This document provides information about cardiac rehabilitation, including indications, contraindications, risk factors, benefits of exercise, and phases of rehabilitation. It indicates that cardiac rehab is indicated for conditions like heart attack, angina, heart surgery, and heart failure. Contraindications include uncontrolled arrhythmias or blood pressure. Benefits of exercise include reduced risk of heart disease. Cardiac rehab occurs in phases from inpatient to lifelong maintenance and focuses on exercise based on metabolic equivalents of tasks.

1. CARDIAC REHABILITATION

2. CARDIAC REHABILITATION: DID YOU KNOW: WITH EVERY HEART BEAT, BLOOD IS PROPELLED
THROUGH THE 60,000-MILE NETWORK OF VESSELS MAKING UP THE CIRCULATORY SYSTEM.
ABOUT 100,000 TIMES A DAY, THE CARDIAC CYCLE REPEATS AND SUSTAINS LIFE.
AMAZING!!
 Review
 Blood flow
 Conduction
System

3. INDICATIONS FOR CARDIAC REHAB
 MI
 Angina (stable)
 Coronary artery bypass Sx
 Compensated heart failure
 Cardiac surgery
 High risk for CAD
 High risk for high blood pressure
 End stage renal failure
 Status post pacemaker insertion
 Cardiomyopathy
 PVD
 Heart transplant
 High risk for diabetes

4. CONTRAINDICATIONS FOR CARDIAC REHAB
 Uncontrolled atrial/ventricular arrythmias
 Recent diagnosis embolism/DVT
 Resting diastolic >110
 Resting systolic >200mm Hg
 Uncompensated CHF
 Thrombophlebitis
 Orthostatic BP >20mm HG drop
 Acute infection
 Unstable angina
 Resting ST segment displacement >2mm

5. RISK FACTORS FOR CARDIAC DISEASE
1. Modifiable factors
 Smoking
 Hypertension
 High cholesterol levels above
200 mg/dL and poor diet
 Sedentary lifestyle
 Stress
2. Non-modifiable factors
 Family hx and culture
 Age
 Sex
3. Secondary factors
o Obesity
o Diabetes
o Alcohol
consumption
o PVD

6. BENEFITS OF ROUTINE EXERCISE
 Decrease myocardial
O2 cost
 Decrease HR/BP
 Increase Max O2
uptake
 Decrease minute
ventilation
 Decrease in
depression/anxiety
 Decrease serum
triglycerides
 Decrease risk of heart
disease
 Decrease % body fat
 Improve glucose
tolerance
 Increase HDL
cholesterol

7. CORONARY ARTERY DISEASE = ISCHEMIC
HEART DISEASE
Coronary Artery
Disease
1. Imbalance of
Myocardial oxygen supply
to meet the needs of the
MVo2 (myocardial O2
demand)
of the heart = ischemia
2. Due to narrowing of
the coronary arteries
secondary to an
atherosclerotic lesion

8. CLINICAL MANIFESTATIONS OF CAD
Symptoms may not be
experienced until the
blood vessel lumen is
at least 70% occluded
Common clinical s/s
 Ischemia – temporary
deficiency in oxygenated
blood flow to the heart
tissues – partial occlusion
of the artery - it reverses
when the supply is
reestablished
 Result of ischemia =
the patient will have
angina = substernal
chest pain accompanied
by the Levine sign = pt.
clenching his or her fist
over the sternum
 Ischemia may also
present as pain or
heaviness in the
shoulder, arm, elbow, jaw
or upper spine between
the scapulae

9. PHYSICAL THERAPY INTERVENTIONS WITH
CAD
1. Phase I = inpatient
2. Phase II = outpatient
3. Phase III =
maintenance
4. Phase IV = lifelong
Rehab is based on
METS
Common activities:
 2 METS – standing,
strolling
 2-3 METS -Level Walking
slow (2 mph) Biking (5
mph)
 Phase I Cardiac Rehab
 3-5 days for
uncomplicated – begins
in ICU or CVICU
 PT begins after patient is
stable, usually 12 to 24
hrs post op
 Generally 1-3 METS
(will vary with protocol
and complications)
Contraindications
 NO ISOMETRICS
 No weights

10. PHASE I CARDIAC REHAB
 ALWAYS check vitals
prior to ANY activity
AND DURING activity
 Warm up doing AAROM
or AROM i.e. Ankle
pumps,
 LE ex, trunk ex, UE ex
 Monitor vitals AGAIN and
DURING prior to
progressing to any other
activity. Also at end of Rx.
 Ambulation – with
Holter monitor
progressive time rather
than distance (however
you should be able to
document both
distance and time)
with stairs being the
last progression
 Enforce the importance
of breathing exercises
– spirometer
 Begin self care – bed
mobility, sitting, BR,
dressing, showers

11. PHASE I CARDIAC REHAB
 Educate patient and
family on:
 Risk factors
 Monitoring vitals
 Behavior
modification
 Recognition of
symptoms
 Appropriate
activities
 Special
Considerations:
Post CABG or ANY open
heart surgery procedure
where the sternum is
open.
 No lifting, pushing or pulling
for 4-6 weeks + until the
sternum is healed
 UE ex may be restricted by
Dr. – see protocol

12. PHASE I CARDIAC REHAB – THERAPIST
MONITORING
 Be alert for orthostatic
hypotension when
OOB (out of bed)
 Monitor BP, HR,
respiration, and pulse
oximeter – O2
Saturation rate above
90%
 Monitor patient
subjective comments
 Use the Borg RPE
(rating of perceived
exertion) scale –
patient should rate at
LESS than 13/20
 Observation – what are
you seeing??