CARDIAC REHABILITATIONCARDIAC REHABILITATION

CHAPTER 5 PRESENTATIONCHAPTER 5 PRESENTATION

SAMSON VASSAMSON VAS

Cardiac rehabilitation aims to reverse Cardiac rehabilitation aims to reverse limitations experienced by patients who limitations experienced by patients who have suffered the adverse have suffered the adverse pathophysiologic and psychological pathophysiologic and psychological consequences of cardiac events.consequences of cardiac events.

The major goals of a cardiac rehabilitation The major goals of a cardiac rehabilitation program are:program are:

Curtail the pathophysiologic and Curtail the pathophysiologic and psychosocial effects of heart disease psychosocial effects of heart disease

Limit the risk for reinfarction or sudden death Limit the risk for reinfarction or sudden death Relieve cardiac symptoms Relieve cardiac symptoms Retard or reverse atherosclerosis by Retard or reverse atherosclerosis by

instituting programs for exercise training, instituting programs for exercise training, education, counseling, and risk factor education, counseling, and risk factor alteration alteration

Reintegrate heart disease patients into Reintegrate heart disease patients into successful functional status in their families successful functional status in their families and in societyand in society

Indications for cardiac rehabIndications for cardiac rehab

Acute myocardial infarctionAcute myocardial infarction Coronary artery bypass grafting Coronary artery bypass grafting Percutaneous coronary vessel remodeling (i.e. Percutaneous coronary vessel remodeling (i.e.

angioplasty, atherectomy, stenting)angioplasty, atherectomy, stenting) Valve replacement or repair Valve replacement or repair Heart transplantationHeart transplantation Major pulmonary surgery, great vessel Major pulmonary surgery, great vessel

surgery, sustained ventricular tachycardia or surgery, sustained ventricular tachycardia or fibrillationfibrillation

Class III or IV congestive heart failure Class III or IV congestive heart failure unresponsive to medical therapyunresponsive to medical therapy

Chronic stable angina pectoris unresponsive to Chronic stable angina pectoris unresponsive to medical therapy which prevents the member medical therapy which prevents the member from functioning optimally to meet domestic from functioning optimally to meet domestic or occupational needsor occupational needs

Cardiac Rehabilitation Cardiac Rehabilitation PhasesPhases

Phase I – InpatientPhase I – Inpatient

Cardiac rehabilitation begins during in-Cardiac rehabilitation begins during in-hospital recovery following surgery or a hospital recovery following surgery or a cardiac event. The first phase is conducted cardiac event. The first phase is conducted by an exercise physiologist. Before each by an exercise physiologist. Before each cardiac patient is discharged, questions cardiac patient is discharged, questions regarding personal recovery are answered, regarding personal recovery are answered, and preparation for the second phase of and preparation for the second phase of cardiac rehabilitation takes place. cardiac rehabilitation takes place.

Phase I includes:Phase I includes:

Monitored hall walking program. Monitored hall walking program. Education about coronary artery disease, Education about coronary artery disease,

the need for aerobic exercise and the the need for aerobic exercise and the fundamentals of exercise. An outline of the fundamentals of exercise. An outline of the symptoms of exercise intolerance, and a symptoms of exercise intolerance, and a home walking program. home walking program.

Personal plan of risk-factor management Personal plan of risk-factor management and activity progressionand activity progression

Phase II – OutpatientPhase II – Outpatient

The outpatient phase of cardiac The outpatient phase of cardiac rehabilitation begins two to six weeks after rehabilitation begins two to six weeks after discharge from the hospital. The second discharge from the hospital. The second phase is conducted by an RN and exercise phase is conducted by an RN and exercise specialist. The patient attends one-hour specialist. The patient attends one-hour outpatient sessions, two to three times per outpatient sessions, two to three times per week. week.

Phase II includes:Phase II includes:

Up to 36 sessions of EKG monitored Up to 36 sessions of EKG monitored exercise (Two to three sessions per week, exercise (Two to three sessions per week, one hour per session). one hour per session).

Blood pressure and heart rates monitored. Blood pressure and heart rates monitored. Exercise performed on treadmills, Exercise performed on treadmills,

stationary bikes, rowing machines, stationary bikes, rowing machines, stairmasters and light weight-lifting. stairmasters and light weight-lifting.

Individual dietary consultation. Individual dietary consultation.

Phase III – Outpatient MaintenancePhase III – Outpatient Maintenance

This optional phase of cardiac rehabilitation This optional phase of cardiac rehabilitation promotes independence within a structured promotes independence within a structured exercise program. The third phase is exercise program. The third phase is conducted by an exercise physiologist in conducted by an exercise physiologist in consultation with the program director. At consultation with the program director. At the outpatient facility, cardiac patients the outpatient facility, cardiac patients exercise under supervision two times a week exercise under supervision two times a week during regular facility hours. Pulse rate and during regular facility hours. Pulse rate and blood pressure continue to be monitored. blood pressure continue to be monitored.

Phase III includes:Phase III includes:

Two sessions per week, one hour per Two sessions per week, one hour per session. session.

Blood pressure and heart rate monitoring. Blood pressure and heart rate monitoring.

CARDIAC REHABILITATION HOME EXERCISE PROGRAM

GUIDELINES FOR EXERCISE ♥ Try to walk on level surfaces. Walk slower if

you do walk on hilly terrain. ♥ Space your activities. Wait at least 1 hour

after you eat a heavy meal or bathe before exercising.

♥ Avoid exercising in extremely hot/humid weather: greater than 80°F/75 percent humidity.

♥ Avoid exercising in extremely cold/damp weather: less than 32° F unless you cover your face with a scarf or mask.

♥ If you are feeling ill, do not exercise. When you are feeling better, start your program again slowly.