Which of the following could be an opportunity?

Mr. J is a 74yoa male with known CAD and a recent diagnosis of heart failure. 3 years ago the patient had a large MI and refused to attend cardiac rehab afterwards. He has had 3 hospital admissions in the past year related to pulmonary edema. Left ventricular ejection fraction was measured 3 months ago at 23%.  He also has osteoarthritis in both knees and type II diabetes. He lives alone on a ground floor of an assisted living facility. He prefers to stay at home, but when he does leave the house and can only walk 2 city blocks without resting. An EKG from his emergency room visit related to the MI is shown below.       Mr. J meet criteria for a cardiac rehab referral.

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program.   While reviewing Mrs. H’s medical chart prior to meeting her, you come across recent ABG results as shown below. Is PaO2 normal or abnormal?   pH: 7.39 PaCO2: 48 PaO2: 61 HCO3-:28 SpO2: 91%

List 5 ABSOLUTE contraindications to symptom-limited maximal exercise testing

Mr. J is a 74yoa male with known CAD and a recent diagnosis of heart failure. 3 years ago the patient had a large MI and refused to attend cardiac rehab afterwards. He has had 3 hospital admissions in the past year related to pulmonary edema. Left ventricular ejection fraction was measured 3 months ago at 23%.  He also has osteoarthritis in both knees and type II diabetes. He lives alone on a ground floor of an assisted living facility. He prefers to stay at home, but when he does leave the house and can only walk 2 city blocks without resting. An EKG from his emergency room visit related to the MI is shown below.      What is Mr. J’s NYHA functional class?

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program.   While reviewing Mrs. H’s medical chart prior to meeting her, you come across recent ABG results as shown below. Is the PaCO2 normal or abnormal?   pH: 7.39 PaCO2: 48 PaO2: 61 HCO3-:28 SpO2: 91%

Barb is a 60yoa female referred by her physician to your phase II cardiac rehab program due to her CVD risk factor profile and a graded exercise test (GXT) that was positive for ST segment depression. A brief synopsis of Barb’s medical history, recent labs, and GXT are shown below.   Family History: mother had a CABG procedure at age 58; older sister also had a stent placed at age 60 Medications: spironolactone 50mg x 2 daily; amlodipine 100mg x 1 daily Tobacco Use: former smoker; quit 20 years ago   Height: 5′ 3”                Weight: 162lbs                      Waist Circumference: 33in Fasting Blood Glucose 110 mg/dL Urea nitrogen 10 mg/dL Creatinine 1.2 mg/dL Sodium 136 mmol/L Potassium 3.6 mmol/L Chloride 105 mmol/L Total Cholesterol 192 mg/dL Triglycerides 195 mg/dL HDL-C 44 mg/dL LDL 102 mg/dL Aspartate aminotransferase (AST) 35 U/L Alanin aminotransferase (ALT) 42 U/L HbA1C 45 mmol/mol   Graded Exercise Test: Resting HR: 80bpm            Supine BP: 138/80            Standing BP: 140/82 Time Speed (mph) Grade (%) HR BP RPE MET Symptoms (0-4 scale) ECG 1 1.7 10 89         .5mm horizontal ST dep. 2 1.7 10 92         .5mm horizontal ST dep. 3 1.7 10 109 154/84 14 4.7   .5mm horizontal ST dep. 4 2.5 12 123         1mm horizontal ST dep. 5 2.5 12 136         1mm horizontal ST dep. 6 2.5 12 152 182/84 19 7.0   1.5mm horizontal ST dep. 7 1.7 0 140         1mm horizontal ST dep. 8 1.7 0 136 166/84       .5mm horizontal ST dep. 9 1.7 0 132         .5mm horizontal ST dep. 10 1.7 0 134 152/84       .5mm horizontal ST dep. 11 Resting seated 115         .5mm horizontal ST dep. 12 Resting seated 107 136/82       NSR   What was Barb’s peak rate pressure product ?

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program.   While reviewing Mrs. H’s medical chart prior to meeting her, you come across recent ABG results as shown below. What is the primary acid-base distrubance?   PaCO2: 48 PaO2: 61 HCO3-:28 SpO2: 91%

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program   If Mrs. H had a positve screening for anxiety and depression, which of the following would NOT be an appropriate intervention for a CEP to perform.  

Barb is a 60yoa female referred by her physican to your phase II cardiac rehab program due to her CVD risk factor profile and a graded exercise test (GXT) that was positive for ST segment depression. A brief synopsis of Barb’s medical history, recent labs, and GXT are shown below.   Family History: mother had a CABG procedure at age 58; older sister also had a stent placed at age 60 Medications: spironolactone 50mg x 2 daily; amlodipine 100mg x 1 daily Tobacco Use: former smoker; quit 20 years ago   Height: 5′ 3”                Weight: 162lbs                      Waist Circumference: 33in Fasting Blood Glucose 110 mg/dL Urea nitrogen 10 mg/dL Creatinine 1.2 mg/dL Sodium 136 mmol/L Potassium 3.6 mmol/L Chloride 105 mmol/L Total Cholesterol 192 mg/dL Triglycerides 195 mg/dL HDL-C 44 mg/dL LDL 102 mg/dL Aspartate aminotransferase (AST) 35 U/L Alanin aminotransferase (ALT) 42 U/L HbA1C 45 mmol/mol   Graded Exercise Test: Resting HR: 80bpm            Supine BP: 138/80            Standing BP: 140/82 Time Speed (mph) Grade (%) HR BP RPE MET Symptoms (0-4 scale) ECG 1 1.7 10 89         .5mm horizontal ST dep. 2 1.7 10 92         .5mm horizontal ST dep. 3 1.7 10 109 154/84 14 4.7   .5mm horizontal ST dep. 4 2.5 12 123         1mm horizontal ST dep. 5 2.5 12 136         1mm horizontal ST dep. 6 2.5 12 152 182/84 19 7.0   1.5mm horizontal ST dep. 7 1.7 0 140         1mm horizontal ST dep. 8 1.7 0 136 166/84       .5mm horizontal ST dep. 9 1.7 0 132         .5mm horizontal ST dep. 10 1.7 0 134 152/84       .5mm horizontal ST dep. 11 Resting seated 115         .5mm horizontal ST dep. 12 Resting seated 107 136/82       NSR   Based on Barb’s GXT, what is her VO2 peak in ml/kg*min? ACSM walking equation: VO2= (0.1 x speed) + (1.8 x speed x grade) + 3.5