Cardiac rehabilitation is a comprehensive long-term program involving medical evaluation, prescribed exercises, education, and risk factor modification beginning in the hospital and continuing after discharge. The overall goal is to help clients live as fully and productively as possible within their heart's limitations. Rehabilitation has four phases - inpatient, immediate outpatient, intermediate outpatient, and maintenance - with each phase involving progressive physical activity, education, acceptance of limitations, and adjustment to lifestyle changes to reduce risk factors.

1. Cardiac rehabilitation
A successful rehabilitation begins with the moment the
client enters the coronary care unit for emergency
care & continues for months and even years after
discharge from the health care facility. The overall goal
of rehabilitation is to help the client live as full vital and
productive a life as possible while remaining within the
limits of the heart’s ability to respond to increase in
the activity and stress.

2. Definition
Cardiac rehabilitation is a comprehensive long term
program that involves periodic medical evaluation,
prescribed exercises & education & counselling about
cardiac risk factor modification.
Cardiac rehabilitation is a multifactorial program that
begins when the client is still hospitalized and
continues throughout recovery.

3. Six important sub goals of rehabilitation process
1.Developing a program of progressive physical activity
2.Educating the client and significant others about the cause,
prevention and treatment of CHD
3.Helping the client to accept the limitations imposed by illness
4.Aiding the client in adjusting to changes in occupational
goals
5. Lessening the exposure to risk factors
6. Changing the psychosocial factors, adversely affecting
recovery from CHD

4. Cardiac rehabilitation- 4 phases
Phase I - Inpatient phase
Phase II - Immediate outpatient
Phase III - Intermediate outpatient
Phase IV - Maintenance outpatient

5. Phase I - Inpatient phase
Begins with the admission to the coronary care unit.
After an MI, Complete bed rest for the 1st
day. Use
bedside commode for bowel movements.
Diet : 2gm sodium diet If nauseated, provide a clear
liquid diet until nausea subsides
Exercise
A coronary care nurse or physiotherapist should start
passive exercises. As the client regains strength, have
the client sit for brief periods on the side of the bed
and dangle the feet

6. Phase II - Immediate outpatient phase
Discharge to home by the end of two weeks if no
complications arise.
Sexual intercourse (4 - 8 weeks) when the client is able to
climb 2 flights of stairs.
Resumption of job: At the end of 8 or 9 weeks if
asymptomatic and if the job is not tiring.
Graded ambulation, By 8th
and 10th
week –
Complete physical examination including ECG,
Exercise stress test, lipid profile and CXR.

7. Phase III – Intermediate outpatient phase
The extended outpatient phase of cardiac rehabilitation
lasts from 4-6 months.
Exercise sections continue to be supervised and clients
are taught how to monitor their exercise intensity by
taking their pulse or if in a walking program
Counting the number of steps they take in a 15 sec
interval.
Periodic evaluation -To assess client’s endurance &
tolerance to the prescribed exercise program.

8. Phase IV - Maintenance outpatient phase
This phase usually take place in the home
or community & is unsupervised

9. Rehabilitation after cardiac surgery
After CABG, the patient will be on ET ventilation. Ideally the
patient can be weaned from the ventilator after 6 hours if the
condition permits. In some
cases the ventilation may extend up to 24 hrs.
On the 2nd
post operative day, the patient will be extubated & on
oxygen mask.
After 2-3 hrs, the patient will be allowed to sit up in bed.
Respiratory exercises and
Incentive spirometry is provided.

10. Rehabilitation cont..d
Ambulation – 2nd
day onwards the client can be ambulated
- graded ambulation.
The client can dangle his / her feet by sitting on
the side of the bed.
On the 3rd
day, the client is mobilised. The client
can be ambulated from the bed and allowed to walk
around the bed.
On the 7th
day, sutures will be removed & patient will be
discharged home.

11. Discharge instructions
CABG- Usual discharge instructions will be followed,
especially graded ambulation.
Valve surgeries
Regarding lifelong anticoagulants. Tab Warf according
to PT & INR. INR must be kept between 2.5 & 3.5 for
MVR, For AVR, INR must be between 2.5 & 3, For DVR - 3
to 3.5. Lowest of the two ranges is preferred. Tab
Ecospirin will also be continued.

12. PPC Concept - 6 elements
Intensive care
Intermediate care - Ambulatory for short periods of time
Self care – Within the limits of his illness
Longterm care - Rehabilitation, Occupational therapy &
Physical therapy - Instruct patients to learn to adjust to
their illness & disability. Home care – Extension of certain
hospital services. Outpatient care – For ambulatory
patients, requiring diagnostic, curative, preventive &
rehabilitating services

13. 1st
day – Bed rest
2nd
day – Ambulation starts, sit up in bed
3rd
day -- Client can walk around the bed
(shifted from ICCU)
4th
day -- Walk to the next bed. Slightly increase walking
periods to 3 mts in the morning & evening. Stomach must
be only half filled.
5th
day -- Usually patient’s will be discharged if no chest
pain occurs with graded ambulation.
Patients after MI (Graded ambulation)

14. Thank
You…
Deepa Merin
Kuriakose
Assistant Professor
Govt. College of
Nursing, Kottayam