AACVPR CCRP flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Phase I cardiac rehab

Inpatient phase starting within days of a cardiac event, consisting of low-level activity, mobility, education, and risk assessment before discharge. Telemetry monitoring is common and activity progresses toward self-care.

Phase II cardiac rehab

Early outpatient phase, usually 2-12 weeks after discharge, featuring ECG-monitored exercise, risk factor education, and counseling. Physician supervision and monitoring are typically required throughout.

Phase IV maintenance

Long-term, often community- or home-based phase after a formal program ends. The focus is sustaining exercise habits, controlling risk factors, and periodic reassessment without routine ECG monitoring.

Medicare cardiac rehab coverage

Covers up to 36 sessions over 36 weeks for qualifying diagnoses such as recent MI, CABG, PCI, stable angina, or valve surgery, with physician supervision and an individualized written plan.

AACVPR core components

Ten required program elements: patient assessment, exercise training, physical activity counseling, nutritional counseling, weight management, blood pressure, lipid, diabetes, and tobacco management, plus psychosocial management.

Physician supervision requirement

A physician must be immediately available and accessible during exercise sessions, on site or by telephone, to manage medical emergencies and to approve the exercise prescription.

Intensive cardiac rehab

Up to 72 sessions over 36 weeks for eligible patients with stable heart failure (EF 35% or less, NYHA II-IV) or recent cardiac events with additional risk factors; combines exercise with intensive education.

Cardiac rehab quality indicators

Standardized measures used to evaluate program performance, including change in functional capacity, quality of life, blood pressure and lipid control, tobacco cessation, and adherence to prescribed sessions.

MET

Metabolic equivalent: 1 MET equals 3.5 mL of oxygen per kilogram per minute, roughly the oxygen cost of resting quietly. Functional capacity is expressed as the number of METs achieved.

NYHA class III

Marked limitation of physical activity, in which less than ordinary activity causes fatigue, palpitations, or dyspnea. The patient is comfortable only at rest.

Karvonen formula

Target heart rate equals ((maximal heart rate minus resting heart rate) times intensity fraction) plus resting heart rate. It uses heart rate reserve and is a preferred method for prescribing aerobic intensity.

Rate-pressure product

Systolic blood pressure multiplied by heart rate, an index of myocardial oxygen demand. It is used to identify the angina threshold and to guide safe training intensity.

Borg RPE scale

A 6-to-20 rating of perceived exertion in which 11-13 approximates moderate intensity and 14-16 approximates hard intensity. It is useful when heart rate is unreliable, as with beta blockers or atrial fibrillation.

6-minute walk test

A submaximal measure of functional exercise capacity in which the distance walked over six minutes is recorded. A change of about 25 meters is generally considered clinically meaningful.

PHQ-9

A nine-item depression screening questionnaire scored from 0 to 27. A score of 10 or higher suggests clinically significant depression and warrants further assessment or referral.

Exercise contraindications

Absolute contraindications include unstable angina, uncontrolled arrhythmias, decompensated heart failure, resting systolic BP above 200 mmHg or diastolic above 110 mmHg, and acute systemic illness.

FITT principle

Frequency, intensity, time, and type: the four components that define an exercise prescription. Cardiac programs commonly prescribe 3-5 days per week at 40-80% of heart rate reserve.

Heart rate reserve

The difference between maximal and resting heart rate, used with the Karvonen method to set a target heart rate. Training at 40-80% of heart rate reserve is moderate to vigorous.

Ischemic threshold

The heart rate or workload at which ECG changes or angina first appear during exercise testing. Training intensity is usually prescribed at least 10 beats per minute below this threshold.

Heart rate recovery

The fall in heart rate during the first minute after exercise stops. A decrease of 12 beats per minute or less is abnormal and predicts increased cardiovascular mortality.

Bruce protocol

A standard treadmill test with 3-minute stages that increase in speed and grade. Stage reached, exercise duration, and estimated METs assess functional capacity and provoke ischemia.

Resistance training prescription

Two to three days per week, 1-3 sets of 8-12 repetitions at 40-60% of 1RM for the upper body and 50-70% for the lower body, avoiding the Valsalva maneuver.

Arm ergometry

Upper-body cycle testing used when lower-extremity exercise is limited. Peak oxygen consumption is typically 10-20% lower than with leg ergometry, so exercise prescriptions are adjusted accordingly.

Exercise test termination

Stop testing for ST depression of 2 mm or more, a systolic BP fall of 10 mmHg or more with increasing workload, severe angina, sustained ventricular tachycardia, or a hypertensive response above 250/115 mmHg.

Beta blockers and exercise

Beta blockers lower resting and exercise heart rate and blood pressure, blunting the chronotropic response. Intensity should therefore be guided by perceived exertion and symptoms as well as heart rate.

Nitroglycerin contraindication

Sublingual nitroglycerin must not be given within 24 hours of sildenafil or 48 hours of tadalafil, because the combination can cause profound and refractory hypotension.

ACE inhibitor cough

A persistent dry cough occurs in roughly 5-20% of patients on ACE inhibitors because of bradykinin accumulation. Switching to an angiotensin receptor blocker usually resolves it.

Statin-associated myopathy

Muscle aches or weakness occurring with statin therapy, sometimes accompanied by elevated creatine kinase. Rhabdomyolysis is rare but requires urgent discontinuation and clinical evaluation.

Warfarin INR target

For atrial fibrillation and most venous thromboembolism, the target INR is 2.0-3.0. Mechanical mitral valves require a higher target of 2.5-3.5.

HFrEF guideline therapy

For heart failure with reduced ejection fraction, four drug classes improve survival: an ARNI, ACE inhibitor, or ARB; an evidence-based beta blocker; a mineralocorticoid receptor antagonist; and an SGLT2 inhibitor.

Digoxin toxicity

Findings include nausea, anorexia, visual disturbances such as yellow halos, confusion, and arrhythmias. The therapeutic serum level is low (about 0.5-0.9 ng/mL), so toxicity is relatively common.

LDL cholesterol goals

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