Exercise Intensity Scales, Cardiac Output, Cardiac Rehabilitation, and Cardiac Medications

Flashcards covering exercise intensity scales, cardiac output, phases of cardiac rehabilitation, and common cardiac medications for exam preparation.

RPE Scale (Rate of Perceived Exertion – Borg)

A scale that measures how hard a person feels they are working.

Original Borg Scale

An RPE scale ranging from 6 (No exertion at all) to 20 (Maximal exertion), where value × 10 approximately corresponds to heart rate.

Modified Borg Scale

An RPE scale ranging from 0 (Nothing at all) to 10 (Maximal).

METs (Metabolic Equivalents)

A measure of the energy cost of activities, where 1 MET equals resting oxygen consumption (~3.5 mL O₂/kg/min).

Cardiac Output (CO)

The volume of blood pumped by the heart per minute, calculated by Heart Rate × Stroke Volume. Normal resting values are ~4–6 L/min.

Stroke Volume (SV)

The amount of blood pumped by the left ventricle in one contraction, typically ~60–100 mL/beat.

Preload (Determinant of CO)

A factor determining cardiac output, related to venous return to the heart.

Afterload (Determinant of CO)

A factor determining cardiac output, related to the resistance the heart must overcome to pump blood into the arteries.

Cardiac Rehabilitation Phase I (Inpatient/Acute)

The hospital-based phase after a cardiac event, focusing on early mobilization and education, typically lasting 3–7 days with 1–4 METs intensity.

Cardiac Rehabilitation Phase II (Outpatient/Subacute)

The medically supervised outpatient phase focusing on a structured exercise program and lifestyle modification, typically lasting 6–12 weeks with 4–9 METs intensity.

Cardiac Rehabilitation Phase III (Maintenance/Training)

A community-based or outpatient phase with less supervision, focusing on independent but structured exercise, with intensity typically ≥5–10 METs.

Cardiac Rehabilitation Phase IV (Lifetime Maintenance)

The lifelong phase of cardiac rehabilitation focusing on long-term adherence to a healthy lifestyle and independent exercise.

Beta-Blockers (e.g., Metoprolol)

Medications that decrease heart rate, blood pressure, and myocardial oxygen demand, used for hypertension, CAD, angina, and post-MI. RPE should be used to monitor exercise intensity as HR response can be blunted.

ACE Inhibitors (e.g., Lisinopril)

Medications that cause vasodilation, decrease blood pressure, and afterload, primarily used for hypertension, CHF, and post-MI. Watch for dizziness/orthostatic hypotension.

ARBs (Angiotensin II Receptor Blockers) (e.g., Losartan)

Medications that cause vasodilation and decrease blood pressure, used for hypertension and CHF (especially if ACEIs are not tolerated), with less dry cough than ACEIs.

Calcium Channel Blockers (e.g., Amlodipine)

Medications that decrease heart rate, cause vasodilation, and decrease oxygen demand, used for hypertension, angina, and arrhythmias. May cause dizziness or ankle swelling.

Diuretics (e.g., Furosemide)

Medications that increase urine output to decrease preload and blood pressure, used for CHF, hypertension, and pulmonary edema. Side effects include dehydration and electrolyte imbalance.

Nitrates (e.g., Nitroglycerin)

Medications that cause vasodilation to decrease myocardial oxygen demand, primarily used for angina and CAD. Patients should sit/lie down after use due to dizziness/hypotension.

Antiplatelets (e.g., Aspirin, Clopidogrel)

Medications that prevent clot formation by inhibiting platelet aggregation, used for CAD, post-MI, and DVT/PE prevention. Caution with manual therapy due to increased bleeding risk.

Anticoagulants (e.g., Warfarin, Heparin)

Medications that prevent clot formation by interfering with coagulation factors, used for AFib, DVT/PE prevention, and valve replacement. Monitor for signs of bleeding.

Statins (e.g., Atorvastatin, Simvastatin)

Medications that decrease LDL cholesterol, used for hyperlipidemia and atherosclerosis prevention. Patients should report unexplained muscle pain as it could indicate myopathy.

RPE use (Physical Therapy Note)

Often used when patients are on beta-blockers because their heart rate response is blunted and unreliable for monitoring exercise intensity.

MET tolerance (Physical Therapy Note)

A key progression marker in cardiac rehabilitation, indicating the patient's ability to perform activities of increasing energy cost.

Stop exercise indications

Angina, significant ST changes on ECG, abnormal blood pressure response, dizziness, or pallor are signs to discontinue exercise immediately.