2. • The ischemic manifestation of CHD is angina or the equivalent whereas
infarct is a myocardial infarction (mi).
• angina is typically described as squeezing, pressure, heaviness, tightness
or pain in your chest. many people with angina say it feels like someone
is standing on their chest.
• angina, also called angina pectoris ("pectoris" means chest), may be
stable or unstable:
• stable angina (persistent, recurring chest pain that usually occurs with
exertion)
• unstable angina (sudden, new chest pain — or a change in the pattern of
previously stable angina — that may signal an impending heart attack)
• a third, a rare type of angina called variant angina (also called
prinzmetal's angina) is caused by a coronary artery spasm.
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4. • PATHOPHYSIOLOGY
• The etiology of coronary artery disease is the
atherosclerotic process. The sites for advanced lesions are
found more in the branch points of the coronary arteries.
• There are three conduit arteries in the myocardium.
• Right Coronary Artery (RCA)
• Left Anterior Descending (LAD)
• Circumflex
• These arteries originate at the base of the aorta through the
RCA and left main artery. The left main divides into the
LAD and circumflex. Each of these arteries supply
different areas and function of the heart; although areas
sometimes overlap.
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6. TREATMENT OF CORONARY ARTERY DISEASE
Treatment of most modern chronic diseases can be
broken down into
• MEDICAL MANAGEMENT
• SURGICAL MANAGEMENT
• Lifestyle Modifications
– Exercise Prescription
– Diet & Nutrition
– Smoking Cessation
– Stress Management
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10. DEFINITION
• In 1993 WHO DEFINED CR AS: `the sum of activities required to
influence favorably the underlying cause of the disease, as well as the
best possible physical, mental, and social conditions so that they may,
by their own efforts preserve or resume when lost, as normal a place
as possible the community
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11. GOAL
• To achivement of an optimal health status for each patients
and maintanence of this status, not only physically and
psychologically but also in social and vocational and
economoical terms.
• limitation of adverse effect of illness
• risk stratification
• modification risk factors
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13. EFFICACY OF CR
• loss of excessive body weight and fat
• lowering lipid level, total cholesterol and triglycerides
• elevations of HDL
• reduced elevated blood sugar levels
• improvement in glucose insulin[1,2,3]
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14. CARDIAC REHABILITATION
• Phase I Inpatient
• Phase II Immediate out patient
• Phase III Intermediate out patient
• Phase IV Maintenance
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15. MANGEMENT AND EVALUATION OF PATIENT
IN ACUTE PHASE
Initial assesment
Chart review
Patient- family interview
Examination
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18. ACTIVITY PROGRAME GUIDELINE
*Indication for Modified and un modified program
indication with hold program
• contra indication
• others
• risk factor and behavior modification
• nutrition
• medications
• role of exercise
• self monitoring
finally Discharge
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19. Phase II
• Discharge after 24hrs to 6weeks
• frequency of visits depends on clinical needs
• Patient on telemetry and self monitoring
• secondary prevention of disease implemented[1,2,3,4]
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20. EXERCISE TRAINING
• Programme started 24 to 48 hrs following discharge
• Goal
• provision of flexible, individual exes leads to improve cardio
vascular fitness
• provision of programme enhance confidence patents ability to work
safe
• risk factor reduction , psychological, behavioral ,educational
improvements
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21. • HOME BASED REHAB
• Initial assesment
• Risk factor stratify
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22. Low Risk patients
• Functional Capacity = 7 METs.
• Absence of myocardial ischemia at rest or stress test with less than 6
METs intensity.
• Left ventricular EF = 50%.
• Absence of significant ventricular ectopic after the third day after AMI.
• Adequate blood pressure response to stress.
• Ability to self-monitor the intensity with which one exercise
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23. •Moderate Risk
•Presence of myocardial ischemia.
• ST depression = 2 mm segment.
• Left ventricular EF = 35-49%.
• Absence of complex ventricular ectopic.
• No drop in blood pressure during exercise
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24. • Recurring angina with ischemic changes in ST segment beyond 24
hours after hospital admission.
• Signs and symptoms of congestive heart failure.
• Left ventricular EF = 35%.
• Complex ventricular ectopy
• Functional Capacity = 5 METs in angina limited exertion test,
• ST segment depression or inadequate blood pressure response.
• Decreased or failure to increase systolic blood pressure during
• exercise.
• Persistent ischemic changes in ST and/or angina during exercise.
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25. EXERCISE FOR PHASE II
• Effects of exercise
• biochemical change
• improve ventricular function
• Type of exercise aerobic anerobic
• Aerobic
involve large muscle groups in a dynamicmanner
• anaerobic – static / isometric
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26. • Fitt principles
• frequency
• no of repetition per day or weeks
• until patient is able to exercise for 15 - 20 min continuously, the
patient should perform twice per day
• once patient perform 15-20 min continuously aerobic frequency
reduced to once a day, 5-6 times per week
• high intensity exercise 20 min continuously three times per week
• moderate 3-5 times per week
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27. • Mode
• large group of muscles in dynamic nature ex walking, jogging, dancing ,
bicycling
• Duration
• depends on individual capacity
• decondition - 1-2 min adequate every day increase 1 min with short
intervel
• sedentary 10-20 min continuously before fatigue
• duration increase from 20 to gradually 45 -60 min[1,2,3,5].
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28. • INTENSITY
PRESCRIBED BY
1 HRmax = 220-AGE
2 KARVONAN FORMULA
THR= %(MHR-RHR)+RHR
3 RPE
4 MET
5 patient sign and symptoms
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29. PHASE III
• Training or intensive rehab
• Patient usually seen once in a week
• Large group exercise program
• Resistance training
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30. • Aerobic exercise
• warm up 5-10
• peak intervel 15-45
• cool down 5-15
• resistance exercise
• circuit training
• flexibility progrms
• four vs two extremity exercise
• programe progression
increse fitt
sfety on rehabilitation.
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31. PHASE IV
• Prevention program
• High risk for infarction due to their risk profile – continued supervise
program
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32. REFERENCES
1. Cardio pulmonary physical therapy elizabeth dean
2. Saunders, Philadelphia, 1990, p 44.
3. Hellerstein, HK, et al: Principles of exercise prescription. In
Naughton, JP (ed): Exercise Testing and Exercise Training in
Coronary Heart Disease. Academic, New York, 1973, p 147.
4. Naughton, J, and Haider, R: Methods of exercise testing. In
Naughton, JP, and Hellerstein, HK (eds): Exercise Testing and
Exercise Training in Coronary Heart Disease. Academic, New
York, 1973, p 80.
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