Lecture 1 - Cardiac Rehab Overview Flashcards
What effects can prolonged bed rest have on your body?
Muscle Dystrophy
Orthostatic intolerance
Decreased exercise capacity
Increased risk of thromboembolism
What are the 3 main aims of CR?
Help a patient achieve optimal:
Physical, Psychological and Functional status
What are some indications of CR?
PACCES
Peripheral Vascular Disease At risk of CAD Cardiomyopathy CABG End Stage Renal Disease Stable Angina
What are some contraindications of CR?
HOUURA
Hyperkalemia or Hypokalemia Orthostatic Intolerance Uncontrolled Diabetes Unstable angina Resting BP of > 200/110 mmHg Active pericarditis
Give a brief description of the 3 phases of CR
Phase 1 = Inpatient, hospital based
Phase 2 = Early Outpatient, monitored exercise
Phase 3 = Outpatient ongoing
What would the HRM be for a patient post MI.?
120bpm or RHR +20bpm
What would the HRM be for a patient post surgery.?
RHR + 30bpm
Give an example of an appropriate hemodynamic response to exercise.
SBP increases with work load.
Give examples of an appropriate ECG response during peak exercise
Normal/Unchanged conduction
Stable arrhythmias
Give examples of CVD. risk factors. **
Nutrition Weight management Smoking Cholesterol Managing diabetes Physical activity
What is a myocardial infarction?
Complete obstruction of blood flow
How does MI develop?
Cholesterol particles can build up and form a plaque, causing the arteries to become narrowed therefore vulnerable to blockages from a blood clot.
Why is exercise better than coronary interventions?
Because coronary interventions only treat a specific area, exercise is more holistic and affects the entire arterial bed by changing endothelial function and disease progression.
Give examples of goals in CR **
Improve mental and emotional well-being
Modify risk factors
Increase functional capability
Reduce mortality
Who would benefit most from CABG?
People with many diseased vessels or main artery disease
What are some special considerations for people who have had CABG?
- Monitor scars for infection and proper healing
- No HR monitor until completely healed
- No Upper Body exercises early post operation
Describe stable angina
- Most common
- Triggered by physical exertion, strong emotional stress, cold temperature
- pain usually lasts 3-5 minutes
- typically relieved by rest
Describe unstable angina
- Is more serious and unpredictable
- Can occur at rest
- Signals a heart attack
What steps must you take when someone has unstable angina?
Sit down
Take NO spray
If symptoms persist 5 minutes later call 111
What causes angina?
Occurs when the coronary arteries are narrowed and decreases the amount of oxygenated blood supplying the heart therefore causing pain.
An imbalance between oxygen supply and demand
What occurs in the atria during atrial fibrillation?
Multiple depolarization resulting in incomplete or absent contraction of the atria and irregular ventricular contraction
What is the role of the pacemaker?
Regulate electrical activity of the heart
What does an ICD do?
Delivers a shock if a dangerous rhythm is detected
How does exercise affect a patient with valvular heart disease?
- Does not improve the function of the valves
- Improves oxygen extraction by the skeletal muscles therefore improve work capacity
What effects does Valvular regurgitation have on the heart?
- Decreases CO
- Diastolic dysfunction
- Myocardial hypertrophy
What intensity of exercise will benefit patients with CHF?
Moderate
Why is exercise considered as medicine?
Because studies have found that increases in exercise participation and improvements in other lifestyle behaviors have the same effects as medicine
