Cardiovascular Disease, Pharmacology, and Risk Factor Management
Cardiovascular Disease
Core disease concepts
Understand atherosclerosis as the underlying process linking risk factors to events, and be able to distinguish acute coronary syndromes, stable angina, and the revascularization pathways of percutaneous coronary intervention and coronary artery bypass grafting. Know that rehabilitation typically begins early after an uncomplicated myocardial infarction or percutaneous intervention and within a few weeks after bypass surgery, with timing and progression individualized.
Heart failure and valves
Heart failure with reduced ejection fraction is generally defined as an ejection fraction of 40% or less; mildly reduced falls in the 41 to 49% range; preserved is 50% or more. Exercise is appropriate for stable patients but is contraindicated during decompensation. Valvular disease matters mainly through severity and symptoms: severe symptomatic aortic stenosis is a contraindication to exercise training, whereas mild asymptomatic disease generally is not.
Arrhythmias and other conditions
Know atrial fibrillation and anticoagulation implications, the significance of ventricular arrhythmias, peripheral artery disease with claudication and supervised walking, cardiomyopathies, and cardiac transplantation with denervation affecting heart rate response.
Worked example
A patient with an ejection fraction of 30%, stable NYHA class II symptoms, and no resting ischemia can generally participate in a monitored program. Rule of thumb: stability and symptom class determine eligibility, not the ejection fraction number alone.
Exam traps
Questions often present a disease label when the real discriminator is acuity. Read for words such as decompensated, resting symptoms, or uncontrolled, and match those to contraindications rather than to the diagnosis.
Pharmacology
Why medications matter in rehabilitation
Drug therapy shapes the exercise response, the safety profile, and the outcome measures you track. Organize knowledge by purpose: antiplatelet and anticoagulant therapy, lipid-lowering therapy, blood pressure and heart failure medications, antianginals, antiarrhythmics, and glucose-lowering agents.
Classes to know
Beta-blockers lower heart rate and blood pressure and blunt the chronotropic response, so heart rate targets must be individualized. Angiotensin-converting enzyme inhibitors and receptor blockers, including angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors form the core of reduced ejection fraction heart failure therapy. Diuretics reduce volume and can cause dehydration, hypotension, and electrolyte disturbance. Statins are central to lipid management and may cause myalgia. Nitrates cause hypotension and headache and are contraindicated with phosphodiesterase-5 inhibitors. Anticoagulants raise bleeding risk with falls or trauma.
Worked example
A patient on a beta-blocker, a loop diuretic, and a nitrate reports dizziness at the start of a session with a blood pressure of 88/54. Rule of thumb: assess symptoms, volume status, and recent medication timing before exercising; hold the session, involve the clinician, and resume with adjusted intensity and hydration guidance when approved.
Exam traps
Questions frequently test why a heart rate target fails (beta-blocker), why a patient is hypotensive (diuretic or nitrate), or which drug must not be combined with a nitrate. Match the adverse effect to the responsible class rather than to the patient's diagnosis.
Risk Factor Management
Targets and framing
Secondary prevention requires systematic management of hypertension, dyslipidemia, diabetes, tobacco use, obesity, physical inactivity, poor diet, and psychosocial distress. Learn the target ranges commonly taught and, more importantly, learn which interventions produce which outcome.
Key targets
Blood pressure is generally targeted below 130/80 mmHg, with lifestyle change plus medication as needed. Low-density lipoprotein cholesterol goals are risk-dependent, with commonly taught thresholds around 70 mg/dL for high-risk patients and lower for very high-risk patients. Glycemic control is commonly framed around an A1c below 7%, individualized. Physical activity recommendations center on roughly 150 minutes per week of moderate-intensity aerobic activity plus resistance training. Weight management emphasizes a 5 to 10% reduction when overweight, and tobacco cessation is the single highest-yield intervention, with counseling plus pharmacotherapy.
Nutrition and behavior
Mediterranean-style and DASH-style eating patterns, sodium restriction, limited alcohol, and structured behavioral support are standard. Screen for depression, anxiety, and social barriers, because these predict adherence and outcomes.
Worked example
A patient with coronary disease, diabetes, and continued smoking has an LDL of 110 and A1c of 8.5%. Rule of thumb: prioritize tobacco cessation first, intensify lipid therapy toward the risk-based goal, address glycemia, and reinforce activity and diet simultaneously rather than sequentially, since risk reduction is cumulative.
Exam traps
Questions often swap goals between conditions, such as applying a blood pressure target to a lipid stem. Read which risk factor is being asked about before selecting a number.