Cardiac Rehabilitation
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| Arrhythmia | -Loss of normal rhythm
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| Dysrhthmia | -Irregular rhythm
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| Fibrillation | -Uncoordinated contractions
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| Heart Block | -Interference with conduction of electrical impulses within the heart
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| Beta-Blockers | -Prevents stimulation of the heart resulting in decreased BP & HR response to activity
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| Calcium Channel Blocker | -Prevents the flow of calcium into smooth muscles so prevents vasoconstriction
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| Digitalis | -Increases strength of the heart's contraction causing a decrease in HR
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| Angiogram | -X-ray photo of blood or lymph vessels
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| Electrocardiogram | -Record of a person's heartbeat
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| 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
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| Thallium Stress Test | - Nuclear imaging test that shows how well blood flows into the heart while you're exercising or at rest
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| Coronary Artery Bypass Graft (CABG) | -Most common form of open heart surgery
-Vein grafts from leg
-# denotes how many grafts were done
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| Valve Replacements | -Prevents back flow
-Aortic
-Mitral
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| 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
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| Stents | -Tubular support placed temporarily inside a blood vessel, canal, or duct to aid healing or relieve an obstruction
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| Ischemia | -Inadequate blood supply to an organ or part of the body, especially heart muscles
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| Myocardial Infarction (MI) | -Blockage of blood flow to the heart muscle
-Risk factors:
-Obese
-Diabetes
-Family history
-High cholesterol
-High fat diet
-Smoking
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| Pulmonary Edema | -Condition that causes excess fluid in the lungs
-Risk factors:
-History of lung disease (TB)
-COPD
-Vascular blood disorders
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| Tachycardia vs Bradycardia | -Tachycardia= abnormally rapid HR
-Bradycardia= abnormally slow HR
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| What is the job of the heart | -Provide adequate blood to the body
-CO= SV x HR
-Needs plenty of oxygen
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| 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
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| ____ is the most prevalent heart disease | -CAD= Coronary Artery Disease
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| ____ is the most common cause of CHD and is a primary contributor to CVA and PVD | -Atherosclerosis
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| #1 cause of death in U.S. | -CHD
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| Team Approach | -Physician
-Exercise professional
-Dietitian
-Behavior specialist
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| 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
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| Pattern 6D | -Impaired aerobic capacity/endurance associated with cardiovascular pump dysfunction or failure
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| 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
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| 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
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| 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
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| Contraindications / Precautions for Exercise | -Unusual HR increase or decrease
-Elevated BP
-Sudden drop in systolic BP
- >10 mmHg change either way in diastolic BP
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| Contraindications cont... | -Angina
-Dyspnea
-Excessive fatigue
-Confusion, Dizziness
-Severe claudication
-Pallor, Cold Sweat, Ataxia
-EKG abnormality
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| Electrocardiogram (ECG or EKG) | -Record of the heart's function
-Records the electrical impulses that stimulate the heart mm to contract and relax
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| Depolarization | -Electrical stimulation to contract
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| Repolarization | -Reversal of electrical stimulation causing relaxation
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| EKG monitoring | -Usually use a 3 lead set-up via telemetry so pt can move around
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| P wave | -Atrial depolarization
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| PR segment | -Conduction delay allowing mechanical contraction of atria to finish
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| QRS Complex | -Ventricular depolarization + Atrial repolarization
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| ST segment | -Conduction delay allowing completion of ventricular contraction
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| T wave | -Ventricular repolarization
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| PR, QT, ST Intervals | -Denote the time it takes the heart to get from one phase to the next
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| Abnormal values found for any of the intervals = | -Denotes dysfunction
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| EKG abnormalities | -Tachycardia and Bradycardia
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| Rhythm problems | -Many are caused by Ectopic foci
-Atrial flutter/fibrillation
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| PVC's | -Bigeminy
-Trigeminy
-Coupplet
-Triplet
-Another abnormality is V-tach
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| Infarctions | -T wave inversion
-ST segment changes: elevation, depression, downsloping with depression
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| Phase I Discharge planning | -Review of general activity guidelines,HEP, diet, medication, and warning S&S
-Possible stress test
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| 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
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| Phase II cont... | -Monitor HR, BP, body weight, EKG.
-May also use Ratings of Perceived Exertion (RPE)
-Education classes: CPR, diet, meds, self-monitoring
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| Delayed entry into Phase II: MI | -MI = Not supposed to do aerobic or strength training for 4-6 weeks while heart tissue heals
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| Delayed entry into Phase I: PTCA | -PTCA = Generally wait 2 weeks
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| Delayed entry into Phase I: CABG | -CABG = No aerobic or strength training until incision is healed and blood levels are normal (~6 weeks)
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| Special considerations during Phase I & II: CHF | -CHF = Can only do low level endurance and resistive training. Need respiratory muscle training
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| Special considerations during Phase I & II: Heart Transplants | -Heart Transplants = Heart is “denervated” so cannot use HR alone to set intensity
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| Special considerations during Phase I & II: Pacemaker/Defibrillator | -Pacemaker/Defibrillator = No UE exercises initially
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| Phase III | -Maintenance or Community Program
-Goals: Maintain function & Promote long-term fitness and health
-6-12 months long, varied supervision level
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| 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
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| 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
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