Cardiac Rehabilitation

Question 1

cardiac rehab services are multidisciplinary long-term programs involving (5)…

Answer 1

medical evaluation
prescribed exercise
cardiac risk factor modification
education
counseling

Question 2

what are the goals of cardiac rehab services?

Answer 2

-limit physiological and psychological effects of cardiac illness
-reduce risk for sudden death or reinfarction
-control cardiac symptoms
-stabilize/reverse atherosclerotic process
-enhance psychosocial/vocational status

Question 3

what physical therapy settings are typically included in cardiac rehab?

Answer 3

-begin with early assessment and mobilization in inpatient
-early outpatient rehab
-longterm maintenance and follow up

Question 4

clinical indications (11) for inpatient and outpatient cardiac rehabilitation?

Answer 4

-medically stable post-MI
-stable angina pectoris
-coronary artery bypass sx
-percutaneous transluminal coronary angioplasty (PTCA)
-compensated HF
-cardiomyopathy
-heart transplant
-other cardiac sx (valve repair, pacemaker)
-PAD
-high risk for CAD with dx of DM, dyslipidemia, HTN or obesity
-end-stage renal disease

Question 5

clinical contraindications (13) for inpatient and outpatient cardiac rehabilitation?

Answer 5

-unstable angina
-resting systolic pressure >200 mmHg or resting diastolic pressure > 110 mmHg
-orthostatic BP drop of > 20 mmHg with symptoms
-critical aortic stenosis
-acute, systemic illness/fever
-uncontrolled atria/ventricular arrhythmias
-3rd deg AV block w/o pacemaker
-active pericarditis or myocarditis
-recent embolism
-thrombophlebitis
-resting ST seg depression or elevation >2mm
-uncompensated CHF
-orthopedic/metabolic conditions that would prohibit exercise

Question 6

resting systolic pressure >__ mmHg or resting diastolic pressure > __ mmHg is a contraindication to IP and OP cardiac rehab

Answer 6

200; 110

Question 7

orthostatic BP drop of > __ mmHg with symptoms is a contraindication to IP and OP cardiac rehab

Answer 7

20

Question 8

a __ degree AV block w/o pacemaker is a contraindication to IP and OP cardiac rehab

Answer 8

3rd

Question 9

resting ST segment __ or __ > 2 mm is a contraindication to IP and OP cardiac rehab

Answer 9

depression or elevation

Question 10

PT role (3) in cardiac rehab?

Answer 10

-develop individualized exercise prescription considering mode, intensity, duration and frequency
-monitor HR, BP, ECG, RPE and s/s
-supervise exercise and promote proper technique and breathing patterns

Question 11

throughout cardiac rehab, PTs should monitor what 5 things?

Answer 11

HR, BP, ECG, RPE and s/s

Question 12

what are the phases of cardiac rehab?

Answer 12

Phase I- IP cardiac rehab
Phase II- immediate OP cardiac rehab

Question 13

when does Phase I begin?

Answer 13

once the patient is medically stable

Question 14

when is a patient considered medically stable and ready to begin Phase I of cardiac rehab?

Answer 14

-no new or recurrent chest pain in the last 8 hours
-no new signs of uncompensated HF (dyspnea at rest, bilateral basilar crackles)
-no new significant, abnormal heart rhythm or ECG changes in 8 hrs

Question 15

what does Phase I consist of?

Answer 15

patient/family edu
self-care evaluation
continuous monitoring of vital signs
group discussions
low-level exercise

Question 16

Phase I IP cardiac rehab includes __-__ exercise including what 3 things?

Answer 16

low-level
-AROM
-ambulation
-self-care

Question 17

exercise intensity in Phase I is prescribed according to what 2 factors?

Answer 17

HR
RPE

Question 18

how long, on average is Phase I? why?

Answer 18

3-5 days
trend toward early discharge following cardiac event

Question 19

when should low-level exercise be discontinued during Phase I?

Answer 19

-HR > 130 bpm or HR > 30 bpm above resting HR
-DBP >/= 110 mm Hg
-decrease in SBP > 10 mm Hg
-significant ventricular or atrial dysarhythmias
-2nd/3rd deg heart block
s/s- angina, marked dyspnea, ECG changes suggesting ischemia

Question 20

what changes in HR indicates that low-level exercise should be discontinued during Phase I?

Answer 20

HR> 130 bpm or HR> 30 bpm above resting HR

Question 21

what changes in SBP or DBP indicates that low-level exercise should be discontinued during Phase I?

Answer 21

DBP >/= 110 mm Hg
decrease in SBP> 10 mm Hg

Question 22

what types of heart blocks indicate that low-level exercise should be discontinued during Phase I?

Answer 22

2nd/3rd deg

Question 23

what s/s (3) indicate that low-level exercise should be discontinued during Phase I?

Answer 23

angina
marked dyspnea
ECG changes indicative of ischemia

Question 24

mode of aerobic exercise during Phase I?

Answer 24

progressive, supervised level walking to walking up and down steps or treadmill walking

Question 25

when performing progressive, supervised level walking during Phase I, what should METs be?

Answer 25

2-3

Question 26

when progressing to walking up and down stairs or treadmill walking during Phase I, what should METs be?

Answer 26

3-4

Question 27

what should patient RPE be less than on the 6-20 scale during aerobic exercise during Phase I?

Answer 27

less than 13

Question 28

duration of aerobic exercise during Phase I?

Answer 28

intermittent bouts of 3-5 mins, progressing to 10-15 mins of continuous activity

Question 29

the duration of aerobic exercise during Phase I begins with intermittent bouts of __-__ min, progressing to __-__ min of continuous activity

Answer 29

3-5; 10-15

Question 30

frequency of aerobic exercise during Phase I during the first 3 days and after the first 3 days?

Answer 30

first 3 days: 3-4x/day after first 3 days: 2-3x/day with increased duration

Question 31

when can activity be progressed during Phase I?

Answer 31

patient demonstrates: adequate increase in HR adequate rise in SBP (10-40 mm Hg) no new dysrhythmias or ST changes on ECG no observed cardiac symptoms

Question 32

expected functional outcomes of Phase I?

Answer 32

walk 5-10 min continuously, or 1,000 ft 4x/day walk up and down 1 FOS independently

Question 33

before progressing to Phase II, a cardiac patient must walk for __-__ min continuously, or __ ft __x/day and walk up and down _ __ independently

Answer 33

5-10; 1,000; 4x; 1 FOS

Question 34

what does Phase II cardiac rehab include?

Answer 34

immediate OP therapy- prescribed exercise cardiac risk factor modification education counseling about diet, disease management

Question 35

when can Phase II cardiac rehab typically begin? how long does it typically last?

Answer 35

begins immediately after discharge from hospital and can last up to 12 weeks