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Exam 2 - ExRx for those with Cardiovascular and Pulmonary Diseases Questions With Correct Solutions, Already Passed!!
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Where in the blood vessels are clots most likely? - Where there is branching? Cardiac Rehabilitation (CR) • Ex and lifestyle interventions • Currently, ........... insurance reimburses for CR for MI/acute coronary syndrome, CABG, PTCA, stable angina, valve repair/replacement, CHF, and heart...

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  • August 16, 2024
  • 31
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • exam 2 exrx for those with cardiovascular

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  • ExRx for those with Cardiovascular and Pu
  • ExRx for those with Cardiovascular and Pu

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PatrickKaylian

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Exam 2 - ExRx for those with
Cardiovascular and Pulmonary Diseases
Where in the blood vessels are clots most likely? - Where there is branching?



Cardiac Rehabilitation (CR)

• Ex and lifestyle interventions

• Currently, ........... insurance reimburses for CR for MI/acute coronary syndrome, CABG, PTCA, stable
angina, valve repair/replacement, CHF, and heart transplant.



Injury to the endothelium (many causes) → .......

-2 main causes? - endothelial dysfunction...

-high Blood Pressure (results in higher turbulent flow - excessive pounding on endothelial cells)

-glycosolated haemoglobin = HbA1c (% of Hb that has glycogen attached) (spikes of the glucose rake the
endothelial layer causing it to become damaged)



Endothelial dysfunction causes .....

-5 step process? - -disturbed blood flow which causes

-endothelial cell activation (since the cells have been damaged)

-recruitment of inflammatory cells to vessel wall (WBCs arrive here)

-cell signaling facilitates LDL retention in tunica intima (LDL is used to help the endothelial layer heal but
if too much LDL is retained, it can lead to blood clotting).

-oxidative modification by ROS and inflammatory enzymes



What is the problem with hypertension/diabetes in terms of the effect on endothelial dysfunction? -
Can cause accumulation of lipids as endothelial layer is constantly being damaged



Accumulation of lipids

-5 step process? - ↳ monocytes become macrophages which try to digest mLDL. When the
macrophages cannot digest any more mLDL, they become foam cells

,↳endoplasmic reticulum stress triggers foam cell apoptosis (organised programmed cell death)

↳Efferocytic program (burying of cells) cannot keep up with source of apoptotic formation

↳Apoptotic cells that aren't being destroyed properly undergo secondary necrosis forming necotic core =
atherosclerotic plaque (purple blob on my pic)

•Unstable and vulnerable to disruption.



2 effects of atherosclerotic plaques developing - -can cause clotting at site of plaque in response
to internal bleeding

-plaque can break off and travel in blood to cause clotting elsewhere



• ..... and ..... (2 phases of CR) - -Medicare/private

-Inpatient and Outpatient



Inpatient Cardiac Rehabilitation: Guidelines

• Current clinical status ..........

• Mobilization

• Identification and provision of information regarding modifiable ..... factors and .....

• Discharge planning with a home ..... and .....

• Referral to .......... CR - -assessment

-risk; self-care

-PA; ADL (activities of daily living)

-outpatient



Inpatient Cardiac Rehabilitation: Guidelines

• ........ Assessments

￮ Note: diagnosis, current medical status, comorbidities, CVD risk factors, personalized goals, as well as
readiness for PA and learning.

• Supervised daily .......

￮ Intermittent ....... or ........ 12-24hrs after MI

,⁃ purpose of this?

⁃ Should include documentation of .....

• Individual education on modifiable ..... factors

￮ After physical ability and psychological willingness is ...... - • Clinical

• ambulation (moving/walking)

￮ sitting; standing

⁃ "prevent" exercise performance decrements

⁃ vital signs

• risk

￮ known



Inpatient Cardiac Rehabilitation: Guidelines

• Before discharge:

￮ Need to know ........ activities (Heavy lifting, climbing stairs, yard work, etc)

￮ Need to have a ..... plan of exercise

￮ Individuals should know how to identify ...... signs and symptoms

￮ Individuals should be strongly encouraged to participate in .......... - -permissible (what they can
do and what they want to do and help them achieve these things)

-safe

-abnormal

-outpatient CR program



American Association of Cardiovascular and

Pulmonary Rehabilitation (AACVPR) Parameters

for Inpatient Cardiac Rehabilitation Daily

Ambulation



- No new or recurrent ....... in previous 8 h

, - Stable or falling ................. (indicative of damage if CK high) and troponin values

- No indication of decompensated (worsening of) .............. (e.g., resting dyspnea and bibasilar rales)

- Normal cardiac rhythm and stable electrocardiogram for previous ..... hours - - chest pain

- creatine kinase

- heart failure

- 8 hours



Indications and Contraindications for Inpatient and Outpatient Cardiac Rehabilitation



*Indications = conditions with which you SHOULD got to CR outpatient*



• Medically ...... postmyocardial infarction

• ...... angina

• Coronary artery ......... graft (surgery)

• Percutaneous transluminal coronary angioplasty - what is this?

• Stable .......... caused by either systolic or diastolic dysfunction

(cardiomyopathy)

• ...... transplantation

• ......... heart disease/surgery

• .......... arterial disease

• At risk for ............. artery disease with diagnoses of diabetes mellitus, dyslipidemia, hypertension, or
obesity

• Other individuals who may benefit from structured exercise and/or

individual education based on ......... referral and consensus of the .......... team - • stable

• Stable

• bypass

• a minimally invasive procedure that opens blocked coronary arteries to improve blood flow to the
heart muscle

• heart failure

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