CARDIAC

CONDITONS - Special considerations: sternal precautions, possible accelerated atherosclerosis (new

CARDIAC REHABILITATION heart, not compatible, trapped lipids since vessels are the surface is still
Definition: Multidisciplinary program of education, exercise, and behavioural changes rough); response of a denervated heart is different; heart rate cannot be
WHO: Individuals with heart disease used for monitoring —> normal BP, HR so you won’t be able to know how
GOAL: Achieving optimal physical, psychological, and functional states within the limits of their the patient is; use subjective ways, such as RPE
disease Discharge instructions
• Showers (tabo, sitting down)
Cardiac Rehabilitation of Special Groups • Incisions (sternal, inguinal, graph site)
Post MI • Care of Surgical Leg
• Signs and symptoms; presentation • Elastic stockings (DVT, edema)
- Chest pain • Rest (depends, not too much)
- Levin sign • Walking (depends on distance)
- Pallor • Sexual relations (when the person can go up 2 flights of stairs without hingal; 1 flight: 7 inches
- Profuse sweating 12 steps)
- Shortness of breath • Sternal precautions
- Weakness
- Fainting Determinants of Exercise
- Vomitting • Intensity
• Atherosclerosis due to risk factors —> distal to thrombus (loss of function) —> necrosis - Patient’s Maximum Oxygen Consumption (not exceed 40-60%)
• Special considerations - Maximum Heart Rate (no exceed 70-85%)
- Vital signs: altered; controlled by HR (HR abnormally low or high) - Karvonen Method: EHR=HRrest + 60-70%(HRmax-HRrest)
- Temperature elevation: common during the initial days after an event - Metabolic Equivalents (METS): measure of oxygen consumption per kilogram of body
- Auscultation of the hear: abnormal heart sounds (lung sounds) weight per minute (3.4)
- Dyspnea: may be present - Rate of perceived exertion using the Borg’s scale and limiting activity to 11-15 rating (linear
Post Heart Surgery Conditions scalee of ratings from 6-20 used to indicate the degree of physical exertion
• Coronary Artery Bypass Graft in a patient performing)
- Saphenous, I, R - Monitor the following: fatigue, light headedness, nausea, onset of angina with activity,
- Graph site care during mobilisation exercise hypotension (>20 mmMg drop in systolic bo); exercise bp rise (10)
- Open heart surgery • Duration and Frequency
- Precaution: Sternotomy; sternal preck (no excessive should retraction and shoulder - Enough to achieve a physiologic effect from the exercise program (at least 20-30 minutes,
abduction if bilateral; only if 90 degrees; horizontal abduction) don’t 2-3x/week for 12 weeks)
stretch the wound; no lifting or weights > 5lbs, overhead activities can - For the severely reconditioned patient and patients confined in the ward (5-10 minute
initial be done but unilaterally, high intensity arm exercises should be program interspersed daily, 2-3 times in appropraiate)
avoided in 3-6 months
- Advantages: Increased ischemic threshold, improved left ventricle function, improved Exercise Prescription
coronary flow, prolonged time in crucifix position • Type of exercise: isotonic, rhythmic, and aerobic (not isometric —> Valsalva)
• Post-valvular replacement • Emphasis on large muscle mass, with no large isometric components
- Prolapse, regurgitation resulting to incomplete valve closure • Calisthenic exercises are also preferred
- Special precuations: sternal precaution, emphasis on BP monitoring especially for aortic • Exercises passive —> actively —> gradually to low level resistance exercises (usually endurance
valve replacement is problem)
- Precautions for Pts on anticoagulants: avoid contact activities that may induce bleeding, • Initiation of ambulation training is also provided
avoid high impact activities, watch out or signs of bleeding • Muscle strength can be masked by patient (don’t be confident to progress, rehab doctor
• Post-angioplasty (stent) should be aware of patient’s condition)
- Special considerations: check inguinal wound where catheter is inserted (also angiogram);
avoid resistive exercises until bleeding has stopped in inguinal region; Exercise Format
check for lower extremity soreness ( suspected DVT since its immbolized • Warm-up
due to pain inguinal wound) • Stimulus Period
• Post heart transplant - Continuous training
 - Interval training - BP parameters
- Circuit training - Ambulation: 3-5 mph
• Cool down
Phase 3: Training/Intensive Rehabilitation Phase
Phase 1: Acute/monitoring (in-patient) phase • Extended, high-level, supervised out-patient program, 4 to 6months post cardiac incident
• Evaluate and provide patient a appropriate management and instructions • Duration and frequency: usually once a week
• Supervise a low-level exercise program and to monitor ADLs • Patients exercise in larger groups and continue to progress in there exercise program
• Constantly evaluate VS and the physiological response to exercise • Resistance training often begins in this phase
• Information regarding the patient’s response to an activity must be directly informed to the • Role of PT:
attending physician - Ensure a committed carry-over of the exercises prescribed of the training program
• Treatment objectives - remind patient to monitor their own pulse rate, a supervisory person avialle is taught how
- Prevent the deleterious effects o bed rest and immobilisation (Splinting during coughing to to monitor
stabilise cut sternum) • Objectives
- Reduce orthostatic hypotension (gradually elevating back rest) - Maintain function
- Maintain joint mobility - Compliance with patient-specific exercise program
- Reduce effects of respiratory compromise - Knowledge of risk factors and modifications
• Monitoring
- HR: <50 and not >120 bpm (if on beta-blockers, not to increase <20 beats) Phase 4: On-going Conditioning (Maintenance) or Prevention Program Phase
- BP: Systolic pressure not to decrease >10-20 mmHg • Stage in CR program that is structure for paßtients who hae plateaued in exercise endurance
- Rhythm: Observe for any signs of arrhythmia and abnormal heart sounds and achieved table risk factor management
- Others: refection fraction (at least 55-70%, maintain MAP as prescribed, burg’s scale up to • For continuation of exercise
11-15)

Phase 2: Sub-Acute/Conditioning Phase (Out-patient)

• Initially as early s 24 hours
• Patient can tolerate ambulation at 2-3 mph for 10-15 minutes
• Can perform all ADLs comfortably
• pERORM LIGHT HOUSE WORK UP TO 3 mets (simple hygiene)
• Form of PT: Formulate an exercise prescription based on traded test results, monitor the
patient according to the level of risk, progress, discharge
• Treat objectives
- Improve functional capacity
- Promote early return to normal activity
- Promote education and postive lifestyle changes
• Program
- Ambulation: focus
- Claisthenics to each extremity
- Stationary bicycle and UE ergometer use
- Warm-up and cool-down
- Breathing exercises
- Treadmill exercises
- or PGH Phase 2 protocol
- Diaphragm positioned gravity eliminated or assisted; patient learned in, with proper
breathing pattern
• Monitoring
- Heart rate
- THR with exercise stress testing
- Pt’s on beta blockers