FINALS: Cardiac Rehabilitation Flashcards
What are the positive risk factors for cardiac rehabilitation based on age?
Men: >45 years old
Women: >55 years old
How does smoking contribute to positive risk factors in cardiac rehabilitation?
Cigarette smoking is a known positive risk factor for cardiac rehabilitation due to its effects on cardiovascular health.
What is considered a positive family history risk factor for cardiac rehabilitation?
Myocardial infarction (MI), coronary revascularization, or sudden death before 55 years in father; before 65 years in mother
How does dyslipidemia affect the risk for cardiac rehabilitation?
Abnormal lipid levels (e.g., high LDL, low HDL) increase the risk.
What BMI indicates obesity as a positive risk factor for cardiac rehabilitation?
BMI >30 kg/m²
Waist girth: >102 cm (40 in) for men, >88 cm (35 in) for women
How does a sedentary lifestyle affect cardiac risk?
Not participating in at least 30 minutes of moderate-intensity physical activity on at least 3 days per week for at least 3 months is a positive risk factor.
What blood pressure values are considered a positive risk factor for cardiac rehabilitation?
Systolic BP ≥140 mmHg
Diastolic BP ≥90 mmHg
What is the role of pre-diabetes in cardiac rehabilitation risk factors?
Pre-diabetes increases the risk for cardiovascular events and is considered a positive risk factor.
Pre-diabetes increases the risk for cardiovascular events and is considered a positive risk factor.
Palpation or auscultation of heart sounds
Observing for irregularities in heart rate and rhythm
What is pulsus alternans, and what does it indicate?
Pulsus alternans is an alternating strong and weak pulse, which can indicate heart failure or significant cardiac dysfunction.
What should be observed in a respiratory examination for a cardiac patient?
Respiratory rate and rhythm
Shortness of breath (SOB) on exertion
Paroxysmal nocturnal dyspnea (PND)
Orthopnea
What is orthostatic hypotension in the context of cardiac examination?
A significant drop in BP when standing (more than 20 mmHg systolic or 10 mmHg diastolic) could indicate orthostatic hypotension.
What is the six-minute walk test used for in cardiac rehabilitation?
To predict VO2max and assess functional capacity by measuring the distance walked in 6 minutes.
What is the dyspnea scale, and what do the grades mean?
+1: Mild, noticeable to patient but not to observer
+2: Mild, some difficulty, noticeable to observer
+3: Moderate difficulty, but can continue
+4: Severe difficulty, patient cannot continue
: What does jugular vein distention (JVD) indicate during a cardiac examination?
JVD can indicate heart failure or increased central venous pressure.
What is the purpose of an exercise tolerance test (ETT)?
To determine physiological responses during exercise
Assess functional exercise capacity
Serve as a basis for exercise prescription
Screen for coronary artery disease (CAD)
What are the two types of exercise tolerance tests?
Submaximal: Used for post-operative patients, sedentary individuals, or stable patients.
Maximal: Used for stable patients, during rehabilitation, or for progression.
How is the target heart rate calculated using Karvonen’s formula?
Target HR = (HRmax - RHR) x (60-80%) + RHR
HRmax = 220 - age
RHR = Resting Heart Rate
What are the criteria for termination during an exercise tolerance test?
Onset of moderate to severe angina
Systolic BP ≥240 mmHg or Diastolic BP ≥110 mmHg
1mm ST segment depression
Increased ventricular arrhythmias
2nd or 3rd degree heart block
What factors may impact participation in cardiac rehabilitation?
Cost, illness, transportation difficulties, distance, work, embarrassment, lack of motivation, and time constraints.
What are the benefits of cardiac rehabilitation?
Improved functional capacity
Reduced mortality rates
Fewer hospital readmissions
Improved quality of life
Reduced risk of a second cardiac event
What are common myths about cardiac rehabilitation?
Patients often believe rehab is unsafe, too time-consuming, unaffordable, or that they already know everything about their health.
What are the indications for cardiac rehabilitation?
Post-myocardial infarction (4-36 hours)
Stable angina
Coronary artery bypass graft surgery (48-72 hours post-op)
Congestive heart failure (compensated)
Cardiomyopathy
Cardiac surgery, pacemaker insertion
At-risk for coronary artery disease (e.g., diabetes, hyperlipidemia)
What strategies can increase participation in cardiac rehabilitation?
Home-based cardiac rehab, primary care physician involvement, and use of modern technology (telehealth, mobile apps).
What are the contraindications for cardiac rehabilitation?
Unstable angina
Resting systolic BP >200 mmHg or DBP >110 mmHg
Acute systemic illness or fever
Uncontrolled arrhythmias
3rd-degree AV block (without pacemaker)
Severe orthopedic or metabolic conditions
Increased heart rate, usually above 100 bpm.
Tachycardia
What is the normal exercise response in a cardiac patient?
Increased maximal oxygen consumption
Elevated heart rate, stroke volume, systolic BP
Increased cardiac output, tidal volume, and respiratory rate
What is an inappropriate exercise response during cardiac rehabilitation?
Persistent dyspnea, dizziness, confusion, or pain
Excessive fatigue, leg claudication
Failure of systolic BP to rise or a drop of 10-15 mmHg
Hypertensive response (SBP >200 mmHg, DBP >110 mmHg)
Abnormal ECG changes
Suggests a possible myocardial infarction or previous injury to the heart.
Reduced R wave, increased Q wave
As heart rate increases, the QT interval shortens, a normal response.
Rate-related shortening of QT Interval
Often seen during exercise, typically indicating a benign response.
ST segment depression, upsloping, less than 1 mm
Premature ventricular contractions during exercise are common but usually benign.
Exertional arrhythmias: rare, single PVCs
Onset of angina with exercise
Suggests possible ischemia or myocardial infarction.
ST segment depression, horizontal or downsloping, >1 mm below baseline
A sign of myocardial ischemia or inadequate oxygen delivery to the heart muscle.
A potentially life-threatening arrhythmia requiring immediate termination.
Ventricular tachycardia (3+ consecutive PVCs)
Most consistent benefit of exercise prescription
At least 3 times per week for 12+ weeks.
Exercise duration for most cardiovascular benefits
20 to 40 minutes per session.
Target exercise intensity
70 to 85% of the baseline maximal exercise test heart rate.
Intensity for deconditioned patients (Phase 1)
Start at 40-60% of max HR.
“No exertion at all” to “Very very light” – low intensity.
RPE 6-7
“Very light” to “Somewhat hard” – moderate intensity for typical exercise.
RPE 9-13
“Hard” to “Very very hard” – near maximal exertion.
RPE 15-19
Phase I - Acute/Inpatient
Focuses on early return to independence, reducing the risk of thrombi, and promoting joint mobility (1-2 weeks post-event).
Phase II - Outpatient/Subacute
Progressive exercise program starting 4-6 weeks post-MI, with 36 visits over 12 weeks.
Phase III - Training
Enhances functional capacity with 45+ minute sessions, 3-4 times a week (typically after Phase II).
Phase IV - Maintenance
Aims for lifelong commitment to cardiovascular health and lifestyle modifications.
Karvonen Formula for HR
40-50% (HRmax - RHR) + RHR for deconditioned; 60-80% (HRmax - RHR) + RHR for typical patients.
MET levels for exercise intensity
Low: 2-4 METs
Moderate: 3-6.5 METs
High: 5-8.5 METs
Limitations of HR for exercise prescription
Beta-blockers, pacemakers, and certain heart conditions can alter HR response during exercise.
Exercise prescription for Heart Transplant patients
Use RPE, METs, and dyspnea scale, not HR; increased fracture risk due to corticosteroids.
Exercise guidelines for CHF
Focus on low-intensity, high-repetition exercises, avoid exercise when HR > 115 bpm.
Pacemaker/ICD patient precautions
Avoid raising arm above shoulder for 2-3 weeks post-surgery; monitor for electromagnetic interference.
Return to Work criteria
> 7 METs for industrial work, >5 METs for household chores, <3 METs unsuitable for most jobs.
