Cardiac Rehabilitation

Question 1

What patients need cardiac rehab?

Answer 1

atherosclerotic disease
congenital heart disease
heart transplants 
ventricular assist devices 
valvular disease
heart failure

Question 2

Benefits of Exercise

Answer 2

reduced cardiac death 
improved fitness
improved symptoms 
improved QOL 
improved overall CV health 
slows progression of CVD 
enhances psychosocial outcomes

Question 3

How do the benefits of exercise work?

Answer 3

Anti-Atherosclerotic

• improved HDL levels
• lowered LDL levels
• lowered BP
• reduced adiposity
• increased insulin sensitivity
• reduced inflammation

Anti-Thrombotic

• reduced platelet adhesiveness
• increased fibrinolysis
• reduced fibrinogen
• reduced blood viscosity

Anti-Arrhythmatic

• increased vagal tone
• reduced adrenergic activity
• increased HR variability

Psychological

• reduced depression
• reduced stress
• increased social support

Anti-Ischaematic

• reduced myocardial O2 demand
• increased ordinary flow
• reduced endothelial dysfunction
• increased nitric oxide

General

• improved oxidative capacity of skeletal muscles
• improved insulin sensitivity
• improved blood glucose homeostasis

Question 4

Components of Patient Assessment - Clinical History

Answer 4

principle diagnosis 
past and current symptoms 
relevant investigations 
modifiable CVD risk factors 
prescribed medications 
co-morbidities and other medical history 
family medical history 
psychosocial status 
fluid and nutrition status

Question 5

Components of Patient Assessment - Objective Assessment

Answer 5

resting HR, PR and rhythm 
BP in sitting and standing 
SpO2
body weight 
signs of fluid retention 
outcome measures

Question 6

Components of Patient Assessment - Exercise Habits

Answer 6

past and present including lifestyle physical activity
personal exercise preferences
barriers to exercise
enablers of exercise

Question 7

Absolute CIs

Answer 7

progressive worsening of exercise tolerance or dyspnoea over the past 3-5 days 
significant ischaemia with low intensity exercise 
uncontrolled diabetes
acute systemic illness or fever
recent embolism 
thrombophlebitis 
active pericarditis or myocarditis 
severe aortic stenosis 
myocardial infarction 
resting HR >120bpm

Question 8

Relative CIs

Answer 8

reduced systolic BP with exercise 
class 4 heart failure 
complex ventircular dysrhythmias with exercise or rest 
supine resting HR >100bpm
pre existing co morbidities 
moderate aortic stenosis 
BP >180/110

Question 9

Safety Considerations

Answer 9

need appropriate risk classification
careful with aquatic exercise - need to monitor thoroughly
take extra care if have had recent medication adjustments
temperature regulation
heart failure decomposition
exercising with oxygen?
any infections
co-morbidities - consider diabetes, COPD, PVD

Monitor of symptoms such as chest pain and dizziness, need to stop exercise
Have emergency plan in place
Have appropriately trained staff