S3 L1: Cardiac Rehab Part 2 Flashcards
True or False: The body needs energy in order for the tissues and cells to work
True
T/F: All nutrients consist of carbon, hydrogen, and oxygen.
T
Main source of energy coming from food
Fuels
a necessary adjunct for the catabolism of fats.
Carbohydrates
What are the three main fuels of the body?
Carbohydrates, Fat, Protein
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
d. Fat serves as a carrier for the fat-soluble
vitamins A, D, E, and K. (VITAMIN B IS NOT INCLUDED)
Used only with severe caloric deprivation,
starvation, or “over-exercising”
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
used primarily for tissue maintenance, repair, and growth.
Protein
Modified T/F: Protein is a poor fuel source. It plays an important role in rebuilding tissue after strenuous exercise
Both True
are considered as the
primary energy source more than the protein
Carbohydrates and fat
T/F: When doing an activity, burning or creating energy from the body, Protein → fat →
carbohydrates
False. It should be:
When doing an activity, burning or creating energy from the body, carbohydrates → fat →
protein
○ Energy in the body
○ Need to relate in exercise
ATP
Aka Phosphocreatine system
ATP-PC
Usually used initially or if we perform fast
movements (eg: sprint)
ATP-PC
T/F: When performing all out activities during the initial
period, Anaerobic Glycolysis is utilized
False. When performing all out activities during the initial
period, ATP/PC system is utilized
No use of oxygen
Anaerobic Glycolysis
T/F: In anaerobic glycolysis, since no oxygen, it won’t undergo Krebs cycle or
Nitric Acid cycle system
True
T/F: Pyruvic Acid → Lactic Acid (by-product)
True
explains why an individual experience exhaustion, muscle soreness, delayed onset muscle soreness
(DOMS
Lactic Acid accumulation:
If the exercise lasts more than 5-10 minutes and less than 40 mins to 1 hour, ___________ is utilized
Anaerobic glycolysis
Aka Aerobic Glycolysis
Oxidative System
T/F: In oxidative system, it undergoes Krebs cycle or Nitric Acid cycle system → allowing to create more ATP
True
T/F: In cardiac rehabilitation, the body is trained to use oxidative system more than the anaerobic system
T
T/F: When participating longer duration exercises, oxidative system is utilized
T
Arrange the following from greatest to least amount of ATP generated:
Anaerobic
ATP-PC
Oxidative
Oxidative > Anaerobic > ATP-PC
T/F: The systems do not overlap with each other
False. The systems may overlap with each other
Substrate of ATP PC system
Stored phosphagens
Substrate of Anaerobic glycolysis
Glycogen/glucose
Substrate of Krebs cycle, electron transport
Glycogen/gl ucose, fats, proteins
Speed of ATP mobilization of ATP PC system and total ATP production
Very fast; small
Speed of ATP mobilization of Anaerobic glycolysis and total ATP production
Fast; small
Speed of ATP mobilization of Krebs cycle and total ATP production
Slow; large
A parameter which is important in cardiac rehabilitation
OXYGEN CONSUMPTION (VO2)
How the cells or tissues use the oxygen in the body
Rate of O2 utilization
T/F: The blood carries oxygen as it needs to deliver it to the tissues
T
What is the Fick Equation?
VO2 = CO X (A-VO2 Diff)
T/F: Should be wider difference between A-VO2
True
T/F: If A-VO2 is narrow, it implies that there is an adequate oxygen delivered to the tissues
False. This implies that there is NO adequate oxygen delivered to the tissues
What is the relationship of AV-O2 Diff, Cardiac Output (CO), and VO2?
The wider the AV-O2 Diff & greater CO (greater blood ejected to the system), the greater VO2 (greater rate of O2 utilization occurs)
What is the relationship between Vo2 and workload?
Both are directly proportionate
T/F: ↑ work → ↑ ATP needed → ↑ O2 needed
T
T/F: There is a limit wherein VO2max will be reached even if the workload continues to increase → VO2max plateaus already
T
T/F: When engaging in continuous aerobic training, VO2max can further increase even if it plateaus
False. It should be:
When engaging in continuous aerobic training, VO2max can further increase BEFORE it plateaus
Quantity of blood pumped with each heartbeat
STROKE VOLUME
What is the determinant of stroke volume?
Determinant: Diastolic Filling Volume
T/F: ↑ Blood ejected → ↑ VO2
True since the blood carries the
oxygen
also represents the amount of work done as
it is directly proportionate to workload
VO2
T/F: At some point the heart can only deliver certain amount of blood as it tries to pump → reaches plateau
True
T/F: When engaging initially in
exercise training → ↑ Stroke Volume gradually (exponentially) → plateau (even if ↑ intensity) due to the Diastolic Filling Volume (main determinant)
True
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
True
Determined through the pulse sites
Pulse Rate
Determined through the apex of the heart (most accurate) using a stethoscope to auscultate bpm
Heart Rate
Number of times myocardial contraction occurs per unit of time
Maximum HR (HRmax)
T/F: At a certain point, HR plateaus = Maximum
HR/HRmax
True
Age dependent
MAXIMUM HEART RATE (HRmax/MHR)
What is the original formula of maximum heart rate?
HRmax = 220 – age
HEART RATE RESERVE (HRR/HRRESERVE) formula
HRR = HRmax – HRrest
Which HRmax formula took the relationship of HR with VO2 into consideration?
HRmax = 217 – 0.85 x age (Miller et al, 1993)*
Which HRmax formula took the decline in HRMax because of aging?
HRmax = 205.8 – 0.685 x age (Inbar et al, 1994)
HRMax decreases by 0.685 bpm per year because of aging
HRMax formula among elderly individuals
HRmax = 208 – 0.7 x age (Tanaka et al, 2001)
Which HRMax Formula considered the person’s physical characteristics (age, sex, load/activity level,
weight, height) of the patient?
HRmax = 206.3 – 0.711 x age (Londeree et al, 1982)
TARGET HEART RATE (THR)/EXERCISE HEART RATE (KARVONEN’S FORMULA)
Normal
THR = 60-80% (HRR) + HRrest
TARGET HEART RATE (THR)/EXERCISE HEART RATE (KARVONEN’S FORMULA)
Athletes
THR = 80-95% (HRR) + HRrest
TARGET HEART RATE (THR)/EXERCISE HEART RATE (KARVONEN’S FORMULA)
Cardiac patients/pulmo patients/elderly/sedentary individuals
THR = 40-60% (HRR) + HRrest
Amount of blood pumped per minute
CARDIAC OUTPUT
T/F: ● ↑ CO ↑ SV & ↑ HR
True
What is the determinant of myocardial blood flow?
Determinant: diameter of coronary arteries
Estimation of the myocardial blood flow by sullivan
RPP or DP = HR x SBP → Sullivan
■ RPP = rate pressure product
■ DP = double product
amount of oxygen that the tissues utilize
VO2
T/F: Heart is a cardiac muscle → also requires its own oxygenation
True
Oxygen utilization of the cardiac muscle
MVO2
At this point, heart muscle will no longer receive
oxygenation
ANGINAL THRESHOLD
Peak of MVO2
ANGINAL THRESHOLD
Modified T/F: Pre-training = MVO2 will easily reached the
angina threshold; Post-training = it will take time to reach the
angina threshold
Both T
Angina threshold is reached easily; steeper slope of MVO2 increase in UE or LE exercise?
UE
Because UE has smaller diameter blood
vessels and is much closer to the heart → received more blood easily
T/F: Upright → MVO2 is higher initially; can easily reached the angina threshold
False. It should be: Supine → MVO2 is higher initially; can easily reached the angina threshold
T/F: During exercise → DBP should remain constant
/ increase a very little only
True
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)
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)
What will happen next if there is a reduction on the amount of blood that goes inside the heart (ventricle)?
It might result to Hypoxic reactions
Modified T/F: GRADED EXERCISE TESTS/EXERCISE TOLERANCE TEST (ETT) is more of an evaluation. It could also be used as an intervention.
TF
T/F: ETT is usually done at the End of Phase 1 before proceeding to Phase 2
True
- Defined by target endpoint HR
- Challenging the heart up to the maximum limit
- WANT the patient to experience angina
MAXIMAL ETT
Common for athletes
MAXIMAL ETT
- Symptom-limited
- Just PRIOR to angina
- For cardiac patients and elderly individuals
SUBMAXIMAL ETT
Used to evaluate the early recovery of patients after MI, CABG, or heart d/o
SUBMAXIMAL ETT
Most Commonly Used Method for ETT
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
T/F: In Treadmill Method, the following should be followed:
○ Athlete: prior to angina
○ Elderlies / cardiac pts: angina
False. It should be:
○ Athlete: Maximal exhaustion / angina
○ Elderlies / cardiac pts: Submaximal exhaustion only
/ prior to the angina
T/F: If the pt has difficulty with ambulation, we can modify the task and do the bicycle
T
What does the PT do if the pt has difficulty with ambulation?
If the pt has difficulty with ambulation, we can modify the task and do the bicycle
Take note, the immediate effect on MVO2
Similar to the 6MWT
SHUTTLE WALKING TEST
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
True
What is the normal heart rate range?
60-100 bpm
What are considered as bradycardia and tachycardia?
○ Bradycardia: <60 bpm
○ Tachycardia: >100 bpm
T/F: Sometimes if we deal with athletes their HR may present as 50-60 bpm
False. Sometimes if we deal with athletes their HR may present as 40-50 bpm (not 50 - 60)
state of the myocardium after systole
ST segment in ECG
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
C
Depression in ST segment in ECG means?
Depression = Ischemia; reversible, ask the pt to rest and breathe properly;
Elevation in ST segment in ECG means?
Elevation = Infarction; especially if it is more than 2
mL
T/F: An inverted T wave represents ischemia
T
We ask the pt to wear a mask then the amount of gas will be recorded
EXPIRED GAS ANALYSIS
T/F: In expired gas analysis, peak oxygen uptake (VO2max), CO2 output (each time we exhale) is recorded.
True
○ 50-60% of peak oxygen uptake
○ The level of effort at which work begins to be
performed anaerobically
Ventilatory Threshold
T/F: Expired Gas Analysis can also measure Minute ventilation, RR, TV, and Respiratory Exchange Ratio
T
Absolute or Relative CI?
Acute MI
Absolute
Absolute or Relative CI?
Hypertrophic cardiomyopathy
Relative
Absolute or Relative CI?
Psychiatric disease
Relative
Psychiatric disease (for as long as they can follow instructions we can still proceed)
Absolute or Relative CI?
Active unstable angina
Absolute
Absolute or Relative CI?
Serious cardiac arrhythmias
Absolute
Absolute or Relative CI?
Arterial or pulmonary hypertension
RElative
Absolute or Relative CI?
Less serious noncardiac disorder
RE;atove
Absolute or Relative CI?
Acute pericarditis (inflammation on the covering of the heart)
Absolute
Absolute or Relative CI?
Endocarditis
Abnsolute
Absolute or Relative CI?
Tachyarrhythmias or bradyarrhythmias
Relative
Absolute or Relative CI?
Moderate myocardial or valvular disease
Relative
Absolute or Relative CI?
Severe aortic stenosis
Absolute
Absolute or Relative CI?
Severe left ventricular dysfunction
Absolute
Absolute or Relative CI?
Pulmonary embolus (any signs of DVT)
Absolute
Absolute or Relative CI?
Acute or serious noncardiac disorder (e.g., acute arthritis, fractures)
Absolute
Absolute or Relative CI?
Severe physical handicap (that will limit them from performing physical activity)
Absolute
What are the five (5) things a PT should monitor during ETT?
● 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)
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
All Except D and H
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
All except F
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.
Both True
