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Cardiopulmonary I > CV Rehab Management - HF, CAD, CR & DM > Flashcards

CV Rehab Management - HF, CAD, CR & DM Flashcards

HF,CAD, CR, & DM

1
Q

What setting does Phase 1 Cardiac Rehab take place in?

A

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

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2
Q

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

A

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

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3
Q

What is the main aim of Phase 1 Cardiac Rehab?

A

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

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4
Q

What setting does Phase 2 Cardiac Rehab take place in?

A

Outpatient setting

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5
Q

When does Phase 2 Cardiac Rehab start?

A

As soon as possible after hospital discharge.

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6
Q

How many sessions does Phase 2 Cardiac Rehab include?

A

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

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7
Q

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

A

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

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7
Q

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

A

False: Exercise physiologist

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8
Q

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

A

Training should mirror the patient’s regular functional tasks

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9
Q

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

A

Exercises should engage muscles used for regular functional tasks.

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10
Q

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

A

True

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11
Q

Why is exercise intensity important in Phase 2 Cardiac Rehab?

A

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

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

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

A

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

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15
Q

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

A

Interval training.

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16
Q

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

A

produces a higher VO2 max consumption.

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17
Q

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

A

45 minutes of continuous steady-state exercise.

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18
Q

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

A

3x per week.

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19
Q

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

A

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

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20
Q

When is resistance training initiated in Phase 2 Cardiac Rehab?

A

after aerobic exercise.

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21
Q

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

A

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

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22
Q

How should weights be progressed in resistance training?

A

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

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23
Q

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

A

Exhale with exertion to avoid the Valsalva maneuver.

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24
Q

What is the primary focus of Phase 3 Cardiac Rehab?

How does supervision change in Phase 3 Cardiac Rehab?

A

It is the maintenance phase, focusing on lifelong exercise involvement.

There is less individualized supervision, with larger exercise groups.

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25
Q

Where do patients typically participate in Phase 3 Cardiac Rehab?

A

YMCA, senior centers, or private gyms.

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26
Q

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

A

decrease both mortality risk and myocardial infarction

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27
Q

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

A

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

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28
Q

What is the greatest predictor of participation in Cardiac Rehab?

A

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

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29
Q

When should patients avoid exercise in relation to meal times?

A

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

30
Q

What types of exercises should be avoided during Cardiac Rehab?

A

Isometric exercises and breath-holding should be avoided.

31
Q

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

A

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

32
Q

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

A

Healthy lifestyle choices reduce the risk of MI by 81-94%,

pharmacotherapies alone result in a 20-30% reduction.

33
Q

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

A

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

34
Q

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

A

Mediterranean diet.

35
Q

What should be increased in the diet to help prevent CVD?

What types of foods should be limited to reduce the risk of CVD?

A

Increased intake of fruits and vegetables.

Limit processed foods.

36
Q

What is a key characteristic of the Mediterranean diet?

A

It includes lots of fresh fruits and vegetables.

37
Q

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

A

Type 1 DM requires insulin replacement.

38
Q

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

A

Medications specifically designed for Type 2 DM. (metformin)

39
Q

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

A

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

40
Q

Do medications for Type 2 DM include insulin replacement?

A

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

41
Q

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

A

Metformin slows the rate of glucose released by the liver.

42
Q

What is the risk of hypoglycemia when using Metformin alone?

A

very low risk of hypoglycemia when Metformin is used alone

43
Q

Does Metformin affect insulin secretion at the pancreas?

A

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

44
Q

What risk is associated with increased exercise while taking Metformin?

A

There is an increased risk of lactic acidosis with exercise.

45
Q

What are GLP-1 agonists?

A

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

46
Q

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

A

successful in promoting weight reduction.

47
Q

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

A

function of DPP-4 inhibitors?

48
Q

How do sulfonylureas work?

A

directly stimulate the pancreas to release insulin.

49
Q

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

A

higher risk of hypoglycemia compared to other insulin stimulators.

50
Q

What are Thiazolidinediones (TZDs)?

A

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

51
Q

How do TZDs affect insulin utilization?

A

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

52
Q

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

A

SGLT-2 inhibitors

53
Q

primary effects of SGLT-2 inhibitors on glucose levels?

A

lower blood glucose levels by increasing glucose excretion in urine.

54
Q

How does sustained physical activity affect insulin secretion?

A

Sustained physical activity reduces insulin secretion.

55
Q

How is decreased insulin secretion compensated during exercise?

A

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

56
Q

how is HF best pharmacologically managed?

A

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

57
Q

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

A

BBs, anti-HTN, and diuretics

58
Q

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

A

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

59
Q

when should you start heavy aerobic exercise in HF patients?

A

when their HF is compensated

60
Q

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

A

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

61
Q

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

A

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

62
Q

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

A

– > 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

63
Q

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

A

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

64
Q

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

A

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

65
Q

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

A

HIIT
straining/valsalva
high intensity activity

66
Q

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

A

stenosis

67
Q

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?

A

at rest: lower HR
increased workload: weakened HR rise

68
Q

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

A

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

69
Q

what is cardiac rehab?

A

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

70
Q

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

A

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

71
Q

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

A

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

72
Q

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

A

– 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

73
Q

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)

A

Medicare Part B

Cardiopulmonary I (25 decks)

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