Week 8- Cardiac Rehabilitation Flashcards
PART 1:
PART 1:
We should provide a _________ approach to the rehabilitation of patients with heart disease involving education, structured progressive physical activity, lifestyle modifications, and vocational counseling.
Multidisciplinary
What patient populations are candidates for cardiac rehab? (7)
- Post MI
- Post-op cardiac surgeries including transplants
- Heart disease
- CHF
- Post PTCA
- Elderly
- Asymptomatic, at risk patients
Who is not a candidate for cardiac rehab? (7)
- Unstable angina
- HEMODYNAMIC INSTABILITY (SP/DP >200/100, orthostatic fall >20mmHg)
- Serious arrhythmias
- Conduction abnormalities
- Active infections
- Uncontrolled DM
- Resting ST segment depression
(T/F) Cardiac rehabilitation is underutilized.
True
Cardiac Rehab:
- Reduces _______
- ______ the heart
- Improves cardiac function
- Might get _______ changes
- Modifies __________
- reduces BW
- unloads the heart
- lifestyle changes
- risk factors
- How any cardiac rehabilitation phases are there?
- Which phase is the most involved and which is the least involved?
- 4
- Phase I = most involved, Phase IV = least involved
PART 2: PHASE I (ACUTE) CARDIAC REHAB
PART 2: PHASE I (ACUTE) CARDIAC REHAB
What are the goals of Phase I (Acute) Cardiac Rehab? (4)
- Independence in ADLs
- Counteract bedrest effects (reduce risk of thrombi and pneumonia, maintain tone, reduce OH)
- Medical surveillance during ADL type of activities
- Education (disease process, CV monitoring, exertional intolerance and energy conservation)
What are some exercise activities to include for Phase I Cardiac Rehab? (5)
- Self care
- Arm/Leg AROM
- Very light weights
- Independent transfers
- Bedside sitting to ambulation to stairs
Patients in Phase I are monitored, what does this mean?
Monitoring vitals through EKG while exercising, making sure no S/Sx before progressing exercise.
What are the (3) instances in Phase I in which we stop treatment?
- Unusual HR increase
- Inappropriate BP response (>220/110 OR 10mmHg drop in DBP with exercise)
- Presence of symptoms
Phase I Intensity Parameters:
- > ___BPM or >___-___BPM increase
- _________
- <120BPM or >20-30BPM increase
- symptoms
What MET level is required for discharge of Phase I? Why?
-3-5 METs by discharge because this is what is required to complete ADLs
PART 3: PHASE II (SUBACUTE) CARDIAC REHAB
PART 3: PHASE II (SUBACUTE) CARDIAC REHAB
What are the goals of Phase II (Subacute) Cardiac Rehab? (6)
- Improved exercise tolerance
- Patient education
- Risk factor reduction/secondary prevention
- Return to work
- Promote psychological, behavioral, and educational improvement
- 9-10 METS (3.0mph for 30m)
How long does Phase II last?
8-12 weeks
Are patients in Phase II monitored like those in Phase I?
Yes, difference is that you are monitored outside of the hospital.
How do we find the HRmax of patients in Phase II?
207-(0.7*age)
What is the Karvonen method for defining a target heart rate range (THR) for patients in Phase II?
(HRR*training %) + resting HR
In Phase II, keep HR below levels that elicit what (5) things?
- ) S/Sx
- ) Dyspnea
- ) Plateauing/decreasing SBP
- ) EKG abnormalities
- ) Arrhythmias >6/min
What would be an acceptable RPE training range for patients in Phase II (endurance vs strength)?
- ENDURANCE = 11-13 RPE
- STRENGTH = 15-17 RPE
What are some things that might indicate an abnormal response to exercise in Phase II patients?
- > 240/110 BP, >20 SBP drop
- Unusual HR response
- S/Sx (angina, dyspnea, excessive fatigue, mental confusion/dizziness, claudication, pallor, cold sweat, ataxia, pulmonary rales)
- ECG abnormalities
Phase II Resistance Training:
- Should we perform resistance training in Phase II?
- __ weeks post PCTA/stent, __ weeks post MI, __ weeks post CABG
- ___-___% 1RM, 8-10 reps 2-3x/week
- Yes (large muscle groups, control weights, breathe during effort)
- 2 weeks post PCTA/stent, 5 weeks post MI, 8 weeks post CABG
- 30-50% 1RM
Should patients in Phase II be encourages in Valsalva maneuvers while performing resistance exercises?
NO
What MET level is required for discharge of Phase II?
9-10 METs (3.0mph for 30m)
PART 4: PHASE III (TRAINING) AND PHASE IV (MAINTENANCE) CARDIAC REHAB
PART 4: PHASE III (TRAINING) AND PHASE IV (MAINTENANCE) CARDIAC REHAB
What is the main difference between Phase II and III of cardiac rehab?
Patient is more self monitoring in Phase III and HEP.
How long does Phase III usually last?
3-6m
Phase III Exercise Parameters:
- ___-___% of HRR on treadmill test
- __-__ sessions/week
- > ___m per session
- 50-80% HRR
- 3-4 sessions
- > 45m
What are (4) important things to note about Phase IV?
- HEP
- Self monitoring
- Environmental concerns
- Adherence
In what stages is EKG monitoring NOT performed?
Stage III and IV
PART 5:
PART 5:
What are some reasons referrals to cardiac rehab programs reman low? (4)
- Lack of centralized method for referral
- Inadequate communication among treatment teams, patients, and CR facilities
- Unfamiliarity with CR among potential referring physicians
- Limited access, competing responsibilities, and perceived inconvenience for the patient
What are some patient barriers to their participation in cardiac rehab programs? (8)
- Poor functional status
- Higher BMI
- Tobacco use
- Depression
- Long distance to CR facilities
- Low health literacy
- High costs
- Inflexible work hours
What is the most powerful predictor of participation in a cardiac rehab program?
The most powerful predictor was the STRENGTH OF THE PRIMARY PHYSICIANS RECOMMENDATION.
- Is home based cardiac rehab effective?
- What are the obvious problems with home-based vs clinic-based cardiac rehab?
- Yes, low-mod strength evidence stating HBCR and CBCR have similar effects.
- Safety and monitoring
HBCR Advantages. (5)
- More convenient for patient
- Individually tailored
- Patient friendly scheduled and access
- Greater privacy
- Put in home routine
HBCR Disadvantages. (7)
-More trust in patient’s ability
-Lack of reimbursement INS
-Less social support
-Less intensive training
-Heavier patient self reliance
-Less face to face monitoring and
communication
-Safety for higher risk patients
