Cardiac rehabilitation program for the patient related to cardiac surgeries, MI, Angina pectoris, and any other cardiac condition.

1. BY
DR. PRASHANT KAUSHIK
MPT SPORTS
ASSISTANT PROFESSOR
KINPMS

2.  INTRODUCTION
 FEATURES OF CARDIAC REHABILITATION
 COMPONENTS OF CR
 INDICATIONS
 CONTRAINDICATION
 CR TEAM MEMBERS
 EXERCISE PHYSIOLOGY
 INPATIENT REHABILITATION PROGRAM
 BENEFITS OF CR PROGRAM

3.  It is the process of restoring patient with heart disease to
optimal functional status keeping in mind the
physiological, psychological, vocational requirements.
 The goal is to maintain good cardiovascular function, and
is to maintain good quality of life.
 The benefit of good rehabilitation program is that the 3
years survival rate is 95% with those in a program while it
is 64% in nonparticipation.

4.  It involves the active participation of patients and family
members.
 It is a sequence of medical and rehabilitation protocols
which merge with each other.
 It is personalized based on patient’s age and habits.
 The patient has to be rehabilitated back to his original
activity, as much as possible.

5.  Medical management of diabetes and hypertension.
 A dietician prescribes a customized diet; usually a low
protein and high fiber diet.
 Patient education, cessation of smoking, medication to
reduce cholesterol and blood thinners.
 Psychological components: Any patient who has
undergone a major surgery would naturally need
counseling by a psychologist regarding issues like quality
of life after surgery.
 Avoiding risk factors like stress and obesity.

6.  Coronary artery disease is one of the leading causes of
death worldwide; survivors of myocardial infarction and
patients with angina pectoris need a good rehabilitation
program.
 Patients who undergo surgeries on the valves.
 Patients needing percutaneous transluminal coronary
angioplasty(PTCA).
 Patients with milder form of MI.
 Patients who undergo coronary active bypass
grafting(CABG).

7.  Severe MI.
 Unstable angina.
 Cardiac arrhythmias.
 Systolic pressure >220mmHg and diastolic pressure
>110mmHg.
 Impaired cognition.
 Possible lack of compliance therapy.

8.  Cardiac rehabilitation specialist.
 Physical therapist.
 Cardiothoracic surgeon.
 Cardiologist.
 Cardiac rehabilitation nurses.
 Psychologist.
 Dietician.
 Family members.

9.  To understand the exercise physiology one must know
a few terms: -
 Total oxygen consumption(VO2 ).
 Aerobic capacity.
 Cardiac output = heart rate/stroke volume.

10.  The rehabilitation program for patient after a cardiac event
like surgery divided into three phases: -
 1. Phases one ( Inpatient phase)
 2. Phases two ( Immediate out patient period)
 3. Phase three ( Intermediate and maintenance periods)

11.  Day of surgery: - In ICU the patient would be connected to
lines and monitors and ventilatory support. He would not be
fully consious because of the effects of anaesthesia. The
therapist visits three to four times during day and gives relaxed
diaphragmatic breathing and gentle toe and ankle movements.
 Day 1: - As the patient is weaned off the ventilator, the
therapist gives assisted coughing in sitting and active exercises
to the upper limb within the pain free range, in addition to the
therapy given above. It must be remembered that the operated
site over the sterum can be painful. It can be repeated three to
four times a day depending on patient’s cooperation.

12.  Day 2: - Patient’s intravenous lines are removed . Repetition
of the same exercises as previous day.
 Day 3: - Patient shifted out of ICU and to ward if he is
declared stable by the attending physician. The previous
exercise are repeated and the patient is made to walk around
the bed under supervision. Sitting in chair with back support is
encouraged.
 Day 4: - Shoulder movements are performed within the pain
free range. Walking distance is increased within the ward under
the supervision of physiotherapist.
 Day 5 and Day 6: - Stair climbing up to five steps is started
under the supervision of physiotherapist.
 Day 7: - The patient is asked to cover the longer distance, with
increase in stride length and cadence.

13.  Day 8: - Patient is counseled in the cardiac rehabilitation
department by a team comprising of a psychologist,
physiotherapist, dietician, cardiologist, and a cardiothoracic
surgeon.
 Day 9 and Day 10: - Home exercise program is taught and
patient is discharged after suture removal. Ideally by now the
patient should achieved a metabolic equivalent between two
and three for progression to the second phase of rehabilitation.

14.  This is an outpatient program which means that the patient
has to be brought to the department following his
discharge until 3 months, thrice a week.
 Activities or exercises of intensity (3-4 METs) are given
for 30 to 45 minutes checking vital signs periodically.
 A gradual warm up session for 5-10 minutes is given,
followed by static cycling, treadmill walking, and group
therapy for up to half an hour.
 Early ambulation is initiated starting in the room and then
corridors of the hospital, starting 1mph and gradually
increasing up to 2.5 mph as tolerated.

16.  A cool down program for 5 minutes is also given at the
end of this session, by which stage the patient is expected
to attain 5 METs.
 ROM exercise can be gradually increased in intensity with
mild resistance or low weight.

17.  A detailed home exercise program is taught which is
followed by the patient at home.
 The rehabilitation program should monitor risk factor in
post myocardial infarction (MI) patients like hypertension,
increased serum cholesterol levels, obesity, and coronary
atherosclerosis. Other habits like smoking and excessive
drinking should be avoided.
 Graded exercise stress test are given to diagnose,
prognosticate , and asses how the patient respond to
increased physical stress.

18.  Improvement in exercise limits.
 Reduction in symptoms of angina pectoris in patient, of
heart failure in patients with left ventricular systolic
dysfunction and improvement in clinical measures of
myocardial ischemia.
 Improvement in blood lipid levels.
 Improvement in psychosocial well being and stress
reduction.
 Reduction in mortality.