancreas to release insulin.

Question 49

What is a significant risk associated with the use of sulfonylureas?

Answer 49

higher risk of hypoglycemia compared to other insulin stimulators.

Question 50

What are Thiazolidinediones (TZDs)?

Answer 50

TZDs are a class of medications that enhance insulin sensitivity in adipose tissue, muscle, and liver.

Question 51

How do TZDs affect insulin utilization?

Answer 51

TZDs allow insulin to be utilized at the cell membrane, making cells more receptive to blood glucose.

Question 52

medications that block glucose absorption in the kidneys, allowing for higher excretion of glucose in urine.

Answer 52

SGLT-2 inhibitors

Question 53

primary effects of SGLT-2 inhibitors on glucose levels?

Answer 53

lower blood glucose levels by increasing glucose excretion in urine.

Question 54

How does sustained physical activity affect insulin secretion?

Answer 54

Sustained physical activity reduces insulin secretion.

Question 55

How is decreased insulin secretion compensated during exercise?

Answer 55

It is compensated for by heightened sensitivity of peripheral tissues to insulin, leading to more rapid glucose uptake by muscles.

Question 56

how is HF best pharmacologically managed?

Answer 56

treating HTN & CAD with combination of BBs and ACE/ARB

Question 57

there is a high likelihood that a patient with HF is on what combination of medications?

Answer 57

BBs, anti-HTN, and diuretics

Question 58

for patients hospitalized for HF, what is the starting point for their rehab? -- intensity -- frequency -- focus on _____ tasks

Answer 58

-- low intensity, low impact activity 5-10 minutes/day; gradually progress to 30 min/day -- frequency 1-2x/day, 5-7 days/week -- functional

Question 59

when should you start heavy aerobic exercise in HF patients?

Answer 59

when their HF is compensated

Question 60

what should HF patients be educated on in relation to their rehab management?

Answer 60

energy conservation self management strategies medical compliance sodium limitations daily weight checks

Question 61

Aerobic exercise recommendations for stable, class 2-3 systolic HF: -- time -- intensity -- frequency -- duration -- mode

Answer 61

-- 20-60 minutes -- 50-90% peak VO2 max -- 3-5x/week -- > 8-12 weeks -- treadmill, cycling, dancing

Question 62

interval training exercise recommendations for stable, class 2-3 systolic HF: -- time & intensity -- frequency -- duration -- mode

Answer 62

-- > 35 minutes ; 1-5 minutes high intensity (>90% VO2 max or MHR) alternating with same duration rest intervals (40-70% VO2 max or MHR) ; progress towards shorter rest intervals -- 2-3x/week -- > 8-12 weeks -- treadmill, cycling

Question 63

resistance training recommendations for stable, class 1-3 systolic HF: -- time -- intensity -- frequency -- duration

Answer 63

-- 45-60 minutes -- 60-80% 1RM, 2-3 sets/muscle group -- 3x/week -- > 8-12 weeks

Question 64

combined exercise recommendations for stable, class 2-3 systolic HF: -- time -- intensity -- frequency -- duration

Answer 64

-- 20-30 minutes added to aerobic exercise training -- 60-80% 1RM, 2-3 sets/muscle group -- 3x/week -- > 8-12 weeks

Question 65

When you know a patient has valve disease, what are 3 things you need to avoid as part of their rehab mangaement?

Answer 65

HIIT straining/valsalva high intensity activity

Question 66

patients who have valve regurgitation may tolerate activity better than those with ______

Answer 66

stenosis

Question 67

your patient has a diagnosis of CAD and is on beta blockers. what would you assume about their heart rate at rest and upon exertion?

Answer 67

at rest: lower HR increased workload: weakened HR rise

Question 68

Your patient has a history of CAD and is on chronotropic drugs. what is the best way to gauge their exercise tolerance?

Answer 68

RPE --> much safer than max HR ** spend adequate time educating patients on RPE

Question 69

what is cardiac rehab?

Answer 69

structured and supervised exercise programs performed after a major cardiac event or surgery that involves multiple phases and elements of care

Question 70

what are 8 common conditions/surgeries that are recommended for CR?

Answer 70

CAD stable angina HF (stages 2-4) PVD Post MI post PCI post open heart surgery post PPM/ICD placement

Question 71

what are 7 common conditions that are NOT recommended for CR?

Answer 71

severe/decompensated HF unstable angina hemodynamic instability serious arrhythmias cardiac conduction problems uncontrolled HTN other organ system failure

Question 72

what is a typical outpatient cardiac rehab structure? -- ___ sessions -- involves (3) -- education provided for: (5)

Answer 72

-- 36 (3x/week for 12 weeks) -- exercise program, diet/nutrition counseling, patient education -- nutrition, exercise programming, tobacco/ETOH cessation, psychosocial issues, medical management of comorbidities

Question 73

what insurance covers 36 visits of CR for each episode of the following: -- MI within the last year -- post CABG -- post valve replacement -- stable angina -- angioplasty/stent -- compensated HF stages 2-4 -- post OHT (heart transplant)

Answer 73

Medicare Part B