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TeraEx 2 > FINALS: Cardiac Rehabilitation > Flashcards

FINALS: Cardiac Rehabilitation Flashcards

1
Q

What are the positive risk factors for cardiac rehabilitation based on age?

A

Men: >45 years old
Women: >55 years old

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2
Q

How does smoking contribute to positive risk factors in cardiac rehabilitation?

A

Cigarette smoking is a known positive risk factor for cardiac rehabilitation due to its effects on cardiovascular health.

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2
Q

What is considered a positive family history risk factor for cardiac rehabilitation?

A

Myocardial infarction (MI), coronary revascularization, or sudden death before 55 years in father; before 65 years in mother

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2
Q

How does dyslipidemia affect the risk for cardiac rehabilitation?

A

Abnormal lipid levels (e.g., high LDL, low HDL) increase the risk.

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2
Q

What BMI indicates obesity as a positive risk factor for cardiac rehabilitation?

A

BMI >30 kg/m²
Waist girth: >102 cm (40 in) for men, >88 cm (35 in) for women

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3
Q

How does a sedentary lifestyle affect cardiac risk?

A

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.

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3
Q

What blood pressure values are considered a positive risk factor for cardiac rehabilitation?

A

Systolic BP ≥140 mmHg
Diastolic BP ≥90 mmHg

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3
Q

What is the role of pre-diabetes in cardiac rehabilitation risk factors?

A

Pre-diabetes increases the risk for cardiovascular events and is considered a positive risk factor.

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3
Q

Pre-diabetes increases the risk for cardiovascular events and is considered a positive risk factor.

A

Palpation or auscultation of heart sounds
Observing for irregularities in heart rate and rhythm

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3
Q

What is pulsus alternans, and what does it indicate?

A

Pulsus alternans is an alternating strong and weak pulse, which can indicate heart failure or significant cardiac dysfunction.

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4
Q

What should be observed in a respiratory examination for a cardiac patient?

A

Respiratory rate and rhythm
Shortness of breath (SOB) on exertion
Paroxysmal nocturnal dyspnea (PND)
Orthopnea

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4
Q

What is orthostatic hypotension in the context of cardiac examination?

A

A significant drop in BP when standing (more than 20 mmHg systolic or 10 mmHg diastolic) could indicate orthostatic hypotension.

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4
Q

What is the six-minute walk test used for in cardiac rehabilitation?

A

To predict VO2max and assess functional capacity by measuring the distance walked in 6 minutes.

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4
Q

What is the dyspnea scale, and what do the grades mean?

A

+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

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4
Q

: What does jugular vein distention (JVD) indicate during a cardiac examination?

A

JVD can indicate heart failure or increased central venous pressure.

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4
Q

What is the purpose of an exercise tolerance test (ETT)?

A

To determine physiological responses during exercise
Assess functional exercise capacity
Serve as a basis for exercise prescription
Screen for coronary artery disease (CAD)

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4
Q

What are the two types of exercise tolerance tests?

A

Submaximal: Used for post-operative patients, sedentary individuals, or stable patients.
Maximal: Used for stable patients, during rehabilitation, or for progression.

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4
Q

How is the target heart rate calculated using Karvonen’s formula?

A

Target HR = (HRmax - RHR) x (60-80%) + RHR
HRmax = 220 - age
RHR = Resting Heart Rate

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4
Q

What are the criteria for termination during an exercise tolerance test?

A

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

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5
Q

What factors may impact participation in cardiac rehabilitation?

A

Cost, illness, transportation difficulties, distance, work, embarrassment, lack of motivation, and time constraints.

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5
Q

What are the benefits of cardiac rehabilitation?

A

Improved functional capacity
Reduced mortality rates
Fewer hospital readmissions
Improved quality of life
Reduced risk of a second cardiac event

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5
Q

What are common myths about cardiac rehabilitation?

A

Patients often believe rehab is unsafe, too time-consuming, unaffordable, or that they already know everything about their health.

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5
Q

What are the indications for cardiac rehabilitation?

A

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)

5
Q

What strategies can increase participation in cardiac rehabilitation?

A

Home-based cardiac rehab, primary care physician involvement, and use of modern technology (telehealth, mobile apps).

6
Q

What are the contraindications for cardiac rehabilitation?

A

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

6
Q

Increased heart rate, usually above 100 bpm.

A

Tachycardia

7
Q

What is the normal exercise response in a cardiac patient?

A

Increased maximal oxygen consumption
Elevated heart rate, stroke volume, systolic BP
Increased cardiac output, tidal volume, and respiratory rate

8
Q

What is an inappropriate exercise response during cardiac rehabilitation?

A

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

8
Q

Suggests a possible myocardial infarction or previous injury to the heart.

A

Reduced R wave, increased Q wave

9
Q

As heart rate increases, the QT interval shortens, a normal response.

A

Rate-related shortening of QT Interval

10
Q

Often seen during exercise, typically indicating a benign response.

A

ST segment depression, upsloping, less than 1 mm

11
Q

Premature ventricular contractions during exercise are common but usually benign.

A

Exertional arrhythmias: rare, single PVCs

11
Q

Onset of angina with exercise

A

Suggests possible ischemia or myocardial infarction.

11
Q

ST segment depression, horizontal or downsloping, >1 mm below baseline

A

A sign of myocardial ischemia or inadequate oxygen delivery to the heart muscle.

12
Q

A potentially life-threatening arrhythmia requiring immediate termination.

A

Ventricular tachycardia (3+ consecutive PVCs)

13
Q

Most consistent benefit of exercise prescription

A

At least 3 times per week for 12+ weeks.

13
Q

Exercise duration for most cardiovascular benefits

A

20 to 40 minutes per session.

14
Q

Target exercise intensity

A

70 to 85% of the baseline maximal exercise test heart rate.

15
Q

Intensity for deconditioned patients (Phase 1)

A

Start at 40-60% of max HR.

16
Q

“No exertion at all” to “Very very light” – low intensity.

A

RPE 6-7

16
Q

“Very light” to “Somewhat hard” – moderate intensity for typical exercise.

A

RPE 9-13

17
Q

“Hard” to “Very very hard” – near maximal exertion.

A

RPE 15-19

17
Q

Phase I - Acute/Inpatient

A

Focuses on early return to independence, reducing the risk of thrombi, and promoting joint mobility (1-2 weeks post-event).

18
Q

Phase II - Outpatient/Subacute

A

Progressive exercise program starting 4-6 weeks post-MI, with 36 visits over 12 weeks.

19
Q

Phase III - Training

A

Enhances functional capacity with 45+ minute sessions, 3-4 times a week (typically after Phase II).

19
Q

Phase IV - Maintenance

A

Aims for lifelong commitment to cardiovascular health and lifestyle modifications.

20
Q

Karvonen Formula for HR

A

40-50% (HRmax - RHR) + RHR for deconditioned; 60-80% (HRmax - RHR) + RHR for typical patients.

21
Q

MET levels for exercise intensity

A

Low: 2-4 METs
Moderate: 3-6.5 METs
High: 5-8.5 METs

21
Q

Limitations of HR for exercise prescription

A

Beta-blockers, pacemakers, and certain heart conditions can alter HR response during exercise.

21
Q

Exercise prescription for Heart Transplant patients

A

Use RPE, METs, and dyspnea scale, not HR; increased fracture risk due to corticosteroids.

22
Q

Exercise guidelines for CHF

A

Focus on low-intensity, high-repetition exercises, avoid exercise when HR > 115 bpm.

23
Q

Pacemaker/ICD patient precautions

A

Avoid raising arm above shoulder for 2-3 weeks post-surgery; monitor for electromagnetic interference.

24
Q

Return to Work criteria

A

> 7 METs for industrial work, >5 METs for household chores, <3 METs unsuitable for most jobs.

25
Q
A
26
Q
A

TeraEx 2 (14 decks)

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