Special Pops Exam 1

What is revascularization

What is revascularization

a surgical procedure to help provide new or additional blood supply to a body part or organ

Contraindications for Cardiac rehab

unstable angina, uncontrolled hypertension( resting sBP >180 and/or resting dBP>110), orthostatic BP drop of >20 with symptoms, significant aortic stenosis, uncontrolled atrial or ventricular arrhythmias, uncontrolled sinus tachycardia, uncompensated heart failure, 3rd degree atrioventricular block w/o pacemaker, active pericarditis or myocarditis, recent embolism(pulmonary or systemic), acute thrombosis, aortic dissection, acute systemic illness or fever, uncontrolled diabetes mellitus, severe orthopedic conditions that prohibit exercise, other metabolic conditions, such as acute thyroiditis, hypokalemia, hyperkaemia, or hypovolemia, sever psychological disorder

how does revascularization develop/progress

clinically significant occlusion (> 50-75%),stability of plaque, location of lesion

Difference between PTCA and CABG

Coronary Artery Bypass Graft (CABG) takes a graft from an arm or leg and is used to bypass the diseased coronary artery beyond the site of occluded area

Pecutaneous Transluminal Coronary Angioplasty (PTCA)- balloon surgery - inflation of the balloon compresses the lesion

under what circumstances would you have a CABG instead of a PTCA

Older people are more likely to have a CABG

Significant left main coronary artery disease; multi-vessel occlusion; failed PTCA/PTCA + stent; technically difficult vessel lesions (ex. on the curve of a vessel; distal location not amendable to angioplasty or stenting)

potential complications of PTCA

Reocclusion, restenosis, acute thrombosis occlusion, MI, arrythmias, dissection of coronary artery, bleeding

advantage of drug-eluting stents*

Stents are being coated with medications to prevent plaque formation and scar tissue from forming, Restenosis rates have dropped to below 5%

positive physiological adaptations post-surgery (ex. effects on exercise capacity)

increase on exercise/functional capacity evident immediately, increased resting heart rate (+ 30 bpm),

how long should you wait to perform exercise test post-CABG

3-4 weeks postsurgury

8 ACSM positive risk factors

Age, family history, smoking, physical inactivity, BMI/ waist circumference, BP, Lipids, blood glucose

Negative risk factor

HDL

Risk factor: Age

Men >45, women >55

Risk Factor: Family history

MI, coronary revascularization, or sudden death before 55 years in father or other male first-degree relative, or before 65 years in mother of other female first-degree relative. 

Risk Factor: Smoking

current smoker or those who quit within the previous 6 months or exposure to environmental tobacco smoke

Risk factor: Physical inactivity

not meeting the minimum threshold of 75-150 min/wk mod to vig intensity PA

Risk factor: BMI/ waist circumference

BMI >30, waist girth >102 cm for men and >88cm for women

Risk factor: BP

systolic BP >130 mmHg or DBP >80 mmHg, confirmed by measurements on at least two separate occasions, or on antihypertensive medication

Risk factor: Lipids

LDL >130 mg/dL or HDL <40 mg/dL, or on lipid-lowering medication.  If total cholesterol is all that is available use >200 mg/dL

Risk factor: blood glucose

Fasting BG >100 mg/dL

Negative risk factor: HDL

>60mg/dL

BMI equation

lb/(in²) x 703 or kg/m²

If you do not have GXT info, what guidelines do you follow for cardio intensity during cardiac rehab?

In outpatient cardiac rehab, without an exercise test, use seated or standing resting heart rate +20 to +30 BPM
- or use an RPE or 12-16

What is peripheral edema/ cause of it

Accumulation of fluid in tissues perfused by the peripheral vascular system, usually the lower limbs and causes swelling - sign of heart failure

What is paroxysmal nocturnal dyspnea?

waking to catch breath

Indicators or red flags to get medical clearance before testing or training a patient (ex. signs/symptoms)

-pain, discomfort in chest, neck, jaw, arms or other areas that may result from myocardial ischemia
-shortness of breath at rest or with mild exertions
-dizziness or syncope
-ankle edema
-palpitations or tachycardia
-intermittent claudication
-known heart murmur
-unusual fatigue or shortness of breath with usual activities

During a GXT, what signs/symptoms/results would indicate the patient is high risk for a cardiac event

-onset of angina or angina like symptoms
-drop in SBP > or equal to 10 mmHg with an increase in work rate or if SBP decreases below the value obtained in the same position prior to testing
-excessive rise in BP: systolic > 250 or diastolic > 115
-SOB, wheezing, leg cramps, or claudication
-signs of poor perfusion: light headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin
-failure of HR to increase with increased exercise intensity
-noticeable change in heart rhythm by palpitation or ausculation
-subject requests to stop
-physical or verbal manifestations of severe fatigue
-failure of testing equipment

Indications FOR performing a GXT (when should you do them?) / Indications for termination of a GXT (when should you stop?)

-to evaluate chest pain as a means to assist in the diagnosis of CAD
-to identify a patients future risk or prognosis
-quantification of change due to an exercise training program or a medical or surgical intervention
-assessment of syncope or near-syncope, exercise induced asthma, exercise induced arrhythmias, and pacemaker or HR response to exercise
-Assessment of BP response to exercise
-Assessment for the purpose of guiding return to work
-Preoperative clearance

What difference(s) is/are found in VO2peak results between treadmill and leg ergometry?

Treadmill VO2 peak is higher than leg ergometry VO2 peak

Primary focus of INPATIENT cardiac rehab for MI patients (what should they be focusing on before leaving the hospital)

- activities including self care, arm and leg ROM, postural changes, limited and supervised ambulation, upper body exercises and minimal stair climbing in preparation for returning home
- patient and family education - introduction of concepts of secondary prevention of atherosclerosis to patients and family members
- exposure to the normal stress of gravity to prevent orthostatic intolerance

Post MI, reasons for doing GXT?

To check heart health

Post MI, How long before starting resistance training

2-5 weeks after the cardiovascular event

Recommended intensity for cardiac training? post MI

RPE 11-16, 40-80% of exercise capacity

For patients with ischemic chest pain, what intensity guidelines should you follow during exercise?

10 BPM below ischemic threshold

Characteristics (signs/symptoms) of patients with heart failure

-exercise intolerance (SOB with exertion, fatigue with very light exertion)
-fluid retention (peripheral edema, weight gain, recent)
-difficulty breathing while sleeping flat (supine - orthopnea)
-paroxysmal nocturnal dysnpea (waking up to catch breath - accompanied by coughing and SOB)
-fluid in lungs (Rales - pulmonary congestion that causes crackling noises)

Review info on cardiac transplantation

Donated heart is permanently decentralized
- except for the parasympathetic nerve fibers that are left in tact, all other autonomic fibers are severed and not connected in the new body

Cardiac response to bouts of acute exercise differ from the normal response (absence of parasympathetic input)
-Resting HR may be 90-100 bpm, so when exercise begins, the HR may change very little

-At peak exercise, HR is lower, and both cardiac output and SV are approximately 25% lower than normal
-Decline of HR in recovery takes longer than normal

What should you monitor during GXT and why

monitor ECG, BP, and RPE and dyspnea scales

- symptoms are typically seen in less than 5 METs so a lower level moderately incremented exercise test is recommended
- a more gradual exercise testing protocol should be employed due to the elevated HR and BP at rest

why are symptom-limited max tests recommended vs. using equations for estimating VO2

more accurate results

what is meant by decentralized

decentralized - transfer from one location to another

COPD includes what conditions?

Chronic Bronchitis or Emphysema

What is the primary cause of COPD?

Cigarette smoking

FEV-1 stages

mild
moderate
severe
very severe

FEV-1 stage: mild

fev1/fvc < 0.70

fev1 > 80% of predicted

FEV-1 stage: moderate

fev1/fvc < 0.70
fev1/fvc between 50 and 80%

FEV-1 stage: severe

- fev1/fvc < 0.70
- fev1 between 30 and 50%

FEV-1 stage: very severe

- fev1/fvc < 0.70
- fev1 less than 30% or less than 50% of predicted with respiratory failure

Inappropriate mode of exercise training for COPD patient / why is it inappropriate?

ARM ERGOMETRY
patients often use the accessory muscles of inspiration for breathing at rest
any additional burden placed on these muscles could result in significant symptoms and distress

Resistance program recommendations for COPD patient

2-3 days/week
50-85% of 1RM
8-10 muscle groups
1 set or more
8-10 reps up to 15 reps
focus on UPPER BODY EXERCISES because ADLs using upper body muscles causes greater dyspnea

Goals of cardio training for COPD patient

3-5 days/week
30-80% of VO2 peak or symptom limited
dyspnea scale 4-6 (on 10 pt scale)
as tolerated working for 30-60 mins
walking (incremental - bouts), cycling
if O2 saturation gets < 88% the use of O2 is strongly recommended

Treatment for COPD is comprehensive – what all is included?

smoking cessation
oxygen therapy (preserves exercise tolerance)
pharmacological therapy
pulmonary rehab
**smoking cessation and oxygen therapy are shown to improve survival rate in patients with COPD

Recommended strategies for exercise training COPD patients

Increase duration before intensity

whole-body training is effective and recommended

Does not participate in regular exercise and no CV, metabolic or renal disease AND no signs or symptoms of CV, metabolic, or renal disease

Medical clearance not necessary, light-to-moderate intensity, may gradually increase to vigorous

Does not participate in regular exercise and known CV, metabolic or renal disease AND asymptomatic

medical clearance recommended, light-to-moderate intensity, may gradually increase as tolerated

Does not participate in regular exercise, Any signs or symptoms suggestive of CV, metabolic, or renal disease (regardless of disease status)

medical clearance recommended, light-to-moderate intensity, may gradually increase as tolerated

participates in regular exercise, no CV, metabolic or renal disease AND no signs or symptoms of CV, metabolic, or renal disease

Medical clearance not necessary, may continue moderate or vigorous intensity exercise

participates in regular exercise, known CV, metabolic or renal disease AND asymptomatic

Medical clearance for moderate intensity not necessary, medical clearance (w/in last 12 months if no change in signs/symptoms) recommended before engaging in vigorous intensity exercise

participates in regular exercise, Any signs or symptoms suggestive of CV, metabolic, or renal disease (regardless of disease status)

discontinue exercise and seek medical clearance, may return to exercise after medical clearance

FITT for cardio

F: at least 3 d/wk

I: Moderate(40-59% HRR) and or vigorous(60-89% HRR)

T: 30-60 minutes moderate, 20-60 minutes vigorous

T: continuous or intermittent sessions involving main muscle groups

FITT for Resistance

F: at least 2d/wk (main muscle groups)

I: for novice, 60-70% 1-RM, performed for 8-12 repetitions

T: multi-joint, singular joint, core, equipment and body weight

FITT for flexibility

F: 2-3 d/wk (daily most effective)

I: to the point of feeling tightness or slight discomfort

T: static for 10-30 sec, 30-60 sec for older individuals, PNF stretching 3-6 sec light to moderate contraction followed by a 10-30 sec assisted stretch

T: each major muscle- tendon group, static, dynamic, ballistic, and PNF