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Special Topics
Cardiac Rehabilitation
| Question | Answer |
|---|---|
| Arrhythmia | -Loss of normal rhythm |
| Dysrhthmia | -Irregular rhythm |
| Fibrillation | -Uncoordinated contractions |
| Heart Block | -Interference with conduction of electrical impulses within the heart |
| Beta-Blockers | -Prevents stimulation of the heart resulting in decreased BP & HR response to activity |
| Calcium Channel Blocker | -Prevents the flow of calcium into smooth muscles so prevents vasoconstriction |
| Digitalis | -Increases strength of the heart's contraction causing a decrease in HR |
| Angiogram | -X-ray photo of blood or lymph vessels |
| Electrocardiogram | -Record of a person's heartbeat |
| Heart Catheterization | -Long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart |
| Thallium Stress Test | - Nuclear imaging test that shows how well blood flows into the heart while you're exercising or at rest |
| Coronary Artery Bypass Graft (CABG) | -Most common form of open heart surgery -Vein grafts from leg -# denotes how many grafts were done |
| Valve Replacements | -Prevents back flow -Aortic -Mitral |
| Percutaneous Transluminal Coronay Angiopasty | -Opens blocked coronary arteries so that blood may flow. Catheter inserted into an artery ; x-rays taken; balloon-tipped catheter is advanced to the heart, and into the narrowed coronary artery, open/close; widening the artery so blood flow improves |
| Stents | -Tubular support placed temporarily inside a blood vessel, canal, or duct to aid healing or relieve an obstruction |
| MET: Metabolic Equivalent | -Cost in terms of O2 consumption and energy expenditure required to do activity -May be used in CR to set intensity of exercises |
| Aneurysm | -Localized, blood-filled balloon-like bulge in the wall of a blood vessel that ruptures -Risk factors: diabetes, obesity, hypertension, tobacco use, alcoholism, increasing age |
| Angina | -Ischemic chest pain caused by decreased blood flow to the heart -Tobacco use, diabetes, high blood pressure, high cholesterol, family history of heart disease, older age, obesity, stress |
| Arteriosclerosis | -Arteriosclerosis is the stiffening or hardening of the artery walls -Risk factor: -High cholesterol -High blood pressure -Smoking -Insulin resistance -Diabetes -Overweight or obesity -Lack of physical activity -Unhealthy diet |
| Atherosclerosis | -Atherosclerosis is the narrowing of the artery because of plaque build-up -Risk factors: -High cholesterol -High blood pressure -Smoking -Insulin resistance -Diabetes -Overweight or obesity -Lack of physical activity -Unhealthy diet |
| Congestive Heart Failure (CHF) | -Chronic condition in which the heart doesn't pump blood as well as it should -Risk factors: -High blood pressure -Heart attack -Coronary artery disease -Sleep apnea -Viruses -Tobacco use -Obese -Congenital heart defects |
| Embolus vs Thrombus | -Thrombus is a blood clot that forms in vein -Embolus is anything that travels through the blood vessels until reaches vessel too small to let it pass; blood flow stopped by embolus |
| Ischemia | -Inadequate blood supply to an organ or part of the body, especially heart muscles |
| Myocardial Infarction (MI) | -Blockage of blood flow to the heart muscle -Risk factors: -Obese -Diabetes -Family history -High cholesterol -High fat diet -Smoking |
| Pulmonary Edema | -Condition that causes excess fluid in the lungs -Risk factors: -History of lung disease (TB) -COPD -Vascular blood disorders |
| Tachycardia vs Bradycardia | -Tachycardia= abnormally rapid HR -Bradycardia= abnormally slow HR |
| What is the job of the heart | -Provide adequate blood to the body -CO= SV x HR -Needs plenty of oxygen |
| Heart Disease | -Acute/chronic cardiac disability resulting from a reduction of blood supply to myocardium w/ associated CAD - MI, Angina, Heart failure, arryhthmias, sudden death, valvular dysfunction |
| ____ is the most prevalent heart disease | -CAD= Coronary Artery Disease |
| ____ is the most common cause of CHD and is a primary contributor to CVA and PVD | -Atherosclerosis |
| #1 cause of death in U.S. | -CHD |
| Team Approach | -Physician -Exercise professional -Dietitian -Behavior specialist |
| Goals of Rehab | -Prevent harmful effects of prolonged bed rest when a patient has been hospitalized -Develop cardiovascular fitness with emphasis on optimal ability -Identify patients whose psychological response to cardiac disease may need extra support |
| Pattern 6D | -Impaired aerobic capacity/endurance associated with cardiovascular pump dysfunction or failure |
| Phase I of cardiac rehab | -In-patient = acute phase -Nursing educates about disease process, prognosis, risk factor mods -Dietician starts pt on strict diet -Therapy evaluates physiological response to self-care & ambulation; provide safeguidelines for activity progression |
| Phase I cont... | -Pts are closely monitored by wired vs. telemetry EKG -Protocols vary from facility to facility-most based on 7-Step MI & 10-Step CABG Programs from Grady Memorial |
| Phase 1 cont... | -ROM exer. and ambulation -Therapy uses BP & HR (before, during, and after rx) to monitor -Open heart pts start sooner and allowed to do more intense workout due to less heart tissue death |
| Contraindications / Precautions for Exercise | -Unusual HR increase or decrease -Elevated BP -Sudden drop in systolic BP - >10 mmHg change either way in diastolic BP |
| Contraindications cont... | -Angina -Dyspnea -Excessive fatigue -Confusion, Dizziness -Severe claudication -Pallor, Cold Sweat, Ataxia -EKG abnormality |
| Electrocardiogram (ECG or EKG) | -Record of the heart's function -Records the electrical impulses that stimulate the heart mm to contract and relax |
| Depolarization | -Electrical stimulation to contract |
| Repolarization | -Reversal of electrical stimulation causing relaxation |
| EKG monitoring | -Usually use a 3 lead set-up via telemetry so pt can move around |
| P wave | -Atrial depolarization |
| PR segment | -Conduction delay allowing mechanical contraction of atria to finish |
| QRS Complex | -Ventricular depolarization + Atrial repolarization |
| ST segment | -Conduction delay allowing completion of ventricular contraction |
| T wave | -Ventricular repolarization |
| PR, QT, ST Intervals | -Denote the time it takes the heart to get from one phase to the next |
| Abnormal values found for any of the intervals = | -Denotes dysfunction |
| EKG abnormalities | -Tachycardia and Bradycardia |
| Rhythm problems | -Many are caused by Ectopic foci -Atrial flutter/fibrillation |
| PVC's | -Bigeminy -Trigeminy -Coupplet -Triplet -Another abnormality is V-tach |
| Infarctions | -T wave inversion -ST segment changes: elevation, depression, downsloping with depression |
| Phase I Discharge planning | -Review of general activity guidelines,HEP, diet, medication, and warning S&S -Possible stress test |
| Phase II | -Out-patient or home-based -Begins as early as 24 hrs post-discharge and lasts 8-12 wks at 2-3 times/wk -Warm-up period= stretching or walking -Circuit interval training period= cardiovascular + light weights -Cool-down period= stretching or walking |
| Phase II cont... | -Monitor HR, BP, body weight, EKG. -May also use Ratings of Perceived Exertion (RPE) -Education classes: CPR, diet, meds, self-monitoring |
| Delayed entry into Phase II: MI | -MI = Not supposed to do aerobic or strength training for 4-6 weeks while heart tissue heals |
| Delayed entry into Phase I: PTCA | -PTCA = Generally wait 2 weeks |
| Delayed entry into Phase I: CABG | -CABG = No aerobic or strength training until incision is healed and blood levels are normal (~6 weeks) |
| Special considerations during Phase I & II: CHF | -CHF = Can only do low level endurance and resistive training. Need respiratory muscle training |
| Special considerations during Phase I & II: Heart Transplants | -Heart Transplants = Heart is “denervated” so cannot use HR alone to set intensity |
| Special considerations during Phase I & II: Pacemaker/Defibrillator | -Pacemaker/Defibrillator = No UE exercises initially |
| Phase III | -Maintenance or Community Program -Goals: Maintain function & Promote long-term fitness and health -6-12 months long, varied supervision level |
| Phase III cont... | -Only a small % of patients continue to this level -Self monitoring primarily – heart watches -May include aerobic dance, weight training, track work, etc. -Advanced education programs |
| Home-based Cardiac Rehab | -Option for Phase II or beyond patient who is “low risk”. -Daily activity logs, weekly check-ins -HH nursing – EKG via telephone -6-12 months |
Created by:
alovedaytn
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