Lecture 13: HF/CAD/DM pt. 1 Flashcards
medication implications for management of HF and CM
HF = managed by treating HTN and CAD
best effects = combo of BBs with ACE/ARB
diuretics cause hypotension, dehydration, electrolyte imbalance
more meds pt is on = greater need to be aware of side effects
high likelihood pt will be on combo of BBs, anti-HTN, and diuretics
starting point or management of HF/CM rehab (likely hospitalized pts)
low intensity, low impact 5-10 min/day
gradually progress to 30 min/day
frequency of 1-2x/day, 5-7 days/wk
focus on functional task
*shouldn’t start on heavy aerobic exercise until HF is compensated
pt edu for HF/CM pts
energy conservation
self management strategies
medical compliance
sodium limitations
daily weights
CPG aerobic exercise guidelines for stable class 2-3 systolic HF
20-60 min
50-90% VO2 max
3-5x/week
> 8-12 weeks
treadmill, cycling, dancing
CPG interval training recommendations for stable, class 2-3 systolic HF
> 35 minutes
1-5 min high intensity (>90 VO2max) alternating with same duration rest intervals (40-70% VO2 max)
2-3x/week
> 8-12 weeks
treadmill, cycling
Resistance training guidelines from CPG for stable, class 1-3 systolic HF
45-60 min
60-80% 1RM
2-3 sets per mm group
3x/week
> 8-12 weeks
combined exercise recommendations for stable, class 2-3 systolic HF
20-30 min resistance added to aerobic
60-80% 1RM
2-3 sets/mm group
3x/week
> 8-12 weeks
total exercise time shouldn’t extend beyond what would be spent on aerobic exercise alone due to reduced adherence
exercise things to avoid for pts who have known valve disease and other things to keep in mind for these pts
Avoid:
- HIIT
- straining/valsalva
- high intensity activity
pts with valve regurgitation may tolerate activity better than those with stenosis
very symptom limited with these pts
medication implications for CAD/MI rehab
pts on BBs will have lower resting HR and blunted HR rise with increased workload
using max HR formulas aren’t reliable for determining intensity
RPE is much safer to use than max HR f pts are on chronotropic drugs
may need to spend more time educating pt on use of RPE
prevention vs intervention
ACSM activity guidelines for CAD/MI rehab
> 150 min/week
what is cardiac rehab
structured/supervised exercise programs performed after a major cardiac event or sx that involves multiple phases and elements of care
AHA recommends cardiac rehab for what conditions
known CAD
stable angina
HF (stages2-4)
PVD
post MI
post Percutaneous Coronary Intervention
post open heart sx
post PPM/ICD placement
cardiac rehab is NOT recommended for what diagnoses
severe/decompensated HF
unstable angina
hemodynamic instability
serious arrhythmia
cardiac conduction problems
uncontrolled HTN
other organ system failure
components of cardiac rehab
pt assessment
nutrition counseling
weight management
BP management
lipid management
diabetes management
tobacco cessation
psychosocial management
physical activity counseling
exercise training
PT role is state dependent
structure of outpatient cardiac rehab
36 sessions (3x/week x12 weeks)
- Medicare pays for PER cardiac event
involves exercise program, diet/nutrition counseling, and pt edu
edu provided for:
- nutrition
- exercise programming
- tobacco/ETOH cessation
- psychosocial issues
- medical management of comorbidities
