Final Exam Prevention and Health Promotion / CVD in Women Ch. 4&20

What patients qualify for need of primary prevention?

at high or moderate risk for CVD prior to diagnosis.

What 4 things do primary prevention programs target?

1. Resting BP

2. Blood sugar Education

3. Cholesterol

4. Sedentary Lifestyle

When in a persons life should primary prevention for CVD begin?

20 years old, repeating every 4-6 years (more for those of higher risk)

What are the components of the ABCDE checklist for atherosclerotic cardiovascular disease programs? (ASCVD)

- Assess risk (aspirin)

- Blood pressure <130/80

- Cholesterol and Cigarettes

- Diet and Diabetes

- Exercise

Through what phase of cardiac rehab does medicare cover?

through phase 2 only

What outcome measure is used to measure exercise readiness prior to starting an exercise program?

PAR-Q+

What is the PAR-Q+? purpose, results...

- 7 step physical activity readiness questions with 10 follow up questions about risk factors

- if yes to any of the questions the patient is not cleared for exercise

If someone is on blood pressure medication does it remove the high blood pressure risk factor?

no

For hypertension what are the risk assessment goals?

- <140/90mmhg

- >30 minutes of moderate exercise daily

- LDL <160 if 1 or less risk factors and <100 if >1 risk factors

- drug therapy if triglycerides >150 or HDL <40

For weight management what are the risk assessment goals?

- BMI 18.5-24.9

- waist circumference <40 for men and <35 for women

- stop smoking

- normal glucose

For dietary intake what are the risk assessment goals?

- healthy diet

- limit saturated fats, cholesterol, salt intake and alcohol (no fun)

What patients qualify for cardiovascular rehabilitation?

patients who have been diagnosed with existing primary or secondary cardiovascular disease

What is the first phase of cardiac rehab?

acute, in-hospital

What is the second phase of cardiac rehab?

early outpatient or intensive monitoring

What is the third phase of cardiac rehab?

training and maintenance

What is the fourth phase of cardiac rehab?

primary prevention for high-risk patients

In phase 1 of cardiac rehab when is the patient ambulating, when are they moved to a step down unit and when are they normally discharged?

- ambulating day 2 post-surgical (CABG)

- step-down unit after 24-48 hours

- D/C in 2 days

How many sessions of outpatient phase 2 cardiac rehab will medicare cover? What is the ideal frequency?

36 hard max

3 days per week for 12 weeks

How many sessions of phase 3 cardiac rehab will medicare cover? What is the ideal frequency?

none

recommended 2-3 days a week for 3 months

How many sessions of phase 4 cardiac rehab will medicare cover? What is the ideal frequency?

none

not formal just rest of life

What patients are not good candidates for cardiac rehab?

- overt HF

- unstable angina pectoris

- hemodynamic instability

- serious arrhythmias

- conduction defects

- impaired function of other organ systems

- uncontrolled hypertension

- healthy individuals (obviously but she mentions not mixing the 2 populations as peoples feelings can get hurt)

What is the primary goal for cardiac rehab phase 1?

safety performing activities in the home and increasing knowledge of disease

What is the ceiling HR for cardiac rehab phase 1?

120 or greater

What is the ideal frequency for phase 1 cardiac rehab?

1x/day for 10-15 minutes (10 minutes for modified programs)

According to the McNeer criteria what are the factors for complicated MI? (9)

- poor ventricular function

- significant ischemia with low-level activity

- cardiogenic shock

- ventricular tachycardiaa and/or fibrillation

- atrial flutter or fibrillation

- 2nd or 3rd degree heart block

- persistent sinus tachycardia (HR >100 at rest)

- persistent systolic hypotension (systolic BP <90 at rest)

- Pulmonary Edema

What are the 7 indications to modify phase 1 cardiac rehab? (7)

- large infarction

- resting tachycardia or inappropriate HR response

- BP failing to rise or decrease with self-care activities

- ECG revealing >6-8 PVC/min or progressive heart block

- angina or undue fatigue with self care activities

- bedrest longer than 4 days

- complications per McNeer criteria

What classifies someone as a high risk subset that would cause you to withold phase 1 cardiac rehab? (5)

- recurrent malignant arrhythmias

- angina at rest

- 2nd or 3rd degree heart block

- persistent hypotension

- rapid atrial rhythm

What are the 2 indications to withold phase 1 cardiac rehab?

- severe pump failure

- classification in a high-risk subset

What 2 procedures are done with a median sternotomy?

CABG and LVAD placement

How long are sternal precautions ussually in place?

6-12 weeks

What is the lifting restriction for sternal precautions?

5-10 lbs

Describe what tube precautions are for sternotomy?

begins immediately post op and is where weighted and resisted movements should not move away from midline (like your in a tube)

What are some general precautions for phase 1 rehab?

- do not initiate exercise within 1 hour of eating (worried about vomiting)

- avoid isometric exercise and breath holding

- assess vitals

What are some relative contraindications for continuing exercise? (same as last exam - theres a bunch) (10)

- unusual heart rate increase (>50 bpm with low level activity)

- Hypertension (>210/>110)

- drop in SBP >10 with low level exercise

- angina 1/4

- excessive dyspnea 2+/4+

- excessive fatigue or mental confusion

- severe leg claudication

- pallor, cold sweat or ataxia

- heart or lung sound changes (may hear lung sounds without auscultation infections are so quick)

- ECG abnormality

Describe the 5 grade angina scale?

0 - no angina

1 - light, barely noticeable

2 - moderate, bothersome

3 - severe pre-infarction pain

4 - excruciating infarction pain

Describe the 5 grade dyspnea scale?

0 - no dyspnea

1 - mild

2 - mild some difficulty

3 - moderate cannot continue

4 - severe cannot continue

What are some specific outcome measures used in acute phase (1) of cardiac rehab?

- self management of symptoms

- patient knowledge

- aerobic capacity (how far can they walk?)

- self care and home management tasks

- symptoms associated with increased O2 demand

- level of assistance

- safety with all activities

When should D/C planning begin from phase 1 cardiac rehab?

at least a day in advance

how soon after finishing phase 1 cardiac rehab should phase 2 begin?

2-3 days after D/C

Who dies of CVD more each year men or women?

women

What age and why is there a significant increase in risk and prevalence and CAD in women?

60 years old

- menopause

Do the majority of women with CVD show symptoms of the CVD before death?

no

What are the risk factors for women and how many of the risk factors increase there chance of developing CVD? (what perctage as well?)

- smoking

- physical inactivity - 3METs on bruce protocol max had 3x greater risk of death

- obesity

- hypertension - black women

- high cholesterol - increase in 1 mmol/L tryglycerides

- diet and diabetes

- stress, age and history - acute MI highly associated with stress and depression

50% increase if 2 or more risk factors

Name who's is higher and who's is lower, men or women, total peripheral resistance?

men higher

women lower

Name who's is higher and who's is lower, men or women, blood volume

men higher

women lower

Name who's is higher and who's is lower, men or women, left ventricular EF time?

men longer

women shorter

Name who's is higher and who's is lower, men or women, heart rates?

men lower

women higher

Name who's is higher and who's is lower, men or women, stress induced rised in BP and pulse pressure?

men lower pulse pressure but greater rise in BP due to stress

women higher pulse pressure but lower rise in BP due to stress

Name who's is higher and who's is lower, men or women, stress response related to hormone status?

men unlisted LOL

women higher the estrogen level, less arterial pressure increase

What is preclampsia?

Preeclampsia is linked to improper development of the placenta, which leads to poor blood flow and causes a release of inflammatory proteins into the mother's blood, resulting in damage to her blood vessels

- causes elevated HR and BP typically during or postpartum

Is alcohol healthy?

Hell yeah 1 glass a wine a day (does not transfer to 7 glasses 1 day of the week;)

When do women often have "angina"?

at night and during stressful events

What percentage of women with STEMI do not have obstructive CAD?

10-20%

What is an independent predictor of CAD?

brachial pulse pressure

Why do women with non-obstructive CAD have a 16% risk of CVD event?

microvascular dysfunction or disease, distal emboli, hormonal influences

What qualifies a women as high risk status in exercise stress testing?

ST segment changes >2mm depression, down sloping or horizontal at low workloads

What is the duke treadmill score?

uses standard bruce protocol, measures maximum net ST segment deviation (depression or elevation) and exercise induced angina

independent predictor of mortality and cardiac mortality in asymptomatic women

What are the limitations of SPECT even though it is recommened for symptomatic women with intermediate to high pretest likelyhood of CAD?

breast tissue and obesity, radiation exposure, women have smaller hearts

What is the DASI?

Duke activity status index

- subjective questionnaire on ADLs

- 2/3 of CVD events = women who score under 4.7 METs

Is the Framingham risk score good for women?

no undrestimates risk of CAD in women

What is the Reynolds risk score and is it good for women?

yes

- includes age, BP, hemoglobin, A1C, smoking, total and HDL cholesterol, CRP, and parental history

What reduces the gender mortility gap?

when they receive guideline indicated therapies

Do women or men experience more cardiac catheterization and revascularization?

men, women undergo less

How are women normally treated with non-obstructive CAD?

treated with reassurance, sedative hypnotic prescriptions and repeat hospitalizations

How should women be treated with non-obstructive CAD?

- she said target the microvascular changes

(however if there are not any well researched drugs that will work and its not obstructive and the majority of deaths occur as a result of stress induce MI wouldn't stress managment be a primary treatment?????)

Do women or men experience more relief following a CABG?

men experience more relief (obviously if a majority of womens CAD is non-obstructive theres not much to fix with a CABG...)

During pregnancy how does HR, blood volume, CO, stroke volume, VO2 and vascular resistance respond?

- HR, blood volume, CO and stroke volume increasein 2nd trimester and reduces in 3rd

- VO2 increases

- systemic vascular resistance reduces

What is the screening for posttraumatic stress disorder? (its alot)

2 or more of the following

problems sleeping

outbursts of anger

recklessness

problems concentrating

feeling on guard

exaggerated startle response

(then a bunch about dreams, flashbacks and avoiding thoughts or situations)

Name a few forms of secondary prevention in cardiac rehab?

diet, exercise, counseling and smoking cessation

What should the intensity of exercise be for cardiac rehab aerobic training to achieve benefits for reduced RHR and improve stroke volume?

What about if the person is severely imparied?

70-85% maximal HR

40-50%

What must the person do before discharding a HR modifying medication?

get an exercise stress test

What perceived exertion score is equivalent to the ventilatory/anaerobic threshold?

13/20 (somewhat hard_

What is an abnormal response to exercise when it comes to exercise hypertension?

anything above 180/110

or drop of 20mmHg of systolic

Stable cardiac patients can exercise up to what level on the angina scale?

1/4

How does altitude influence exercise programs?

above 3500' the body increases HR to meet CO (angina may occur faster)

How does cold influence exercise programs?

increases peripheral resistance at rest and during exercise so can increase BP and symptomos of ischemia

How does heat and humidity influence exercise programs?

dilation of peripheral vasculature and HR increases to maintain CO

What temperatures and humidity should exercise be voided

no vigorous exercise or activity above 75 degrees or humidity greater than 65-70%