Bridgeport Hospital Cardiac Rehab and ACSM-EP Practice Flashcards

A collection of vocabulary flashcards covering blood pressure categories, lipid and glucose thresholds, BMI ranges, and cardiac rehabilitation protocols based on the Bridgeport Hospital and ACSM-EP guidelines.

Normal Blood Pressure

\text{SBP} < 120 and \text{DBP} < 80

Elevated BP

$\text{SBP}$ of $120\text{--}129$ and \text{DBP} < 80

Stage 1 Hypertension

$\text{SBP}$ of $130\text{--}139$ or $\text{DBP}$ of $80\text{--}89$

Stage 2 Hypertension

$\text{SBP} \ge 140$ or $\text{DBP} \ge 90$

Hypertensive Crisis

$\text{SBP} \ge 180$ or $\text{DBP} \ge 120$; consult physician immediately.

Optimal LDL “bad cholesterol”

< 100\,\text{mg\,dL}^{-1}

Protective HDL “good cholesterol”

> 60\,\text{mg\,dL}^{-1}

Low HDL

< 40\,\text{mg\,dL}^{-1}

Normal Triglycerides

< 150\,\text{mg\,dL}^{-1}

Normal Fasting Glucose

$$60\text{--}99\,\text{mg\,dL}^{-1}$$

Prediabetes Fasting Glucose

$$100\text{--}125\,\text{mg\,dL}^{-1}$$

Diabetes Fasting Glucose

$$\ge 126\,\text{mg\,dL}^{-1}$$

Normal BMI

$$18.5\text{--}24.9$$

Overweight BMI

$$25\text{--}29.9$$

Obese BMI

$$\ge 30$$

Cardiac Rehabilitation

A process to reduce mortality and morbidity, improve lifestyle behaviors, and promote physical activity.

Common Cardiac Rehab Referrals

MI, CABG, PCI/Stent, Stable Angina, HFrEF, Valve Surgery, and Heart Transplant.

Angina

Chest pain or discomfort caused by inadequate oxygen delivery to the myocardium.

Stable Angina

Angina that occurs with exertion and is relieved by rest.

Unstable Angina

Angina that can occur at rest; considered a medical emergency.

Exercise Prescription for Angina

Maintain exercise HR approximately $10\,\text{bpm}$ below the anginal threshold.

PCI

Percutaneous Coronary Intervention; balloon angioplasty with stent placement.

CABG

Coronary Artery Bypass Graft; surgical bypass of blocked coronary arteries.

Heart Failure with Reduced EF (HFrEF)

Heart failure with an ejection fraction $\text{EF} < 40\%$

Normal Ejection Fraction

$$55\text{--}70\%$$

Increase in SBP during exercise

Indicates an appropriate cardiovascular response to exercise.

Heart Rate Recovery

HR should decrease toward resting values during recovery.

Typical Cardiac Rehab RPE Range

$11\text{--}13$ (Light to Somewhat Hard).

Borg 12-14

Somewhat Hard RPE Rating

Borg 15-18

Hard RPE Rating

Borg 17

Very Hard

Clinical Scenario assessment (CHF EF 35%)

Evaluate for appropriate HR response, appropriate BP response, moderate intensity, absence of adverse symptoms, and that exercise is well tolerated.

Telemetry Strip Assessment (5 Key Items)

1. Rhythm regularity, 2. Heart rate, 3. QRS presence, 4. Changes with exercise, 5. Symptoms.

Most Common Diagnoses in Cardiac Rehab

MI, CABG, PCI/Stent, CHF/HFrEF, Stable Angina, and Valve Surgery.

What populations does a CEP commonly work with?

• Mostly Cardiovascular

• Pulmonary

• Metabolic

• Orthopedic

• Neuromuscular

• Neoplastic (cancer)

• Immunologic

• Hematologic

What is the difference between primary prevention and secondary prevention?

Primary: prevent disease before it occurs

Secondary: disease already exists, goal is to prevent future complications (ex: CR= secondary prevention)

Low Risk

• Ejection fraction of 50% or more

• functional capacity of 7 or more METs

• no angina

• no significant symptoms

• normal BP response

• no complex arrhythmias

Moderate Risk

• Ejection fraction between 40-49%

• functional capacity of less than 5 METs

• mild ischemia (2 mm or less of ST depression)

• symptoms only at high workloads (more than 7 METs)

High Risk

• Ejection Fraction of less than 40%

• CHF

• Symptoms at low workloads (5 METs or less)

• Complex ventricular arrhythmias

• Significant ischemia (2 or more mm of ST depression)

• Abnormal hemodynamic response

What is the most important value related to high-risk category?

ejection fraction of less than 40% , normal: 55-70%

Ejection Fraction

Percentage of blood ejected from the left ventricle during systole

First 5 things to review in a cardiac rehab chart…

• diagnosis

• ejection fraction

• stress test results

• medications

• symptoms

How do medications impact someone’s cardiac rehab?

they alter HR response, BP response, exercise tolerance, risk level

Myocardial Infarction (MI)

complete coronary artery blockage causing myocardial tissue death. better known as a heart attack

Stable Ischemia

Reduced myocardial oxygen supply occurring during exertion

Stable Angina

Reduced myocardial oxygen supply occurring during exertion/exercise and symptoms will improve during rest

Unstable Ischemia

symptoms may occur at rest and are unpredictable, classified as a medical emergency, does not qualify for exercise testing

Angina

chest discomfort/pain caused by myocardial ischemia

PCI

percutaneous coronary intervention

balloon angioplasty and stent placement

CABG

• Coronary artery bypass graft

• Surgical rerouting of blood around blocked coronary arteries

CHF/HFrEF

Heart Failure with reduced ejection fraction (EF of less than 40%)

Expected BP response during exercise

SBP increases and DBP remains stable

High LDL “bad cholesterol”

130mh/dL or higher

• associated with CAD risk

T1DM

insulin deficiency due to beta-cell destruction

T2DM

insulin resistance

• strongly associated with excess abdominal fat

1 MET equals how many mL/kg/min?

3.5 mL/kg/min

Conversion from VO2 to METs

VO2/3.5

Conversation from METs to VO2

METs x 3.5

HHR

HRmax-HRrest

Karvonen Formula

Target HR= (HRR x %workload) + HRrest

VO2 Reserve Formula

VO2max-3.5

Target VO2 Formula

(target% x VO2R) + 3.5

walking equation (VO2)

VO2 = 3.5 + (0.1 x speed) + (1.8 x speed x grade)

running equation VO2

VO2 = 3.5 (0.2 x speed) + (0.9 x speed x grade)

cycle equation VO2

VO2 = 7 + [(1.8x work rate) / body mass]

kcals per minute

(METs x 3.5 x body mass kg) / 200

calories per pound

3500 kcal = 1 lb

Ace Inhibitors

• Allows blood vessels to dilate to lower blood pressure

• Retains water

• Dry cough, hyperkalemia (high potassium levels), fatigue, dizziness, headache, loss of taste, rash, kidney failure

Angiotensin Receptor Blockers (Losartan, Valsartan)

• prevents a hormone from working which means the blood vessels will not constrict, resulting in lower blood pressure

• dizziness, headache, fatigue, nausea, vomiting, diarrhea, hyperkalemia, low blood pressure, muscle or bone pain, rash

Anticoagulants

• prevent blood clots from forming in the blood in the blood vessels

• can dissolve clots that have already formed

• indigestion , constipation, diarrhea, fatigue, fatigue, rash, hair loss, jaundice (yellowing of the skin), bleeding, anemia, abdominal pain, fever

Antiplatelet Agents

• prevents platelets from forming which causes the blood to thin slightly

• increase bleeding, nose bleeds, blood in stool, urine, vomit, abdominal pain, headache, dizziness, nausea, constipation, diarrhea, indigestion

Beta Blockers (Propanalol, Metropolol)

• prevents adrenaline release

• increases blood pressure that prevents adrenaline from attaching to the heart

• lowers blood pressure and slows heart rate

• dizziness, fatigue, cold hands and feet, headache, upset stomach, weight gain

calcium channel blockers (amlodipine, nicardipine)

• prevents calcium from helping heart and blood vessels work effectively

• allows muscles of the heart and the walls of the vessels to relax ad the arteries to open up wider

• lowers blood pressure and improvers the amount of blood returning to the heart

• low blood pressure, slow heart rate, fatigue, constipation, swelling of feet and ankles, GERD, increased appetite

Clot Dissolving Agents (Alteplase, Tissue Plasminogen Activator)

• Dissolves bloods clots very fast, these are used immediately for a heart attack or stroke

• bleeding, low blood pressure, fever, allergic reaction

Digoxin (digitalis)

• increases the calcium to the heart cells which will increase the strength of the heart beat. used to alleviate symptoms of heart failure caused by weakened heart muscle

• can sometimes be used to control certain arrhythmias

• dizziness, mental disturbances, headache, nausea, diarrhea, rash

Diuretics (Loop Diuretic - Furosemide, Thiazide Diuretic)

• removes fluid form the body which causes urination

• can help lower blood pressure

• can cause low sodium levels, headache, dizziness, thirst, muscle cramps, diarrhea, gout, rash, dehydration

nitrates (nitroglycerin)

• Widens arteries and veins, which improves blood flow

• The heart does not have to beat as hard, which helps with angina

• mild anti-clotting factor