KNGF Guideline Cardiac rehabilitation

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KNGF Clinical Practice Guideline for physical therapy in patients undergoing cardiac rehabilitation Supplements Supplement 10 Effects of medication on heart rate, blood pressure, ECG and exercise capacity Medications Heart Rate Blood Pressure ECG Exercise Capacity ß-Blockers (including (R and E) (R and E) HR (R) in patients with angina; carvedilol, labetalol) ischemia (E) or in patients without angina II. Nitrates (R) (R) HR (R) in patients with angina; or (E) or (E) or R (E) in patients without angina ischemia (E) or in patients with congestive heartfailure (CHF) III. Calcium channel blockers Amlodipine or HR (R and E) Felodipine ischemia (E) in patients with angina’ Isradipine in patients without angina Necardipine or (R and E) Nifedipine Nimodipine Nisoldipine (R and E) Bepridil HR (R and E) Diltiazem (R and E) ischaemia (E) Verapamil IV. Digitalis in patients with (R and E) May produce nonspe- Improved only in patients with atrial fibrillation cific ST-T wave atrial fibrillation or in and possibly CHF change (R) patients with CHF Not significantly altered May produce ST segin patients with sinus ment depression (E) rhythm V. Diuretics (R and E) or (R and E) or PVCs (R) , except possibly in patients May cause PVCs and with CHF ‘false positive’ test results if hypokalemia occurs May cause PVCs in hypomangnesemia occurs (E) VI. Vasodilators, nonadren- or (R and E) (R and E) or HR (R and E) , except or in patients ergic with CHF ACE inhibitors (R and E) (R and E) (R and E) , except or in patients with CHF α-Adrenergic blockers (R and E) (R and E) (R and E) Antiadrenergic agents or (R and E) (R and E) or HR (R and E) without selective blockade VII. Antiarrhythmic agents All antiarrhythmic agents may cause new or worsened arrhtyhmias (proarrhythmic effect) Class I Quinidine or (R and E) ? or (R) or HR (R) may Disopyramide (E) May prolong QRS and QT intervals (R) Quinidine may result in ‘false negative’ test results (E) Procainamide (R and E) (R and E) May prolong QRS and QT intervals (R) May result in ‘false positive’ test results (E) Phenytoin Tocainide (R and E) (R and E) (R and E) Mexiletine Flecainide Moricizine (R and E) (R and E) May prolong QRS and QT intervals (R) (E) Propafenone (R) (R and E) HR (R) or (E) or HR (E) Class II ß-Blockers (see I.) Class III Amiodarone (R and E) (R and E) HR (R) (E) Class IV Calcium Channel Blockers (see III.) V-08/2011 42
KNGF Clinical Practice Guideline for physical therapy in patients undergoing cardiac rehabilitation Supplements Medications Heart Rate Blood Pressure ECG Exercise Capacity VIII. Bronchodilators (R and E) (R and E) (R and E) Bronchodilators exercise capacity in patients limited by Bronchospasm Anticholinergic agents or (R and E) or HR May produce PVC’s (R and E) Sympathomimetic agents or (R and E) , or (R and E) or HR (R and E) Cromolyn sodium (R and E) (R and E) (R and E) Corticosteroids (R and E) (R and E) (R and E) IX. Hyperlipidemic agents Clofibrate may provoke arrhytmias, angina in patients with prior myocardial infarction Nicotinic agents may BP All other hyperlipidemic agents have no effect on HR, BP, and ECG X. Psychotropic medications Minor tranquilizers May HR and BP by controlling anxiety: no other effects Antidepressants or (R and E) or (R and E) Variable (R) May result in ‘false positive’ test results (E) Major tranquilizers or (R and E) or (R and E) Variable (R) May result in ‘false positive’ or ‘false negative’ test results (E) Lithium (R and E) (R and E) May result in T wave changes and arrhythmias (R and E) XI. Nicotine or (R and E) (R and E) or HR , except or in May provoke ischemia, patients with angina arrhythmias (R and E) XII. Antihistamines (R and E) (R and E) (R and E) XIII. Cold medications with Effects similar to those described in sympathomimetic agents, Sympathomimetic agents although magnitude of effects is usually smaller XIV. Thyroid medications (R and E) (R and E) HR , unless angina worsened May provoke Only levothyroxine arrhythmias ischemia (R and E) XV. Alcohol (R and E) Chronic use may May provoke have role in BP arrhythmias (R and E) (R and E) XVI. Hypoglycemic agents (R and E) (R and E) (R and E) Insulin and oral agents XVII. Dipyridamole (R and E) (R and E) (R and E) XVIII. Anticoagulants (R and E) (R and E) (R and E) XIX. Antigout medications (R and E) (R and E) (R and E) XX. Antiplatelet medications (R and E) (R and E) (R and E) XXI. Pentoxyfiline (R and E) (R and E) (R and E) or in patients limited by intermittend claudication XXII. Caffeine Variable effects depending upon previous use Variable effects on exercise capacity May provoke arrhythmias XXIII. Anorexiants/diet pills or (R and E) or (R and E) or (R and E) Key: = increase; = no effect; = decrease; R = rest; E = exercise; HR = heart rate; PVC’s = premature ventricular contractions * ß-Blockers with ISA lower resting HR only slightly. + May provide or delay myocardial ischemia. Table reproduced by kind permission of the original author/publisher. V-08/2011 43
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KNGF Guideline Cardiac rehabilitation

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