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UBE vs Leg ergometry: effect on VO2 max, HR, stroke volume, SBP and DBP UBE: lower V02 max, higher HR, lower SV, higher SBP & DBP
Initial Exercise Perscription: Intensity used Moderate - 40% of HR max
Phase 1 of Cardiac Rehab -MET -RPE MET: 3-5 by discharge RPE: fairly light 11-13 (6-20 scale)
Phase 1 Cardiac Rehab: Frequency and Duration Duration: intermittent bouts 3-5' progressing to 10-15' Frequency: 3-4x/day progressing to 2x/day with increased duration
Phase 2 Cardiac Rehab - MET - RPE MET: 9 RPE: 12 - 16 (somewhat hard - hard)
Phase 2 Cardiac Rehab: Frequency and Duration Duration: 1st month, 3-4 months, 6 months 1st month: 15-20' of continuous or intermittent 3-4 months: 25-30' 6 mo: 40' or longer with 5-10' warm up/cool down Frequency: 3-5x/week
MET needed for functional capacity 5
Phase 1: INTENSITY: HR restrictions for post MI and post surgical Post MI: Keep HR < 120 or < 20 bpm above resting Post surgical: Keep HR < 30 bpm above resting HR
RPE Scale (6-20) 6 = nothing at all 9 = Very light 11 = Fairly light 13 = Somewhat hard 15 = Hard 17 = Very hard 19 = Very, Very hard
RPE (0-10) 0 = nothning 3 = moderate 4 = somewhat strong 5 = strong 7 = very strong 10 = maximul
When to begin strength training for Phase 2 For Post MI and Post Surgerical 3 wks in cardiac rehab, 5 wks post-MI, 8 wks post-CABG
RPP is an index of what, correlates with what and how is it measured. index of myocardial oxygen consumption and coronary blood flow. Correlates with onset of angina and ECG abnormalities. RPP = HR x SBP
What % of Max HR does an RPE of 13-14 represent. 70%
Entry criteria for phase 3 Functional capacity of 5 METs, clinically stable angina, medically controlled arrhythmias during exercise
Phase 3 progression 50-85% functional capacity, 3-4x/wk/ 45+ minutes
Normal ECG findings with exercise P wave increased height R and T waves decreased height ST up-slopes (<2mm) QT interval shortens
ST depression & elevation > 2mm depression = ischemia elevation = MI
What valves are closing during S1 Mitral and Tricuspid (Atrioventricular valves)
What valves are closing during S2 Aortic and Pulmonic (Semilunar Valves)
FEV1/FVC normal range > 80% predicted
Semilunar Valves Aortic (between LV and Aorta) Pulmonic (between RV and Pulmonary Artery)
Normal value for CO and equation 4-5L/min CO = SVxHR
What are the steps for Cardiac conduction 1. SA node stimulates atria to contract 2. AV node stimulated 3. Transmitted down bundle of his. 4. Into perkinje fibers 5. Impulse sent to ventricles = Contract
Heart Auscultation Locations Aortic - 2nd right Pulmonic - 2nd left Erbs - 3rd left Tricuspid - 4th left Mitral - midclavicular line @ 5th on left
What % of HR does RPE of 12-13 equal 16 RPE equals 12-13 = 60% 16 = 85%
Newborn respiratory rate 35-45 breaths/min
Normal I:E I:E with COPD normal 1:2 COPD 1:3 or 1:4
S4 - 4 pathologies associated Stenosis, CAD, MI, chronic HTN
S3 - pathology LV CHF
What is a thrill and how is it detected murmor, felt with palpation
What are brut sounds, where are the typically found and what do the imply murmor, blowing sound heard *common in carotid/femoral arteries - atherosclerosis
What are the symptoms of right sided heart failure Ascities, jugular vein distension, dependent edema, Hepatomegally (enlarged liver), cyanosis
Cyanosis is typical with right or left sided heart failure right
What are the symptoms of left sided heart failure Dyspnea, dry cough, orthopenia, pulmonary rales/wheezing, hypotension, tachycardia, fatigue, decreased exercise tolerance, enlarged heart
Dyspnea and dry cough are common with right or left sided heart failure Left
Hypotension and tachycardia are common with right or left sided heart failure Left
Where is the AV node located between the RA and RV
Where is the SA node located between the SVC and RA
What is the normal value for end diastolic volume 120mL
What is the normal value for end systolic volume 50
What does a decreased S2 sound indicate aortic stenosis
Normal stroke volume 55-100mL/beat
What influences stroke volume LVEDV (preload) Contractility Afterload
What is afterload the force the LV has to generate to open the aortic valve
Normal EF, what does it measure and what is the EF equation 60-70%, < 40 = HF measures LV function EF = SV/LVEDV
What represents myocardial oxygen demand RPP = SBPxHR
Normal and abnormal ABI >1.2 Falsely elevated – arterial hardening 0.95 – 1.2 Normal 0.94 – 0.75 Mild arterial disease 0.74 – 0.50 Moderate arterial disease <.5 – severe disease, rest pain, ulceration, refer to vascular specialist
What is the pathophysiology of left sided heart failure LV receives oxygen rich blood from LA to pump the blood to the rest of the body. With LHF, the LV has to work harder to pump out the blood which leads to pulmonary congestion and backflow of blood into the LA and Lungs
What is the pathophysiology of right sided heart failure typically due to LHF - get back up into lungs which RV has to pump against. Get back flow into veins causing leg swelling and distension
What is hypoakelemia and what are the effects on ECG decreased potassium causes flattened T-wave, prolonged PR and QT intervals *can progress to V-Fib
What is hyperakelemia and what are the effects on ECG increased potassium causes widened PR & QRS and tall T-waves
What is the iontropic Effect increased force of contraction
What is the chronotropic effect increased HR
decreased afterload causes increased or decreased CO increased
ECG arrythymias - contraindications to PT (8) 1. Sinus Brady < 40 2. Sinus Tach > 150 3. A-Fib with abnormal hemodynamic response 4. 2nd and 3rd heart blocks 5. > 7 PVCs 6. V-Tach (>3PVCs) 7. V-Fib 8. A-flutter + tachy (>120)
ECG arrythymias - ok to treat (7) 1. Sinus Tach < 140 & no symptoms 2. Sinus brady > 40 & no symptoms 3. PACs (inverted P-wave) 4. A-flutter with normal HR 5. 1st degree heart block 6. PVCs (<7) 7. A-fib with normal HR
A-Fib: ECG changes and can you treat? absent p-wave and irregular *can treat as long as they have a normal HR and hemodynamic response
A-Flutter: ECG changes and can you treat? saw tooth *can treat as long as they have a normal HR and hemodynamic response
PACs: ECG changes and can you treat? Inverted P-wave Yes
Heart Blocks: ECG changes and can you treat? QRS dropped and long PR interval Can only treat 1st, 2nd and 3rd med ER
V-Tach: ECG changes and can you treat? > 3 PVCs High and widened QRS waves, no other distinguishable features. NO, terrible CO! can progress to V-fib
V-Fib: ECG changes and can you treat? oh jesus NO! see ya NO CO
Created by: leaderjenna