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DPT 629: Cardio > PT Interventions for the Cardiac System > Flashcards

PT Interventions for the Cardiac System Flashcards

1
Q

what is the importance of PT in cardiac interventions?

A

assess for s/s of decompensation

interventions and advice for symptom management

offer safe and appropriate exercise interventions

communicate concerns to the interdisciplinary team members

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2
Q

what is the concern with stage 4/D HF?

A

decompensation

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3
Q

what stage of HF do pts have symptoms at rest and are unable to do and physical activity without symptomology?

A

class 4 C/D HF

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4
Q

t/f: ppl can move back and forth bw stages of HF

A

true

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5
Q

who is the HF CPG NOT appropriate for?

A

those in NYHA class 4 HF

those with signs of decompensation

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6
Q

who is the HF CPG NOT indicated for?

A

ppl w/o participation restriction and are physically active

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7
Q

what settings is the HF CPG most relevant to?

A

outpatient, home care, and SNFs

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8
Q

why is the HF CPG not very relevant to acute care most times?

A

bc most pts with HF in acute care are decompensated to some degree

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9
Q

t/f: pts with HF don’t need to have completely clear lung sounds to be appropriate for PT

A

true

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10
Q

when is the initiation of PT appropriate with HF pts?

A

when RR<30 and can speak comfortably

when resting HR<120 beats/min

when crackles are below rib 5 posteriorly

CI>2L/min/mg2

CUP <12 mmHg

MAP >60 mmHg

minimal to no weight gain in 24 hours

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11
Q

what are reasons to stop PT with pts with HF?

A

when RR>40 and unable to speak comfortably

onset of S3 heart sounds

pulmonary crackles above rib 5 posteriorly

HR decreased >10 beats/min

SBP decreased >10 mmHg

MAP increased >10 mmHg

CVP inc or dec >6 mmHg

new or worsening dysrhythmias

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12
Q

in pts with HF, why should we be monitoring for signs of hypotension?

A

bc of the decreased CO associated with it

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13
Q

what vitals should we be monitoring in pts with HF?

A

JVD and peripheral edema

RR, PR, and rhythm

S3 heart sounds

RPE

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14
Q

what are the signs of exertional intolerance?

A

chest pain

abnormal VS response

new onset pulmonary crackles

new onset S 3 heart sound

new onset/change in cardiac rhythm (ECG, auscultation, pulse)

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15
Q

if someone has no participation restriction and is active, is PT indicated?

A

likely not

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16
Q

if someone has no participation restrictions, are not active, and have no activity limitations, what may be indicated?

A

education, aerobic training, resistance training, or a combo

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17
Q

if someone has no participation restriction, is not active, has activity limitations but can perform the activity with no endurance limit, what is indicated?

A

identify a new task

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18
Q

if someone has no participation restriction, is not active, has activity limitations and cannot perform the activity, what is indicated?

A

PT as appropriate (education, NMES, inspiratory muscles training, etc)

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19
Q

if someone has no participation restriction, is not active, has activity limitations but can perform the activity with endurance limitations and no signs of exersion, what is indicated?

A

education, aerobic training, resistance training, NMES, HIIT, inspiratory muscles training, or combo

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20
Q

if someone has no participation restriction, is not active, has activity limitations but can perform the activity with endurance limitations and signs of exersion that are not relieved with rest, what is indicated?

A

ER!

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21
Q

if someone has no participation restriction, is not active, has activity limitations but can perform the activity with endurance limitations and signs of exersion that are relieved with rest, what is indicated?

A

contact their PCP

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22
Q

if someone has a participation restrictions, activity limitations, and cannot perform the activity, what is indicated?

A

PT as appropriate (education, NMES, inspiratory muscle training)

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23
Q

if someone has a participation restrictions, but no activity limitations, what is indicated?

A

education, aerobic resistance, combo

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24
Q

if someone has a participation restrictions, activity limitations, can perform the activity with no endurance limitations, what is indicated?

A

ID a new task

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25
Q

if someone has participation restrictions, activity limitations, can perform the activity but has endurance limitations with no signs of exersion, what is indicated?

A

education, aerobic training, resistance training, NMES, HIIT, inspiratory muscles training, combo

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26
Q

if someone has participation restrictions, activity limitations, can perform the activity but has endurance limitations with signs of exersion not relieved with rest, what is indicated?

A

ER!

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27
Q

if someone has participation restrictions, activity limitations, can perform the activity but has endurance limitations with signs of exersion relieved with rest, what is indicated?

A

contact their PCP

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28
Q

what do we address first, activity limitations or endurance issues?

A

activity limitations

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29
Q

what is the definition of physical activity?

A

any bodily movt produced by skeletal muscles that results in energy expenditure beyond resting expenditure

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30
Q

what is the definition of exercise?

A

subset of physical activity involving structured, repetitive, and purposeful move to improve overall physical fitness

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31
Q

what are the benefits of physical activity?

A

physiologic, MSK, and psychosocial benefits

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32
Q

physical activity can also improve what peripheral conditions of HF?

A

impaired vasoactvity

reduced MSK oxidative capacity

fxnal iron deficiency

decreased bone mineral density

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33
Q

t/f: adherence to exercise is crucial to improve exercise capacity and performance and increase overall daily physical activity in pts with HF

A

true

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34
Q

why is long term adherence to exercise important for pts with HF?

A

bc it helps break the negative cycle of inactivity and deconditioning that occurs with chronic conditions

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35
Q

what are some approaches to adherence encouragement?

A

goal setting

positive feedback

problem solving

learning by doing

role modeling

supportive visits and phone calls

caregiver engagement

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36
Q

PTs _______ advocate for physical activity as an essential component of care for pts with stable HF

A

SHOULD

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37
Q

t/f: HIIT should start out lower

A

true

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38
Q

what is the frequency for aerobic HIIT?

A

3-5 days/week

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39
Q

what is the frequency for strengthening HIIT

A

1-2 nonconsecutive days/week

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40
Q

what is the time for aerobic HIIT?

A

progressively increase to 30 min/day up to 60 min/day

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41
Q

what is the time for strengthening HIIT?

A

2 sets of 10-15 reps with a focus on major muscle groups

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42
Q

what type of exercise is included for aerobic HIIT?

A

treadmill

free walking

stationary cycle

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43
Q

what type of exercise is included for strengthening HIIT?

A

resistance machines may be best

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44
Q

what is the intensity for aerobic HIIT?

A

moderate

60-80% HRR

OR

RPE 11-14 on 6-20 scale

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45
Q

what is the intensity for strengthening HIIT?

A

begin with 40% 1RM UE and 50% 1RM LE

increased to 70% 1RM

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46
Q

why is the UE HIIT guidelines diff from LE?

A

bc the UE activity will result in increased return to the heart and so we want to be more careful and gradual with UE activity than LE

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47
Q

PTs _____ make appropriate nutrition referrals, perform medication reconciliation, and provide appropriate education on preventative self-care behaviors to reduce risk of hospital readmissions

A

MUST

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48
Q

what things MUST a PT do according to the action statements of the HF CPG?

A

make appropriate nutritional referrals, performs medication reconciliation, and provide appropriate education on preventative self-care behaviors

prescribe aerobic exercise training for pts w/stable NYHA class 2-3 HF

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49
Q

what things SHOULD a PT do according to the action statements of the HF CPG?

A

advocate for physical activity as an essential component of care in pts with stable HF

prescribe HIIT for pts w stable NYHA class 2-3 HFrEF

prescribe resistance training for the UE/LE major muscle groups for pts with stable NYHA class 1-3 HFrEF

prescribe inspiratory muscles training w/a threshold device for pts with stable NYHA class 2-3 HFrEF

prescribe NMES in pts with stable NYHA class 2-3 HFrEF

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50
Q

what things MAY a PT do according to the action statements in the HF CPG?

A

prescribe combo aerobic and resistance training for pts with stable NYHA class 2-3 HFrEF

prescribe inspiratory muscles training w/aerobic training

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51
Q

what is involved in nutritional education for pts according to the HF CPG?

A

daily weight measurements to ID an increase of >2-3 lbs in 24 hrs or 5lbs in 3 days

recognition of s/s of exacerbation

action planning (nutritional plan, medication management)

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52
Q

what weight gain in 24 hours would be a red flag for pts with HF?

A

2-3 lbs

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53
Q

what weight gain in 3 days would be a red flag for pts with HF?

A

5 lbs

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54
Q

what is the protocol for aerobic training?

A

20-60 minutes

50-90% peak VO2 or peak work

3-5x/week for at least 8-12 weeks

treadmill or cycle ergometer or dancing

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55
Q

what is VO2max?

A

max volume of O2 consumed per unit of time (usually per min)

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56
Q

what is the gold standard for measurement of cardiorespiratory fitness?

A

VO2max

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57
Q

VO2max is related to____ _____

A

cardiac output (CO)

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58
Q

what measure is considered to be the fxnal capacity of the heart?

A

VO2max

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59
Q

what is VO2peak?

A

max O2 consumed during exercise testing when testing is limited by factors other than circulatory dynamics (muscle fatigue or ventilatory capacity)

60
Q

is VO2max or VO2peak more often used in chronic disease populations?

A

VO2peak

61
Q

how do we estimate VO2max from submaximal tests like the 6MWT?

A

based on the HR workload relationship

use the distance, their age, their weight, their height, their rate pressure product (HR x SBP)

62
Q

VO2max=…….=……..

A

mL/kg/min=resting + horizontal + vertical/resistance

63
Q

PTs must prescribe aerobic training to HF pts in what NYHA class?

A

2-3

64
Q

PTs SHOULD prescribe HIIT to HF pts in what NYHA class?

A

2-3

65
Q

PTs ______ prescribe HIIT for pts w/stable NYHA class 2-3 HFrEF

A

SHOULD

66
Q

what is the protocol for HIIT according to the action statements for the HF CPG?

A

> 35 min total of 1-5 min high intensity (>90%) alternating with 1-5 min at 40-70% active rest intervals w rest intervals shorter than the work intervals

2-3x/week for at least 8-12 weeks

treadmill or cycle ergometer

67
Q

working at a % VO2max is ideal, but we can use what other measures?

A

%HR or RPE

68
Q

PTs _____ prescribe resistance training for the UE/LE major muscle groups for pts with stable NYHA class 1-3 HFrEF

A

SHOULD

69
Q

what is the protocol for resistance training according to the action statements from the HF CPG?

A

45-60 min/session

60-80% 1 RM, 2-3 sets/muscle group

3x/week for at least 8-12 weeks

70
Q

t/f: resistance exercise has an effect on skeletal muscle but elicits less strain on the cardiorespiratory system compared to aerobic exercises and may therefore be a suitable alternative for pts with CHF

A

true

71
Q

how does resistance training work as an alternative b4 aerobic training if a pt cant tolerate aerobic training?

A

it lowers the O2 needs of muscles, lowering dyspnea do they can tolerate aerobic training

72
Q

PTs ____ prescribe combo aerobic and resistance training for pts with stable NYHA class 2-3 HFrEF

A

MAY

73
Q

what is the protocol for combo resistance training and aerobic training according to the action statements from the HF CPG?

A

20-30 min resistance training added to aerobic training

2-3 sets/major muscle group at 60-80% 1RM

3x/week for at least 8-12 weeks

74
Q

would a sedentary pt be a good candidate for combo resistance and aerobic training?

A

NO

75
Q

PTs ____ prescribe inspiratory muscle training w/a threshold device for pts with stable NYHA class 2-3 HFrEF

A

SHOULD

76
Q

PTs SHOULD prescribe resistance training to pts with HF in what NYHA class?

A

1-3

77
Q

PTs MAY prescribe combo aerobic and resistance training to pts with HF in what NYHA class?

A

2-3

78
Q

PTs SHOULD prescribe inspiratory muscles training to pts with HF in what NYHA class?

A

2-3

79
Q

what is the protocol for inspiratory muscles training for pts with HF according to the action statement from the HF CPG?

A

30 min/day or less if using HIIT

> 30% MIP

5-7 days/week for at least 8-12 weeks

80
Q

PTs ____ prescribe inspiratory muscle training w aerobic training

A

MAY

81
Q

what is the protocol for combo inspiratory muscles training and aerobic training for pts with HF according to the HF CPG?

A

30 min/day

> 30% MIP

5-7 days/week for at least 8-12 weeks

82
Q

pts with HF unable to ambulate >____ m in the 6MWT have poorer short term survival

A

468

83
Q

how many meters in the 6MWT seems to be important in determining ST and LT survival w HF?

A

300

84
Q

PTs ____ prescribe NMES in pts w stable NYHA class 2-3 HFrEF

A

SHOULD

85
Q

PTs SHOULD prescribe NMES to pts with HF in what NYHA class?

A

2-3

86
Q

what is the protocol for NMES for pts with HF according to the action statement from the HF CPG?

A

30-60 min/session

biphasic symmetrical pulses at 15-50 Hz

on/off time=2/5 sec

pulse width for larger muscles of LE should be 200-700ms ; for small LE muscles .5-.7ms

20-30% of MVIC, intensity to contract muscles

5-7 days/week for at least 5-10 weeks

87
Q

what is cardiac rehab?

A

a program in outpatient that is multidisciplinary to target exercise, education, and lifestyle modification

88
Q

what is primary prevention in cardiac rehab?

A

active intervention for risk factors that cause CVD

89
Q

who are candidates for primary prevention in cardiac rehab?

A

those at moderate to high risk of CVD and those with a family hx of CVD

90
Q

primary prevention in cardiac rehab is needed to address what?

A

high prevalence of modifiable risk factors of CVD

91
Q

what are the problems with primary prevention in cardiac rehab?

A

compliance and lack of payment by insurance

92
Q

what risk factors are affected by primary prevention in cardiac rehab?

A

lower total chol/HDL ratio

lower LDLs

increased exercise tolerance and aerobic capacity

increased feeling of wellbeing and stress tolerance

decreased BMI

decreased resting BP

increased glucose tolerance and insulin sensitivity

93
Q

t/f: rehab of pts with documented CVD may have a primary or secondary CVD

A

true

94
Q

t/f: rehab of pts with documented CVD helps them achieve optimal physical, psychological, and functional status

A

true

95
Q

what are the components of the rehab program of pts with documented CVD?

A

education in recognition, prevent, and treatment of CVD

decreasing risk factors

dealing with psychological/behavioral factors influencing recovery

structured, progressive physical activity at rehab or home

vocational or return to leisure activities counseling

ADL and fxnal training

96
Q

what is phase 1 of cardiac rehab for pts with documented CVD?

A

in the acute hospital when medically stable

97
Q

what is phase 2 of cardiac rehab for pts with documented CVD?

A

early outpatient care with intensive monitoring and lifestyle/risk factor modification

98
Q

what is phase 3 of cardiac rehab for pts with documented CVD?

A

maintenance program in larger group exercise

independent progression

99
Q

what is phase 4 of cardiac rehab for pts with documented CVD?

A

disease prevention program for those at high risk for infarction or who need continued medical supervision

100
Q

what are the specific goals of inpatient CR (cardiac rehab) in phase 1?

A

eval of physiologic responses to self care and ambulation activities

provide feedback to clinicians so recommendations can be made

provide safety guidelines for progression of activity

education

101
Q

what VSs would show that PT is appropriate in CR phase 1?

A

RR<30 breaths/min

resting HR <120 beats/min

MAP min of 60 mmHg

SpO2>90%

SBP <140 mmHg

102
Q

what VSs would indicate to stop PT in phase 1 CR?

A

unable to speak comfortably

RR>40 breaths/min

onset of S3 heart sound

HR drops >10 beats/min

SBP drops >10 mmHg

MAP increases >10 mmHg

SpO2 <90% or a drop of >4%

new/worsening dysrrhythmia

return of pre-MI angina-like pain

103
Q

how do we calculate MAP?

A

SBP +2DBP/3

104
Q

how long is diastole compared to systole?

A

diastole is twice as long as systole

105
Q

what does a MAP increased of >10 mmHg indicate?

A

kidney failure or heart failure

106
Q

what are day 1 CR phase 1 activities?

A

sleeping, watching TV, writing/desk work, typing, slow level ground walking

107
Q

how many METs is appropriate day 1 in phase 1 CR?

A

1-2 METs

108
Q

what are day 2-5 CR phase 1 activities?

A

up to average walking speed on even ground

stationary cycling at very light effort

109
Q

how many METs is appropriate day 2-5 in phase 1 CR?

A

2-4 METs

110
Q

how many METs is very light intensity?

A

<3 METs

111
Q

what activities are included in very light intensity?

A

anything up to light walking

112
Q

how many METs is moderate intensity?

A

3-6 METs

113
Q

what activities are included in moderate intensity?

A

anything up to light biking

114
Q

how many METs is vigorous activity?

A

> 6 METs

115
Q

what activities are included in vigorous activity?

A

anything up to jumping rope

116
Q

what is the frequency for phase 1 CR?

A

2-3x/day working up to 5-6x/day by the end of week 1

117
Q

what is the intensity for phase 1 CR?

A

HR increase of 20-30 bpm

Borg rating bw 11-13 (light to somewhat hard)

118
Q

how long should interventions in phase 1 CR be?

A

3-5 minutes working up to 30 minutes by week 4

119
Q

what types of activities are included in phase 1 CR?

A

ADLs, fxnal activity, walking, stair assessment

120
Q

who may be a candidate for phase 2 CR?

A

MI (w/in 12 months)

HF

angioplasty

heart transplant

stable angina

CABG

valve replacement

comorbid conditions

poor ejection fraction

cardiomyopathy

serious arrhythmias

121
Q

where is the biggest growth in home-based CR in phase 2?

A

tele-based CR

122
Q

who would be a good candidate for home-based CR phase 2?

A

pts diagnosed with chronic HF that were recently dc from the hospital

123
Q

what is involved in secondary prevention in CR?

A

interdisciplinary approach

smoking cessation, nutrition, exercise, psych, HTN management, DM management, bone density

124
Q

what are the components of the initial assessment in rehab/secondary prevention CR in outpatient settings?

A

thorough medical and psych hx

pt/fam interview

physical exam

exercise test, 6MWT, or shuttle walk

blood chem panel

physical activity status

QOL questionnaire

125
Q

what factors determine the frequency of monitoring and the degree of supervision during rehab/secondary prevention CR in outpatient settings?

A

prior clinical course

exercise test results

degree of ventricular impairment

initial assessment

risk stratification

126
Q

ideally, when does the rehab/secondary prevention CR program begin?

A

as soon as it’s safe after hospital d/c

127
Q

what types of interventions are included in the rehab/secondary prevention CR program?

A

ther ex, pt ed, coordination/communication

aerobic exercise, resistance training, flexibility, circuit training

128
Q

what is the intensity of rehab/secondary prevention CR?

A

70-85% max HR

50-85% VO2max

129
Q

t/f: the rehab/secondary prevention CR program exercises muscles frequently used by the pt

A

true

130
Q

what is circuit training?

A

series of activity one after another keeping the HR high

131
Q

how can we progress the CR program?

A

increase duration of exercise

increase intensity of exercise

change the mode of exercise

132
Q

what are the post op precautions for a new pacemaker/ICD?

A

no shoulder mov’t >90 deg

no lifting >10-15 lbs

133
Q

how long will precautions be in place after pacemaker/ICD placement?

A

up to 4 weeks

134
Q

what precautions are followed after a median sternotomy?

A

sternal precautions

135
Q

what is the risk following a median sternotomy?

A

wound infection

sternal dehisence

136
Q

what risk factors increase chances of infection or dehiscence post median sternotomy?

A

obesity (BMI>30)

DM requiring meds for BG control (HIGHEST RISK FACTOR)

HF

previous sternotomy

respiratory failure

137
Q

what are the sternal precautions?

A

no UE use above shoulder level

no UE behind the back

no lifting >5-10 lbs

no excessive pushing/pulling

no UE use with functional movt

138
Q

what are the limitations of sternal precautions?

A

there are no universally accepted set of precautions

it is based on anecdotal evidence and expert opinions

it is applied to all pts w/o consideration for individual differences

it may impede on fxnal recovery bc it is too restrictive

it is not supported by current evidence

139
Q

what is a new alternative to sternal precautions that are sometimes used?

A

keep your move in the tube

140
Q

what does “keep your move in the tube” do?

A

it reduces the force on the sternum by keeping the UEs closer to the midline during weighted movt and arm WB activities

141
Q

what are some considerations for CTs following surgery?

A

pain

complications

respiratory effects

142
Q

what are the consequences of CT pain following surgery?

A

can limit deep breaths

143
Q

do younger or older pts tend to have more pain with chest tubes?

A

younger

144
Q

why may younger pts have more pain with CTs?

A

they have more muscle

they have more perceptible nerve endings

they have more vasculature

145
Q

what is a common complication from CTs (chest tubes) seen in days 3-5 post-op?

A

A fib

146
Q

what are the respiratory effects of chest tubes post-op?

A

pain with inspiration and coughing

volume overload–>pulmonary edema–>dyspnea

atelectasis (not taking deep breaths)

147
Q

what are relative contraindications to continuing exercise?

A

HR increase of >50 bpm w/low level activity

HTN SBP >210 mmHg or DBP >110 mmHg

decrease in SBP >10mmHg w/low level activity

angina, excessive fatigue, dyspnea, mental confusion, dizziness, severe LE cluadication pain

palor, cold sweats, ataxia

changes in heart sounds

changes in EKG

decrease in SBP, excessive HTN, or low heart response w/ excessive activity

DPT 629: Cardio (11 decks)

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