Lecture 14: Cardiac Rehab Medical Conditions I Flashcards
What are the two main components of cardiac rehabilitation?
- Exercise
2. Patient Education
Why is patient education so important in cardiac rehabilitation?
It lets patients know what they can do - because being sedentary is the last thing someone with a cardiac problem should do
What are 5 general goals for a cardiac patient?
- Risk Factor Reduction
- Increase aerobic activity
- Return to safe vocational and recreational activities
- Decrease angina
- Decrease anxiety
When is aerobic activity (always involves overload) not indicated (in cardiac patients)?
After/during acute MI
What are the two most common complications for cardiac patients?
Depression and anxiety
What are some cardiac patients that we will see (5)?
- MI
- CABG
- Transplant
- Valve Replacement
- patients at risk for MI
What are the phases of cardiac rehabilitation (4 + 1 in between phase)? What are the timelines for each phase?
- Inpatient (2 days post event - discharge from the hospital)
- Transitional (immediately after hospital discharge to until outpatient program begins)
- Outpatient (1-3 weeks post event to ~3 months after event)
- Transitional - short term weaning from outpatient to lifetime self-management
- Lifetime - 3 months post event to the remainder of the life of the patient
What should you work on with the patient in the Phase I after MI? (5)
- Patient Education
- Exercise guidelines
- Risk factor reduction
- Teaching home exercise Rx
- Low level exercise (< 3 METs)
What are the factors that the patient must be taught during patient education in Phase I after post MI?
Having the patient self record HR, BP and RPE.
Why is teaching a patient to monitor RPE so important during phase I post MI?
RPE may be the most accurate representation of the patient’s effort during activity (because medication can disrupt both BP and HR)
How intense should exercise be during phase I post MI?
Low level exercise (<3 METs, 2-4 times per day, 5-7 days per week)
If indicated, what (6) activities can be used during the inpatient phase (phase I)
- ADLs
- breathing exercises
- AROM
- Warm ups
- Ambulation
- Cool down
- maybe stairs
What are the safety guidelines for the inpatient phase (phase I) for BP?
SBP should not increase >20 mmHg
DBP should remain stable
What are the safety guidelines for the inpatient phase (phase I) for HR?
HR should not increase >20 bpm
What are the safety guidelines for the inpatient phase (phase I) for RPE?
Modified: <12
What are the safety guidelines for the inpatient phase (phase I) for SaO2?
Must stay >90%
When can an inpatient (phase I) receive a low level exercise test?
1 week post discharge
What is the timeline for the transitional phase (phase II)
From immediately being discharged from hospital until the outpatient program begins.
What is occurring physiologically to the heart during the transitional phase (phase II)?
Scar formation is occurring over the infarcted areas
What type of exercise can you not do during the transitional phase (phase II)?
- Resistance training (Not until outpatient phase)
2. Aerobic training (2-8 weeks)
At what exercise intensity and frequency should you exercise patience during the transitional phase (phase II)?
Low level exercise: < 3-5 METs, 1-3 times/day, 4-5 days/week
What exercise routine should you do with patients in the transitional phase (phase II)?
ADLs, AROM, Warm up, Ambulation (steady pace, avoid inclines), and Cool down
- Patient may gradually increase distance over time
What are the safety guidelines for the transitional phase (phase II) for BP?
SBP should not increase >20 mmHg
What are the safety guidelines for the transitional phase (phase II) for HR?
HR should not increase >20 bpm
What are the safety guidelines for the transitional phase (phase II) for RPE?
Modified: 3-4
Unmodified: 11-12
When can an ETT (GXT) be performed?
At the end of the first transitional phase (phase II)
What is the timeline of the outpatient phase (phase III)?
1-3 weeks post event to 3 months post event
What is the PT intervention for the transitional phase (phase II)?
- PT provides HEPs for the patient to do without PT assistance
- Patient is instructed to keep a diary of exercises and symptoms
What is the goal of the outpatient phase (phase III)?
To increase aerobic and strength capacity