Client X

Derrick Rugege, Nick Wallace, Keith

Lewis, Alex Datri
Patient Information

-80 years old

-68 inches tall (168 cm)

-Weighs 174 lbs (79 kg)

-Overweight on the BMI

scale of 26.5
Patient Information Cont.

-Retired office worker

-Widowed

-Only participated in
light walking
Patient Information Continued

-Quit smoking in 2002 -Blood pressure 110/70

-No drugs or alcohol mmHg

-Sinus bradycardia -Resting heart rate of

55 bpm
Family History

-Heart disease

-Hypertension

-Father died of pancreatic carcinoma

-Mother died of a stroke 29

Symptoms (Prior to Cardiac Rehab)

-Chest pain

-Angina with palpitations

-Dyspnea

-Fatigue
Medical History

-Ischemic cardiomyopathy -Ejection fraction of 30-35%

-Coronary artery disease - Gastritis

-Congestive heart failure -Atrial flutter with variable

block
Continued

-Hypertension -Type II diabetes

-Hyperlipidemia mellitus

-Anemia -Psoriasis
Continued

-Cardiac rehab -Transient ischemic attack

-(STEMI) myocardial infarction (TIA), left cardial infarction

Atheroslcerotic Disease

● Six complete 100 % blockages

● One in left main coronary artery

● Two in anterior descending

● One in circumflex

● Two in right coronary artery

 Collaterals

-Formed Collaterals

-From the RCA to the LAD

-From OM to the Diagonals

Surgeries

-Two saphenous vein grafts

-Attached to OM of the LAD

- PDA of the RCA

CABG

-Coronary artery bypass graft surgery (1981, 1987,

2002)
 Evaluations

-Sub Maximal Test

-Cardiologists administer test

-Walk as much as they can in 6 minutes

-Monitored to see changes in vital signs

-Can sit down at any time during 6 minute walk.

https://www.youtube.com/watch?v=hZJKMX5WyuY
Evaluation (Results)

-Walked A total of 1100 ft (335m)

-Resting Heart Rate of 60bpm

-VO2 from test 14.8ml/kg/min

6 Minute Walk Test Formula

VO2 max (mL·kg(-1)·min(-1)) = 70.161 + (0.023 ×

6MWT [m]) - (0.276 × weight [kg]) - (6.79 × sex,

where m = 0, f = 1) - (0.193 × resting HR [beats

per minute]) - (0.191 × age [y]).

Medications

-Metoprolol: Beta-Blocker

-Lisinopril: Hypertension

-Atorvastatin: Cholesterol

-Spironolactone: Hypertension/Hypokalemia
Medications

-Amiodarone: Anti-arrhythmic

-Xarelto: Blood thinner

-Ranexa: Anti-anginal

-Metformin: Anti-diabetic
Medication Interactions

Caution Advised:

Atorvastatin + Ranexa = May increase atorvastatin levels, risk

of myopathy, rhabdomyolysis

Metoprolol + Ranexa = May increase metoprolol levels, risk of

hypotension, bradycardia, AV block
Medication Interactions To Monitor

Amiodarone + Metoprolol = May increase metoprolol levels, risk of

hypotension, bradycardia

Amiodarone + Ranexa = May increase amiodarone levels, risk of cardiac

arrhythmias

Atorvastatin + Metoprolol = May decrease antihyperlipidemic efficacy

Lisinopril + Spironolactone = May increase risk of hyperkalemia

Metformin + Ranexa = May increase metformin levels, risk of lactic

acidosis
Exercise Testing Results

-BMR: 1446.2 kcal/day -MHR : 140 bpm

-TDEE: 1735.44 -METS:4.2

-VO2: 14.8 ml/kg/min - RHR : 55 bpm

Exercise Prescription Goals

-Improve ADLs

-Inhibit age related Atrophy

-Improve Cardiovascular health

-Reduce risk of future disease

-Decrease risks of falls

-Stop use of certain medications

Exercise Prescription Schedule

Monday : Cardiovascular and Resistance Training

Tuesday : off

Wednesday : Cardiovascular

Thursday : off

Friday : Cardiovascular and Resistance Training

Saturday : off

Sunday : off
Exercise Prescription Schedule

Monday : Cardiovascular and Resistance Training

Tuesday : off

Wednesday : Cardiovascular

Thursday : off

Friday : Cardiovascular and Resistance Training

Saturday : off

Sunday : off
Warm Up

Dynamic Warm up

Followed by Gradual increase in exercise intensity

Exercise Reps

Walking High Knees 10

Leg swings 10

Trunk Rotations 10

Walking Arm Swings 10

Walking Arm circles 10

 Resistance Training
Monday Friday

Exercise Sets Reps Exercise Sets Reps

Wall Push 2 15 RB Chest Press 2 15

Ups
Seated Leg 2 15
Chair Stands 2 15 Extension or
Stationary
One Arm 2 15 Lunges
Shoulder
One Arm Bicep 2 15
Press
Curls
RB Rows 2 15
Box Step Ups 2 15
Seated Trunk 2 15 OH Tricep 2 15
Rotation w/ Extension
med ball
Seated Crunch 2 15
SL Stance 2 20 sec
 Cardiovascular Program

Monday Wednesday Friday Monday (Week

2)

Type Cycle Ergometer Walking Cycle Ergometer Walking

Duration 15 mins 15 mins 15:30 mins 15:30 mins

Intensity (HRR) 40% 40% 40% 40%

HR (BPM)

KP (Resistance .60 .60

on Bike)

40% V02 Max 4. 4.44 4.44 4.44

(ml/kg/min)
Monitor During Exercise

Continuously Monitor HR

Watch Closely for Signs and Symptoms

EKG

RPE

Ask Questions
 Cool-down Muscle Group Stretch

Deltoid Pull arm across body

Chest Field Goal doorway stretch

Gradual decrease in Exercise Intensity Tricep Pull arm behind head

Followed by static stretching Bicep Place arm 180 on wall and rotate inward

Quadricep ankle to butt stretch

Hamstring 90/90 Hamstring stretch

Calves Standing Calf Stretch

Lower Back Lying Knee Twist

Hip flexor Deep Lunge

Works Cited

Acsm's Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, 2017.

https://www.thefix.com/sites/default/files/styles/article/public/drug-cocktail-fixbestof.png

https://www.google.com/search?q=collaterals+in+heart&rlz=1C1CHFX_enUS602US602&source=lnm
s&tbm=isch&sa=X&ved=0ahUKEwi3t6CWpd3XAhWHPN8KHVwoCeoQ_AUICigB&biw=1517&bih=73
5#imgrc=UH5Ocv_7jz9vyM

http://www.almaterhospital.com/wp-content/uploads/2013/09/coronary-bypass.jpg

https://www.ncbi.nlm.nih.gov/pubmed/21673494

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