chap 5 presentation

1. CARDIAC REHABILITATIONCARDIAC REHABILITATION
CHAPTER 5 PRESENTATIONCHAPTER 5 PRESENTATION
SAMSON VASSAMSON VAS

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

3. The major goals of a cardiac rehabilitation programThe major goals of a cardiac rehabilitation program
are:are:
 Curtail the pathophysiologic and psychosocialCurtail the pathophysiologic and psychosocial
effects of heart diseaseeffects of heart disease
 Limit the risk for reinfarction or sudden deathLimit the risk for reinfarction or sudden death
 Relieve cardiac symptomsRelieve cardiac symptoms
 Retard or reverse atherosclerosis by institutingRetard or reverse atherosclerosis by instituting
programs for exercise training, education,programs for exercise training, education,
counseling, and risk factor alterationcounseling, and risk factor alteration
 Reintegrate heart disease patients intoReintegrate heart disease patients into
successful functional status in their familiessuccessful functional status in their families
and in societyand in society

6. Indications for cardiac rehabIndications for cardiac rehab
 Acute myocardial infarctionAcute myocardial infarction
 Coronary artery bypass graftingCoronary artery bypass grafting
 Percutaneous coronary vessel remodeling (i.e.Percutaneous coronary vessel remodeling (i.e.
angioplasty, atherectomy, stenting)angioplasty, atherectomy, stenting)
 Valve replacement or repairValve replacement or repair
 Heart transplantationHeart transplantation
 Major pulmonary surgery, great vessel surgery,Major pulmonary surgery, great vessel surgery,
sustained ventricular tachycardia or fibrillationsustained ventricular tachycardia or fibrillation
 Class III or IV congestive heart failureClass III or IV congestive heart failure
unresponsive to medical therapyunresponsive to medical therapy
 Chronic stable angina pectoris unresponsive toChronic stable angina pectoris unresponsive to
medical therapy which prevents the membermedical therapy which prevents the member
from functioning optimally to meet domestic orfrom functioning optimally to meet domestic or
occupational needsoccupational needs

7. Cardiac Rehabilitation PhasesCardiac Rehabilitation Phases
Phase I – InpatientPhase I – Inpatient
 Cardiac rehabilitation begins during in-hospitalCardiac rehabilitation begins during in-hospital
recovery following surgery or a cardiac event.recovery following surgery or a cardiac event.
The first phase is conducted by an exerciseThe first phase is conducted by an exercise
physiologist. Before each cardiac patient isphysiologist. Before each cardiac patient is
discharged, questions regarding personaldischarged, questions regarding personal
recovery are answered, and preparation for therecovery are answered, and preparation for the
second phase of cardiac rehabilitation takessecond phase of cardiac rehabilitation takes
place.place.

8. Phase I includes:Phase I includes:
 Monitored hall walking program.Monitored hall walking program.
 Education about coronary artery disease, theEducation about coronary artery disease, the
need for aerobic exercise and the fundamentalsneed for aerobic exercise and the fundamentals
of exercise. An outline of the symptoms ofof exercise. An outline of the symptoms of
exercise intolerance, and a home walkingexercise intolerance, and a home walking
program.program.
 Personal plan of risk-factor management andPersonal plan of risk-factor management and
activity progressionactivity progression

9. Phase II – OutpatientPhase II – Outpatient
 The outpatient phase of cardiac rehabilitationThe outpatient phase of cardiac rehabilitation
begins two to six weeks after discharge from thebegins two to six weeks after discharge from the
hospital. The second phase is conducted by anhospital. The second phase is conducted by an
RN and exercise specialist. The patient attendsRN and exercise specialist. The patient attends
one-hour outpatient sessions, two to three timesone-hour outpatient sessions, two to three times
per week.per week.

10. Phase II includes:Phase II includes:
 Up to 36 sessions of EKG monitored exerciseUp to 36 sessions of EKG monitored exercise
(Two to three sessions per week, one hour per(Two to three sessions per week, one hour per
session).session).
 Blood pressure and heart rates monitored.Blood pressure and heart rates monitored.
 Exercise performed on treadmills, stationaryExercise performed on treadmills, stationary
bikes, rowing machines, stairmasters and lightbikes, rowing machines, stairmasters and light
weight-lifting.weight-lifting.
 Individual dietary consultation.Individual dietary consultation.

11. Phase III – Outpatient MaintenancePhase III – Outpatient Maintenance
 This optional phase of cardiac rehabilitationThis optional phase of cardiac rehabilitation
promotes independence within a structuredpromotes independence within a structured
exercise program. The third phase is conductedexercise program. The third phase is conducted
by an exercise physiologist in consultation withby an exercise physiologist in consultation with
the program director. At the outpatient facility,the program director. At the outpatient facility,
cardiac patients exercise under supervision twocardiac patients exercise under supervision two
times a week during regular facility hours. Pulsetimes a week during regular facility hours. Pulse
rate and blood pressure continue to berate and blood pressure continue to be
monitored.monitored.

12. Phase III includes:Phase III includes:
 Two sessions per week, one hour per session.Two sessions per week, one hour per session.
 Blood pressure and heart rate monitoring.Blood pressure and heart rate monitoring.

13. 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.