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(3) Cardio-Pulmo-Renal Rehabilitation > S3 L1: Cardiac Rehab Part 2 > Flashcards

S3 L1: Cardiac Rehab Part 2 Flashcards

1
Q

True or False: The body needs energy in order for the tissues and cells to work

A

True

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2
Q

T/F: All nutrients consist of carbon, hydrogen, and oxygen.

A

T

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3
Q

Main source of energy coming from food

A

Fuels

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4
Q

a necessary adjunct for the catabolism of fats.

A

Carbohydrates

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5
Q

What are the three main fuels of the body?

A

Carbohydrates, Fat, Protein

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6
Q

The following are benefits of fat, EXCEPT:
a. Fats have the highest energy yield of any of the substrates in the body.
b. Fat provides a layer of insulation for the
body that helps maintain thermal homeostasis.
c. Fat surrounds body organs (eg, heart, kidneys) and protects them from injury.
d. Fat serves as a carrier for the fat-soluble
vitamins A, B, E, and K.
e. NOTA

A

d. Fat serves as a carrier for the fat-soluble
vitamins A, D, E, and K. (VITAMIN B IS NOT INCLUDED)

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7
Q

Used only with severe caloric deprivation,
starvation, or “over-exercising”

A

Protein

Note: when carbohydrates or fat are exhausted
during severe caloric deprivation, starvation, carbs diet – deprivation of carbohydrates, or “over-exercising”; consumed already the carbohydrates and fat

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8
Q

used primarily for tissue maintenance, repair, and growth.

A

Protein

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9
Q

Modified T/F: Protein is a poor fuel source. It plays an important role in rebuilding tissue after strenuous exercise

A

Both True

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10
Q

are considered as the
primary energy source more than the protein

A

Carbohydrates and fat

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11
Q

T/F: When doing an activity, burning or creating energy from the body, Protein → fat →
carbohydrates

A

False. It should be:
When doing an activity, burning or creating energy from the body, carbohydrates → fat →
protein

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12
Q

○ Energy in the body
○ Need to relate in exercise

A

ATP

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13
Q

Aka Phosphocreatine system

A

ATP-PC

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14
Q

Usually used initially or if we perform fast
movements (eg: sprint)

A

ATP-PC

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15
Q

T/F: When performing all out activities during the initial
period, Anaerobic Glycolysis is utilized

A

False. When performing all out activities during the initial
period, ATP/PC system is utilized

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16
Q

No use of oxygen

A

Anaerobic Glycolysis

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17
Q

T/F: In anaerobic glycolysis, since no oxygen, it won’t undergo Krebs cycle or
Nitric Acid cycle system

A

True

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18
Q

T/F: Pyruvic Acid → Lactic Acid (by-product)

A

True

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19
Q

explains why an individual experience exhaustion, muscle soreness, delayed onset muscle soreness
(DOMS

A

Lactic Acid accumulation:

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20
Q

If the exercise lasts more than 5-10 minutes and less than 40 mins to 1 hour, ___________ is utilized

A

Anaerobic glycolysis

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21
Q

Aka Aerobic Glycolysis

A

Oxidative System

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22
Q

T/F: In oxidative system, it undergoes Krebs cycle or Nitric Acid cycle system → allowing to create more ATP

A

True

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23
Q

T/F: In cardiac rehabilitation, the body is trained to use oxidative system more than the anaerobic system

A

T

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24
Q

T/F: When participating longer duration exercises, oxidative system is utilized

A

T

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25
Q

Arrange the following from greatest to least amount of ATP generated:

Anaerobic
ATP-PC
Oxidative

A

Oxidative > Anaerobic > ATP-PC

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26
Q

T/F: The systems do not overlap with each other

A

False. The systems may overlap with each other

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27
Q

Substrate of ATP PC system

A

Stored phosphagens

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28
Q

Substrate of Anaerobic glycolysis

A

Glycogen/glucose

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29
Q

Substrate of Krebs cycle, electron transport

A

Glycogen/gl ucose, fats, proteins

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30
Q

Speed of ATP mobilization of ATP PC system and total ATP production

A

Very fast; small

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31
Q

Speed of ATP mobilization of Anaerobic glycolysis and total ATP production

A

Fast; small

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32
Q

Speed of ATP mobilization of Krebs cycle and total ATP production

A

Slow; large

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33
Q

A parameter which is important in cardiac rehabilitation

A

OXYGEN CONSUMPTION (VO2)

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34
Q

How the cells or tissues use the oxygen in the body

A

Rate of O2 utilization

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35
Q

T/F: The blood carries oxygen as it needs to deliver it to the tissues

A

T

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36
Q

What is the Fick Equation?

A

VO2 = CO X (A-VO2 Diff)

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37
Q

T/F: Should be wider difference between A-VO2

A

True

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38
Q

T/F: If A-VO2 is narrow, it implies that there is an adequate oxygen delivered to the tissues

A

False. This implies that there is NO adequate oxygen delivered to the tissues

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39
Q

What is the relationship of AV-O2 Diff, Cardiac Output (CO), and VO2?

A

The wider the AV-O2 Diff & greater CO (greater blood ejected to the system), the greater VO2 (greater rate of O2 utilization occurs)

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40
Q

What is the relationship between Vo2 and workload?

A

Both are directly proportionate

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41
Q

T/F: ↑ work → ↑ ATP needed → ↑ O2 needed

A

T

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42
Q

T/F: There is a limit wherein VO2max will be reached even if the workload continues to increase → VO2max plateaus already

A

T

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43
Q

T/F: When engaging in continuous aerobic training, VO2max can further increase even if it plateaus

A

False. It should be:

When engaging in continuous aerobic training, VO2max can further increase BEFORE it plateaus

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44
Q

Quantity of blood pumped with each heartbeat

A

STROKE VOLUME

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45
Q

What is the determinant of stroke volume?

A

Determinant: Diastolic Filling Volume

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46
Q

T/F: ↑ Blood ejected → ↑ VO2

A

True since the blood carries the
oxygen

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47
Q

also represents the amount of work done as
it is directly proportionate to workload

A

VO2

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48
Q

T/F: At some point the heart can only deliver certain amount of blood as it tries to pump → reaches plateau

A

True

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49
Q

T/F: When engaging initially in
exercise training → ↑ Stroke Volume gradually (exponentially) → plateau (even if ↑ intensity) due to the Diastolic Filling Volume (main determinant)

A

True

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50
Q

T/F: When engaging in aerobic training, heart can adapt at which it can eject more blood in Post-Training as compared to Pre-Training → ↑ plateau than the Pre-Training

A

True

51
Q

Determined through the pulse sites

A

Pulse Rate

52
Q

Determined through the apex of the heart (most accurate) using a stethoscope to auscultate bpm

A

Heart Rate

53
Q

Number of times myocardial contraction occurs per unit of time

A

Maximum HR (HRmax)

54
Q

T/F: At a certain point, HR plateaus = Maximum
HR/HRmax

A

True

55
Q

Age dependent

A

MAXIMUM HEART RATE (HRmax/MHR)

56
Q

What is the original formula of maximum heart rate?

A

HRmax = 220 – age

57
Q

HEART RATE RESERVE (HRR/HRRESERVE) formula

A

HRR = HRmax – HRrest

58
Q

Which HRmax formula took the relationship of HR with VO2 into consideration?

A

HRmax = 217 – 0.85 x age (Miller et al, 1993)*

59
Q

Which HRmax formula took the decline in HRMax because of aging?

A

HRmax = 205.8 – 0.685 x age (Inbar et al, 1994)

HRMax decreases by 0.685 bpm per year because of aging

60
Q

HRMax formula among elderly individuals

A

HRmax = 208 – 0.7 x age (Tanaka et al, 2001)

61
Q

Which HRMax Formula considered the person’s physical characteristics (age, sex, load/activity level,
weight, height) of the patient?

A

HRmax = 206.3 – 0.711 x age (Londeree et al, 1982)

62
Q

TARGET HEART RATE (THR)/EXERCISE HEART RATE (KARVONEN’S FORMULA)

Normal

A

THR = 60-80% (HRR) + HRrest

63
Q

TARGET HEART RATE (THR)/EXERCISE HEART RATE (KARVONEN’S FORMULA)

Athletes

A

THR = 80-95% (HRR) + HRrest

64
Q

TARGET HEART RATE (THR)/EXERCISE HEART RATE (KARVONEN’S FORMULA)

Cardiac patients/pulmo patients/elderly/sedentary individuals

A

THR = 40-60% (HRR) + HRrest

65
Q

Amount of blood pumped per minute

A

CARDIAC OUTPUT

66
Q

T/F: ● ↑ CO ↑ SV & ↑ HR

A

True

67
Q

What is the determinant of myocardial blood flow?

A

Determinant: diameter of coronary arteries

68
Q

Estimation of the myocardial blood flow by sullivan

A

RPP or DP = HR x SBP → Sullivan

■ RPP = rate pressure product
■ DP = double product

69
Q

amount of oxygen that the tissues utilize

A

VO2

70
Q

T/F: Heart is a cardiac muscle → also requires its own oxygenation

A

True

71
Q

Oxygen utilization of the cardiac muscle

A

MVO2

72
Q

At this point, heart muscle will no longer receive
oxygenation

A

ANGINAL THRESHOLD

73
Q

Peak of MVO2

A

ANGINAL THRESHOLD

74
Q

Modified T/F: Pre-training = MVO2 will easily reached the
angina threshold; Post-training = it will take time to reach the
angina threshold

A

Both T

75
Q

Angina threshold is reached easily; steeper slope of MVO2 increase in UE or LE exercise?

A

UE

Because UE has smaller diameter blood
vessels and is much closer to the heart → received more blood easily

76
Q

T/F: Upright → MVO2 is higher initially; can easily reached the angina threshold

A

False. It should be: Supine → MVO2 is higher initially; can easily reached the angina threshold

77
Q

T/F: During exercise → DBP should remain constant
/ increase a very little only

A

True

78
Q

T/F: If there is too much decrease in DBP during
exercise, it means that the heart is no longer resting (Diastole = representation of heart rest)

A

False. It should be: If there is too much INCREASE in DBP during exercise, it means that the heart is no longer resting (Diastole = representation of heart rest)

79
Q

What will happen next if there is a reduction on the amount of blood that goes inside the heart (ventricle)?

A

It might result to Hypoxic reactions

80
Q

Modified T/F: GRADED EXERCISE TESTS/EXERCISE TOLERANCE TEST (ETT) is more of an evaluation. It could also be used as an intervention.

A

TF

81
Q

T/F: ETT is usually done at the End of Phase 1 before proceeding to Phase 2

A

True

82
Q
  • Defined by target endpoint HR
  • Challenging the heart up to the maximum limit
  • WANT the patient to experience angina
A

MAXIMAL ETT

83
Q

Common for athletes

A

MAXIMAL ETT

84
Q
  • Symptom-limited
  • Just PRIOR to angina
  • For cardiac patients and elderly individuals
A

SUBMAXIMAL ETT

85
Q

Used to evaluate the early recovery of patients after MI, CABG, or heart d/o

A

SUBMAXIMAL ETT

86
Q

Most Commonly Used Method for ETT

A

TREADMILL

● You need to constantly monitor the vital signs (BP, HR, SO2) and ECG
● You gradually increase the speed up to the point of limit of the pt

87
Q

T/F: In Treadmill Method, the following should be followed:

○ Athlete: prior to angina
○ Elderlies / cardiac pts: angina

A

False. It should be:
○ Athlete: Maximal exhaustion / angina
○ Elderlies / cardiac pts: Submaximal exhaustion only
/ prior to the angina

88
Q

T/F: If the pt has difficulty with ambulation, we can modify the task and do the bicycle

A

T

89
Q

What does the PT do if the pt has difficulty with ambulation?

A

If the pt has difficulty with ambulation, we can modify the task and do the bicycle

Take note, the immediate effect on MVO2

90
Q

Similar to the 6MWT

A

SHUTTLE WALKING TEST

91
Q

T/F: We need to monitor the HR, METs, and RPE, and observe the patient; together with the psychological state of the pt in order to perform a safe and beneficial exercise intensity during ETT

A

True

92
Q

What is the normal heart rate range?

A

60-100 bpm

93
Q

What are considered as bradycardia and tachycardia?

A

○ Bradycardia: <60 bpm
○ Tachycardia: >100 bpm

94
Q

T/F: Sometimes if we deal with athletes their HR may present as 50-60 bpm

A

False. Sometimes if we deal with athletes their HR may present as 40-50 bpm (not 50 - 60)

95
Q

state of the myocardium after systole

A

ST segment in ECG

96
Q

The following items are matched correctly, EXCEPT:
A. High systolic BP: risk for stroke
B. High diastolic BP: may lead to ischemia
C. None of the above

A

C

97
Q

Depression in ST segment in ECG means?

A

Depression = Ischemia; reversible, ask the pt to rest and breathe properly;

98
Q

Elevation in ST segment in ECG means?

A

Elevation = Infarction; especially if it is more than 2
mL

99
Q

T/F: An inverted T wave represents ischemia

A

T

100
Q

We ask the pt to wear a mask then the amount of gas will be recorded

A

EXPIRED GAS ANALYSIS

101
Q

T/F: In expired gas analysis, peak oxygen uptake (VO2max), CO2 output (each time we exhale) is recorded.

A

True

102
Q

○ 50-60% of peak oxygen uptake
○ The level of effort at which work begins to be
performed anaerobically

A

Ventilatory Threshold

103
Q

T/F: Expired Gas Analysis can also measure Minute ventilation, RR, TV, and Respiratory Exchange Ratio

A

T

104
Q

Absolute or Relative CI?
Acute MI

A

Absolute

105
Q

Absolute or Relative CI?
Hypertrophic cardiomyopathy

A

Relative

106
Q

Absolute or Relative CI?
Psychiatric disease

A

Relative

Psychiatric disease (for as long as they can follow instructions we can still proceed)

107
Q

Absolute or Relative CI?

Active unstable angina

A

Absolute

108
Q

Absolute or Relative CI?

Serious cardiac arrhythmias

A

Absolute

109
Q

Absolute or Relative CI?

Arterial or pulmonary hypertension

A

RElative

110
Q

Absolute or Relative CI?

Less serious noncardiac disorder

A

RE;atove

111
Q

Absolute or Relative CI?

Acute pericarditis (inflammation on the covering of the heart)

A

Absolute

112
Q

Absolute or Relative CI?

Endocarditis

A

Abnsolute

113
Q

Absolute or Relative CI?

Tachyarrhythmias or bradyarrhythmias

A

Relative

114
Q

Absolute or Relative CI?

Moderate myocardial or valvular disease

A

Relative

115
Q

Absolute or Relative CI?

Severe aortic stenosis

A

Absolute

116
Q

Absolute or Relative CI?

Severe left ventricular dysfunction

A

Absolute

117
Q

Absolute or Relative CI?

Pulmonary embolus (any signs of DVT)

A

Absolute

118
Q

Absolute or Relative CI?

Acute or serious noncardiac disorder (e.g., acute arthritis, fractures)

A

Absolute

119
Q

Absolute or Relative CI?

Severe physical handicap (that will limit them from performing physical activity)

A

Absolute

120
Q

What are the five (5) things a PT should monitor during ETT?

A

● HR ↑ as the intensity ↑
● SBP ↑ as intensity ↑, DBP remains the same (or increases only a bit)
● RPE ↑ as intensity ↑ (important when patient is taking
beta-blockers, because HR is no longer reliable)
● Usually there is ST segment depression less than 1mm as intensity ↑
● (+) single PVC (premature ventricular contraction) is (N)

121
Q

Select the items that are included in the list of inidcations for terminating the ETT:

A. Progressive angina
B. Ventricular tachycardia
C. Failure to ↑ or drop of SBP with an ↑ in load/intensity
D. Increased HR
E. Signs of ↓ blood supply in the brain and periphery
F. Onset of 2nd and 3rd degree AV block
G. >3 mm ST segment deviation
H. Singular PVC
I. Multiple PVCs

A

All Except D and H

122
Q

Select the items that are included in the list of inidcations for terminating the ETT:

A. SBP >250 mmHg; DBP >120 mmHg
B. Sustained supraventricular tachycardia
C. Exercise induced (L) BBB
D. Subject request to stop
E. Failure of the monitoring system
F. Borg RPE scale of 13
G. 260/130 BP

A

All except F

123
Q

Modified TF: ETT is usually done at the end of Phase I so that you have a baseline of the pt’s capacity/ability. After about several months or 1 yr, ETT is done again to see if there are improvements/progressions happening to the pt.

A

Both True

(3) Cardio-Pulmo-Renal Rehabilitation (34 decks)

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