Cardiac presentation CRP ,Bangladesh

1. Welcome to my
presentation

2. My presentation
on
Mithun Adhikari
Roll:30,Batch-17th

3. Supervised By
Ehsanur Rahman Robin
Asstt. Prof. of Department of
Physiotherapy
&
Fatema Akter Lopa
Lecturer of Department of
Physiotherapy

4. Contents
Definition of Cardiac rehabilitation
Cardiac Rehab Team
Indication for CR
Contraindications for CR
Risk factors for Cardiac disease
Goals of CR
Guidelines
Measuring THR
Physiotherapy interventions
Benefits of Routine Exercise
Outcomes of CR services

5. Definitions of Cardiac Rehabilitation
• “Cardiac rehabilitation is the process by which patients with cardiac
disease, in partnership with a multidisciplinary team of health
professionals, are encouraged and supported to achieve and
maintain optimal physical and psychosocial health”
• (SIGN) SIGN. Guideline 57 Cardiac Rehabilitation. Available
at: www.sign.ac.uk/guidelines/fulltext/57/section1.html

6. The Cardiac Rehab Team
The cardiac rehab team may be include –
Doctors(such a family doctor, a heart specialist, a surgeon)
,physical and occupational therapist, nurses, exercise specialist,
dietitians or nutritionist, and psychologist or other mental health
specialist.
_NHLBI,NHI

7. Indications for Cardiac
Rehab
•MI
•Angina (stable)
•Coronary artery bypass Surgery
•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

8. Contraindications for cardiac
rehab

9. 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 history and culture
• Age
• Sex

10. Cont…..
3. Secondary Factors
• Obesity
• Diabetes
• Alcohol consumption
• PVD

11. Goals of Cardiac Rehab
For those able to return to work:
 Return to productive employment as soon as possible
 Improve and maintain as cardiovascular fitness
For those not able to return to work:
 Maintain an active life as possible
 Establish new areas of interest to improve quality of life
Patient Education and Reduction of Coronary Risk
Factors

13. Guideline
LifestyleLifestyle
Regular activityRegular activity
Stop SmokingStop Smoking
Mediterranean DietMediterranean Diet
Healthy weightHealthy weight
14 “units” of alcohol per14 “units” of alcohol per
weekweek
No beta-caroteneNo beta-carotene

14. Cont..
Drug TreatmentDrug Treatment
 ACEACE
 AspirinAspirin
 Beta-blockerBeta-blocker
 StatinStatin

15. Measuring Target Heart Rate:
1.Find resting heart rate as soon as wake up
For example, (62 + 65 + 63) / 3 = 63
2.Find your maximum heart rate and heart rate reserve
Maximum heart rate (Hrmax).
For example, the HRmax for a 40-year-old would be 220 - 40
= 180.
Heart rate reserve (HrmaxRESERVE)
For example, HRmaxRESERVE = 180 - 63 = 117

16. CONt….
3.Calculate the lower limit of THR.
For example, (117 * 0.6) + 63 = 133.
4.Calculate the upper limit of THR.
For example, (117 * 0.8) + 63 = 157.
5.Target heart rate (THR).
For example, (133 + 157) / 2 = 145

17. Physical interventions
•Phase -1:Inpatient
•Phase -2:Outpatient
•Phase -3:Maintanence
•Phase -4:Lifelong

18. Physical Therapy Interventions with Cardiac
Rehab
• 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 Isometric
• No weights

19. Phase-1 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

20. 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??

21. 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

22. Outcomes of CR services
The most substantial benefits:
 Improvement in Exercise Tolerance
 Improvement in Symptoms
 Improvement in Blood Lipid Levels
 Reduction of Cigarette Smoking
 Improvement in Psychosocial Well-being and Stress Reduction
 Reduction in Mortality
 Safety

24. Thank YouThank You