AACVPR CCRP cheat sheet

Cardiac rehabilitation has four phases: Phase I inpatient, Phase II early outpatient (typically 2-12 weeks with ECG monitoring), Phase III late outpatient, and Phase IV long-term maintenance.

Medicare covers up to 36 cardiac rehabilitation sessions over 36 weeks; intensive cardiac rehabilitation (ICR) covers up to 72 sessions over 36 weeks.

Medicare-qualifying diagnoses include acute MI within 12 months, CABG, PCI, stable angina, heart valve repair or replacement, and heart or heart-lung transplant.

Exercise sessions require physician supervision, meaning a physician is immediately available and accessible on site or by telephone to manage emergencies.

AACVPR core components: patient assessment, exercise training, physical activity counseling, nutritional counseling, weight, blood pressure, lipid, diabetes, and tobacco management, plus psychosocial management.

Required emergency equipment includes a defibrillator, crash cart, oxygen, suction, and airway equipment, checked on a defined schedule.

Staff supervising exercise must hold current BLS; ACLS is expected for staff managing higher-risk patients and emergency response.

Programs track outcomes such as functional capacity (6-minute walk distance, peak METs), quality of life scores, risk factor control, and adverse events.

1 MET equals 3.5 mL O2/kg/min; estimated functional capacity in METs is peak VO2 (mL/kg/min) divided by 3.5.

NYHA classification: I = no symptoms with ordinary activity; II = slight limitation; III = marked limitation with less-than-ordinary activity; IV = symptoms at rest.

Estimated maximal heart rate = 220 minus age; the Tanaka equation (208 minus 0.7 times age) is an alternative for adults.

Karvonen target heart rate = [(HRmax - HRrest) x intensity fraction] + HRrest.

Rate-pressure product = systolic blood pressure x heart rate; it indexes myocardial oxygen demand and helps locate the angina threshold.

Absolute contraindications to exercise include unstable angina, resting SBP above 200 mmHg or DBP above 110 mmHg, uncontrolled arrhythmia, decompensated heart failure, and acute illness.

Borg RPE 6-20: ratings of 11-13 correspond to moderate intensity (roughly 40-60% heart rate reserve); 14-16 corresponds to hard intensity.

A change of approximately 25 meters in 6-minute walk distance is generally treated as clinically meaningful in cardiac populations.

A PHQ-9 score of 10 or higher suggests clinically significant depression and triggers further evaluation or referral.

Aerobic FITT: 3-5 days per week, 40-80% of heart rate reserve or 50-80% of VO2peak, 20-60 minutes per session, with gradual progression.

Resistance training: 2-3 days per week, 1-3 sets of 8-12 repetitions at 40-60% 1RM for upper body and 50-70% 1RM for lower body.

Warm-up and cool-down of 5-10 minutes each reduce the risk of exercise-induced ischemia, hypotension, and arrhythmia.

Terminate a graded exercise test for ST depression of 2 mm or more, exertional SBP fall of 10 mmHg or more, SBP above 250 or DBP above 115 mmHg, sustained ventricular tachycardia, or severe angina.

When exercise-induced ischemia is present, prescribe a training heart rate at least 10 beats per minute below the ischemic threshold heart rate.

Heart rate recovery of 12 beats per minute or less at one minute after exercise is an abnormal finding associated with increased mortality.

Arm ergometry produces a peak VO2 roughly 10-20% lower than leg ergometry and is used when lower-extremity exercise is limited.

Beta blocker therapy blunts the heart rate response, so intensity is prescribed using RPE and symptom scores in addition to heart rate targets.

Beta blockers lower heart rate, blood pressure, and myocardial oxygen demand; the blunted chronotropic response requires RPE-based intensity prescription.

Sublingual nitroglycerin 0.4 mg may be repeated every 5 minutes for up to 3 doses; it is contraindicated within 24 hours of sildenafil and 48 hours of tadalafil.

ACE inhibitor adverse effects include dry cough, hyperkalemia, hypotension, and angioedema, with angioedema risk higher in Black patients.

Statins lower LDL cholesterol; monitor for myalgia and elevated transaminases, and discontinue urgently if rhabdomyolysis is suspected.

LDL-C goals: below 70 mg/dL for high-risk patients and below 55 mg/dL for very high-risk patients with established atherosclerotic disease.

Blood pressure goal for most adults with cardiovascular disease is below 130/80 mmHg; HbA1c goal for most patients with diabetes is below 7%.

Warfarin for atrial fibrillation targets an INR of 2.0-3.0; mechanical mitral valves target 2.5-3.5.

HFrEF guideline-directed therapy combines an ARNI, ACE inhibitor, or ARB with an evidence-based beta blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor.

Digoxin has a narrow therapeutic range (0.5-0.9 ng/mL); toxicity presents with nausea, visual disturbances, confusion, and arrhythmias.