Flashcards
Cardiac Rehabilitiation
Cards in this deck (17)
- 1List and describe some absolute contraindications for exercise after an MIa. Recent significant change in resting ECG suggesting ISCHEMIA, MI within past 2-days, or other acute cardiac events.
b. Unstable angina
c. Uncontrolled cardiac arrhythmias
d. Acute infections
g. Dissecting aneurism
h. Acute myocarditis or pericarditis - 2List and describe some relative contraindications for exercise after MIa. left main artery stenosis
b. Hypokalaemia, hypomagnesaemia
c. SBP >200, DBP >100
d. tachy or brady arrhythmias
g. Ventricular aneruism (bulging)
j. chronic infectious disease
k.Neuromuscular, musculoskeletal or rheumatoid disorders that are exacerbated by exercise. - 3When are exercise-induced ventricular arrhythmias considered to be life-threatening and a contra-indication for exercise?a. More than 6 premature ventricular contractions (pvcs) in a minute
b. When pvcs are multifocal
c. when a PVC falls of a T-wave - 4Discuss the rationale for exercise training after MI. List positive effects of exercise on cardiac function in CAD clients.* decreased myocardial oxygen demand which allows a higher work rate at a given intensity: delayed onset of ST-segment depression and decreased risk of future myocardial infarction.
*increased myocardial oxygen supply due to decreased arteriosclerotic plaque (increased lumen diameter) increased oxygen transport and coronary revascularization
*Body's natural ability to dissolve blood clots is enhance
*Lowers the total risk of cardiovascular mortality by 20-25%
*Relief of angina symptoms at a given exercise intensity - 5What markers of general health and fitness can improve in CAD clients participating in exercise training?*increased HDL cholesterol
*Improved ventilator response to exercise
*Improve sense of well-being and self-efficiency
*Increased VO2max - 6What does research indicate regarding the effect of exercise on left ventricular ejection fraction and myocardial perfusion in post-MI CAD clients?*Conventional training does little to increase left ventricular ejection fraction and myocardial perfusion. Numerous studies have indicated increased exercise tolerance in clients with impaired left ventricular function, despite a lack of improvement in resting hemodynamics or ejection fraction.
- 7What does research indicate with regard to the effect of exercise on cardiovascular mortality after MI?20-25% reduction in total and cardio-vascular-related mortality.
- 8What is the effect of exercise on CAD risk factors?*Reduced blood pressure
*Reduced body fat
*Reduced insulin resistance
*Reduced total and LDL cholesterol - 9List the indicators for terminating an exercise test in a CAD Client*Decreased SBP
*Severe angina
*Signs of poor perfusion (cyanosis and pallor)
*ECG changes (dysrhythmias)
*Volitional exhaustion - 10Describe the four phases of cardiac rehabilitation including how long each lasts, the exercise aims of each phase, and where each phase takes place? (phase 1)Inpatient in ICU at hospital
5-14 days
Aims - to reduce the negative physical and mental effects of bed rest
-return clients to normal activities of daily living.
-to maintain muscle tone and joint mobility. - 11Describe the four phases of cardiac rehabilitation including how long each lasts, the exercise aims of each phase, and where each phase takes place? (phase 2)*outpatient
1-3 months
Aim: to restore functional capacity and ability to perform activities of daily living. - 12Describe the four phases of cardiac rehabilitation including how long each lasts, the exercise aims of each phase, and where each phase takes place? (phase 3)*Community exercise programs
6-12 months
Aims: To improve fitness and strength
*To learn to exercise at higher intensities
*To make exercise a habit - 13Describe the four phases of cardiac rehabilitation including how long each lasts, the exercise aims of each phase, and where each phase takes place? (phase 4)Unsupervised exercise at a community center
*This phase lasts indefinitely
Aim: to maintain functional capacity and strength. - 14Summarize the exercise intensity, duration and frequency recommendations for cardiac clients.Exercise at least 3 x a week
40-85% HHR or RPE 11-16 or 10bpm below ischemic threshold
20-40 minutes of continuous or interval exercise, preceded and followed by 10 minutes of warm-up/cool-down. - 15Identify 6 recommendations for exercise testing a client with previous myocardial infaction*Check carefully for contraindicationa to exercise before starting.
*Monitor ECG, HR, and BP throughout test
*Begin at an intensity significantly below anticipated peak capacity
*2-3 minute stages
*Total test duration 8-12 minutes
*Watch closely for indicators for cessation of test. - 16List 6 aspects of client education necessary during phase 2, before clients can move on to phase 3.a. Client must be able to describe and define angina, including the difference between angina and exercise-induced shortness of breath.
b.Client must know the effect of their HR and BP medications on their responses to exercise.
c. Client must know their symptom limits and their target HR
d. Client must understand their training goals in terms of sets and repetitions, and overall training load.
F. Provide clients basic nutrition and management of heart disease, as well as basic nutrition, and stress management. - 17What are the criteria for moving a cardiac rehab patient on from phase 2 to phase 3?a. Risk classification: client meets low-risk criteria with a stable exercise response below and at their symptom limits
b. Client has a good grasp of the main points from phase 3 education
c. Client has been exercising regularly for at least 3-months.