Cardiac Rehabilitation Flashcards
(33 cards)
What are the goals of cardiac rehabilitation?
- limit the physiological and psychological effects of cardiac illness
- reduce the risk of sudden death or re-infarction
- control cardiac symptoms
- stabilize or reverse the atherosclerotic process
- enhance the psychosocial and vocational status of selected patients
What are the clinical indications for inpatient/outpatient cardiac rehab?
- medically stable post-myocardial infarction
- stable angina pectoris
- coronary artery bypass surgery
- percutaneous transluminal coronary angioplasty
- compensated heart failure
- cardiomyopathy
- heart transplant
- other cardiac surgeries
- PAD
- end stage renal disease
- high risk of coronary artery disease with a diagnosis of DM2, dyslipidemia, hypertension, or obesity
What are the contraindications for inpatient/outpatient cardiac rehabilitation?
- unstable angina
- resting systolic BP over 200 or resting diastolic BP over 110
- orthostatic blood pressure drop of over 20 mm Hg with symptoms
- critical aortic stenosis
- acute systemic illness or fever
- uncontrolled atrial/ventricular arrythmias
- 3rd degree atrial ventricular block w/o a pacemaker
- active pericarditis or myocarditis
- recent embolism
- thrombophlebitis
- resting ST segment depression or elevation over 2mm
- uncompensated congestive heart failure
- any other orthopedic or metabolic conditions that would prohibit exercise
What is the role of a PT in cardiac rehab?
- develop an individualized exercise prescription considering mode, intensity, duration, and frequency
- monitor heart rate, blood pressure, ECG, RPE, and signs/symptoms
- supervise exercise and promote proper technique and breathing patterns
What is phase 1 of cardiac rehabilitation?
inpatient cardiac rehab
What does phase 1 of cardiac rehab consist of?
- patient and family education
- self care evaluation
- continuous monitoring of vital signs
- group discussions, and low-level exercise
How long does phase 1 of cardiac rehab usually last?
3-5 days
What is the procedure of the medical evaluation for phase 1 cardiac rehab?
- no new or recurrent chest pain in eight hours
- no new signs of uncompensated heart failures (i.e dyspnea at rest with bilateral basilar crackles)
- no new significant, abnormal heart rhythm or ECG changes in eight hours
- stable creatine kinase and troponin levels
When should phase 1 of cardiac rehab be discontinued for safety concerns?
- HR over 130 bpm or over 30 bpm above resting HR
- Diastolic BP over 110
- decreased Systolic BP by 10
- significant ventricular or atrial dysrhythmias
- 2nd or 3rd degree heart block
- signs or symptoms including angina, marked dyspnea, and ECG changes suggestive of ischemia
When can active upper and lower extremity begin after a bypass graft surgery and after a cardiac infarction?
24 hours after bypass graft surgery
2 days after infarction
How should active exercise progress during phase 1 of cardiac rehab?
from sitting to standing (1-4 METS)
What should the mode be for aerobic exercise in phase 1 of cardiac rehab?
progressive, supervised level walking (2-3 METs) to walking up and down step or treadmill walking (3-4 METs)
What should the Intensity be for aerobic exercise in phase 1 of cardiac rehab?
- RPE under 13 (6-20 scale)
- For post-infarction patients: HR under 120 bpm or under 20bpm above resting HR
- For post-surgical patients: under 30bpm above resting HR
What should the Duration be for aerobic exercise in phase 1 of cardiac rehab?
intermittent bouts of 3-5 minutes, progressing to 10-15 minutes of continuous activity
What should the frequency be for aerobic exercise in phase 1 of cardiac rehab?
first three days: 3-4 times a day
After first 3 days: twice a day with increased duration
What should the progression be for aerobic exercise in phase 1 of cardiac rehab?
progress varies according to patient tolerance and risk stratification
-activity may be progressed provided there is an adequate increase in heart rate and systolic BP (10-40 mm HG), no new dysrhythmias or ST changes on the ECG, and no cardiac symptoms are observed (palpitations, dyspnea, angina, or excessive fatigue)
What are the expected outcomes of phase 1 of cardiac rehab?
- prevent harmful physiological and psychological effects of best rest during hospitalization
- walk 5-10 minutes continuously or 1000ft, 4x daily
- walk down and up one flight of stairs independently
- know safe heart rate and RPE limits for exercise
- recognize abnormal signs and symptoms suggesting intolerance to activity
- promote a more rapid and safe return to ADLs within the limits imposed by their disease
- prepare the patient and home support system to optimize recovery following discharge
What is the second phase of cardiac rehab?
immediate outpatient rehabilitation with a comprehensive program that includes prescribed exercise, cardiac risk factor modification, education, and counseling about diet and disease management
What can a patient begin phase 2 cardiac rehab? How long does it last?
immediately after hospitalization and lasts up to 12 weeks
Why is an exercise test with ECG recommended before beginning phase 2 cardiac rehab?
used to asses:
- HR and rhythm
- signs and symptoms
- ST segment changes
- exercise capacity
- risk stratification
- target HR for exercise
- initial level of work for exercise
What should be included in a physical exam of a patient before beginning formal physical activity?
- medical history
- cardiovascular disease risk profile
- BMI or waist-hip ratio
- resting ECG and BP
- auscultation of lung sounds
- palpation and inspection of extremities for arterial pulses, edema, and skin integrity
How many sessions should ECG and BP be monitored for when working with a low risk patient with known stable coronary artery disease?
6-12
How many sessions should ECG and BP be monitored for when working with a moderate-high risk patient or patients unable to self-regulate/don’t understand recommended activty levels?
usually over 12 session
When should you discontinue phase 2 of cardiac rehab for safety reasons?
- plateau or decrease in HR with increase of work
- SBP plateaus or falls with increase in work or rises over 250 mm Hg
- diastolic BP over 115 mm Hg
- ST segment depression over 1 mm
- 2nd or 3rd degree heart block
- ventricular dysrhythmias
- angina or other symptoms of CV insufficiency
