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CardioPulmonary > Lecture 14: Cardiac Rehab Medical Conditions I > Flashcards

Lecture 14: Cardiac Rehab Medical Conditions I Flashcards

1
Q

What are the two main components of cardiac rehabilitation?

A
  1. Exercise

2. Patient Education

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2
Q

Why is patient education so important in cardiac rehabilitation?

A

It lets patients know what they can do - because being sedentary is the last thing someone with a cardiac problem should do

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3
Q

What are 5 general goals for a cardiac patient?

A
  1. Risk Factor Reduction
  2. Increase aerobic activity
  3. Return to safe vocational and recreational activities
  4. Decrease angina
  5. Decrease anxiety
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4
Q

When is aerobic activity (always involves overload) not indicated (in cardiac patients)?

A

After/during acute MI

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5
Q

What are the two most common complications for cardiac patients?

A

Depression and anxiety

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6
Q

What are some cardiac patients that we will see (5)?

A
  1. MI
  2. CABG
  3. Transplant
  4. Valve Replacement
  5. patients at risk for MI
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7
Q

What are the phases of cardiac rehabilitation (4 + 1 in between phase)? What are the timelines for each phase?

A
  1. Inpatient (2 days post event - discharge from the hospital)
  2. Transitional (immediately after hospital discharge to until outpatient program begins)
  3. Outpatient (1-3 weeks post event to ~3 months after event)
    1. Transitional - short term weaning from outpatient to lifetime self-management
  5. Lifetime - 3 months post event to the remainder of the life of the patient
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8
Q

What should you work on with the patient in the Phase I after MI? (5)

A
  1. Patient Education
  2. Exercise guidelines
  3. Risk factor reduction
  4. Teaching home exercise Rx
  5. Low level exercise (< 3 METs)
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9
Q

What are the factors that the patient must be taught during patient education in Phase I after post MI?

A

Having the patient self record HR, BP and RPE.

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10
Q

Why is teaching a patient to monitor RPE so important during phase I post MI?

A

RPE may be the most accurate representation of the patient’s effort during activity (because medication can disrupt both BP and HR)

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11
Q

How intense should exercise be during phase I post MI?

A

Low level exercise (<3 METs, 2-4 times per day, 5-7 days per week)

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12
Q

If indicated, what (6) activities can be used during the inpatient phase (phase I)

A
  1. ADLs
  2. breathing exercises
  3. AROM
  4. Warm ups
  5. Ambulation
  6. Cool down
    - maybe stairs
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13
Q

What are the safety guidelines for the inpatient phase (phase I) for BP?

A

SBP should not increase >20 mmHg

DBP should remain stable

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14
Q

What are the safety guidelines for the inpatient phase (phase I) for HR?

A

HR should not increase >20 bpm

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15
Q

What are the safety guidelines for the inpatient phase (phase I) for RPE?

A

Modified: <12

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16
Q

What are the safety guidelines for the inpatient phase (phase I) for SaO2?

A

Must stay >90%

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17
Q

When can an inpatient (phase I) receive a low level exercise test?

A

1 week post discharge

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18
Q

What is the timeline for the transitional phase (phase II)

A

From immediately being discharged from hospital until the outpatient program begins.

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19
Q

What is occurring physiologically to the heart during the transitional phase (phase II)?

A

Scar formation is occurring over the infarcted areas

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20
Q

What type of exercise can you not do during the transitional phase (phase II)?

A
  1. Resistance training (Not until outpatient phase)

2. Aerobic training (2-8 weeks)

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21
Q

At what exercise intensity and frequency should you exercise patience during the transitional phase (phase II)?

A

Low level exercise: < 3-5 METs, 1-3 times/day, 4-5 days/week

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22
Q

What exercise routine should you do with patients in the transitional phase (phase II)?

A

ADLs, AROM, Warm up, Ambulation (steady pace, avoid inclines), and Cool down
- Patient may gradually increase distance over time

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23
Q

What are the safety guidelines for the transitional phase (phase II) for BP?

A

SBP should not increase >20 mmHg

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24
Q

What are the safety guidelines for the transitional phase (phase II) for HR?

A

HR should not increase >20 bpm

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25
Q

What are the safety guidelines for the transitional phase (phase II) for RPE?

A

Modified: 3-4
Unmodified: 11-12

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26
Q

When can an ETT (GXT) be performed?

A

At the end of the first transitional phase (phase II)

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27
Q

What is the timeline of the outpatient phase (phase III)?

A

1-3 weeks post event to 3 months post event

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28
Q

What is the PT intervention for the transitional phase (phase II)?

A
  1. PT provides HEPs for the patient to do without PT assistance
  2. Patient is instructed to keep a diary of exercises and symptoms
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29
Q

What is the goal of the outpatient phase (phase III)?

A

To increase aerobic and strength capacity

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30
Q

What is the PT intervention of the outpatient phase (phase III)?

A
  1. Outpatient program (1-3 visits/wk)

2. ECG telemetry

31
Q

When is ECG telemetry used during the outpatient phase (phase III)?

A
  1. During the first visit

2. Used during subsequent visits when exercise intensity increases

32
Q

What is the exercise intensity and frequency for the outpatient phase (phase III)?

A

5-8 METs, once/day, 4-5 days/week
Include 5-10 min warm-up and 5-10 min cool down
Aim for 20-40 min at target HR

33
Q

Can you include resistance exercise during the outpatient phase (phase III)?

A

Yes, but monitor HR and BP changes carefully

34
Q

What are the safety guidelines of the outpatient phase (phase III) for HR?

A

Stay within target HR training range

Keep 10 bpm less than ischemic threshold HR

35
Q

What is the formula to finding the target HR range?

A

HR reserve formula:

[(maxHR - restingHR) x %HR) + restingHR = targetHR

36
Q

What are the safety guidelines of the outpatient phase (phase III) for RPE?

A

Modified: 4-5
Unmodified: 13-14

37
Q

How long is the outpatient program?

A

4-12 weeks

38
Q

What are 3 things to do with the patient at the end of the outpatient phase (phase III)?

A
  1. Discuss importance of maintenance of the program
  2. Discuss how the patient will maintain the program
  3. ETT (GXT)
39
Q

There is a second transitional phase after the outpatient phase (phase III). What is this phase also known as?

A

The weaning phase

40
Q

There is a second transitional phase after the outpatient phase (phase III). What is the purpose of this phase?

A

It is a short term weaning phase that transitions the patient from supervised outpatient to lifetime self-management

41
Q

What is the timeline for the lifetime phase (phase IV)?

A

~3 months post event to end of life

42
Q

What is the goal of the lifetime phase (phase IV)?

A

Maintenance

43
Q

What is the PT intervention like during the lifetime phase (phase IV)?

A

Little to none

44
Q

What is the exercise intensity and frequency for patients in the lifetime phase (phase IV)?

A

~8 METs, once/day, 4-5 days/week
Include 5-10 min warm-up and 5-10 min cool down
Aim for 20-40 min at target HR
Include resistance exercise (be aware of HR, BP changes)

45
Q

What are the safety guidelines for patients in the lifetime phase (phase IV) for HR?

A

Stay within the calculated target HR range

Stay 10 bpm below the ischemic threshold HR

46
Q

What are the safety guidelines for patients in the lifetime phase (phase IV) for RPE?

A

Modified: 5-6
Unmodified: 15-16

47
Q

What is a submaximal ETT (GXT)?

A

An ETT that is stopped at a predetermined level (METs or HR)

48
Q

What is a symptom limited ETT (GXT)?

A

An ETT that is stopped when signs and symptoms of ischemia appear or the patient requests to stop.

49
Q

What is a maximal ETT (GXT)?

A

An ETT that determines maximal exercise capacity, or is halted by going slightly above the point of ischemia (for cardiac patients)

50
Q

What is a positive ETT?

A

Appearance of signs and symptoms of cardiac ischemia

51
Q

What is a negative ETT?

A

No appearance of signs and symptoms of cardiac ischemia

52
Q

What is the problem with a negative ETT?

A

Its very possible to have a false negative test

53
Q

What are 9 indications for stopping an ETT?

A
  1. If acute MI is expected
  2. ST elevation
  3. ST segment depression more than 2 mm
  4. Moderate to severe angina (3-4/10)
  5. Significant (>10-20 mmHg drop) decrease in systolic BP
  6. Second/Third degree heart block (Develop during the test)
  7. Ventricular Tachycardia
  8. Signs and symptoms of cardiac issues
  9. Patient requests to stop
54
Q

What are 6 signs and symptoms of cardiac issues that would indicate stopping an ETT?

A
  1. Poor perfusion (pale, clammy, sweating, cyanosis)
  2. Nausea
  3. Clumsy
  4. Claudication
  5. SBP >260 mmHg
  6. DBP >115 mmHg
55
Q

What are the blood pressure contraindications (3) to exercising a cardiac patient?

A
  1. SBP >200 mmHg
  2. DBP >110 mmHg
  3. SBP falls >20 mmHg during exercise
56
Q

What are 3 contraindications to exercising a cardiac patient that are detected DURING exercise?

A
  1. SBP falls by more than 20 mmHg
  2. Patient develops ventricular tachycardia or
  3. Patient develops 3rd degree heart block
57
Q

What are 10 conditions that are absolute contraindications to exercising a cardiac patient?

A
  1. Pericarditis
  2. Myocarditis
  3. Pericardial effusion
  4. Pulmonary emboli
  5. Digitalis toxicity
  6. Hypoglycemia
  7. Low O2
  8. CHF
  9. Acute MI
  10. Fever
58
Q

What O2 level is considered contraindicated for a cardiac patient?

A

PaO2: <90%

59
Q

What hypoglycemic blood sugar level is considered contraindicated for a cardiac patient?

60
Q

What are the 3 characteristics of profound CHF?

A
  1. Crackles more than half way up the back = profound!
  2. Extremely SOB
  3. Cardiac rales will be heard
61
Q

How soon after an MI can you see a patient for therapy?

A

2-3 days post stabilization

62
Q

What are two common complications after an MI?

A
  1. CHF

2. Arrhythmias

63
Q

What are 5 infectious/inflammatory cardiac pathologies?

A
  1. Endocarditis
  2. Rheumatic Heart Disease
  3. Myocarditis
  4. Pericarditis
  5. Rheumatic fever
64
Q

What is endocarditis, its symptoms, and what is it caused by?

A
  • Inflammation of endothelial lining of the endocardium of heart, including lining of the valves (so possible damage to the valves).
  • S&S: low grade fever, joint pain, flu-like symptoms
  • Caused by infectious agents.
65
Q

What is SBE, its symptoms, and what is it caused by?

A
  • Subacute bacterial endocarditis infection
  • Lethargy/more than normal tiredness for months at a time (soft symptom that doesn’t prompt them to see the doctor).
  • Caused by Strep (treated with long course antibiotics)
66
Q

What is a major concern for endocarditis?

A

Valve damage

67
Q

What is a cause for valve damage in endocarditis?

A

Vegitations

68
Q

What are “Vegitations”, and where do they most commonly collect?

A

Collections of WBC, RBC, Fibrin that commonly collect on the Mitral valve.

69
Q

What is the diagnostic test for endocarditis?

A

Echocardiogram (non-invasive)

70
Q

What is the cause of Rheumatic heart disease?

A

Streptococci: leads to endocarditis affecting cardiac valves

71
Q

How does rheumatic heart disease work?

A

Antigen antibody attaches onto the valve can lead to stenosis and valve insufficiency

72
Q

What is the cause of myocarditis?

A

Infections (bacterial, viral, fungal, parasitic) or chemical exposure

73
Q

What is most importantly affected by myocarditis?

A

Cardiac output (life threatening) leading to CHF or cardiomyopathy

74
Q

What are 5 clinical clues to detecting myocarditis?

A
  1. JVD
  2. crackles
  3. peripheral edema
  4. central cyanosis (low Sa02)
  5. ascities

CardioPulmonary (13 decks)

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