REHABILITASI

JANTUNG

Sutrisno
STIKes Surya Mitra Husada Kediri

Definisi Rehab Jantung

Serangkaian aktivitas yang dibutuhkan untuk
mencapai kondisi fisik, mental dan sosial
terbaik. Agar mereka dapat mencapai kehiduan
optimal di masyarakat dengan upaya sendiri
(WHO 1993)

Kandidat Rehabilitasi Jantung

Post MCI
Pasca CABG
Pasca PTCA
CHF Stabil
Aritmia Jantung
Pasca Operasi Katup
Penyakit Jantung
Bawaan
Pasca Transplantasi

Rehabilitasi Jantung

Evaluasi Medis
Peresepan Latihan
Edukasi
Counselling
Modifikasi faktor
resiko

Goal rehabilitasi jantung

Optimalisasi fungsi

Fisik
Psikologis
Sosial

Menurunkan
morbiditas dan
mortalitas

OPERATIF

OBAT

PENATALAKSANAAN

REHABILITASI

Rehabitilasi Jantung

Fase I : Inpatient
Fase II : Out Patient
Fase III : Maintenance
Fase IV : Long term CR

Goals of cardiac rehabilitation

The general goals of cardiac rehabilitation are to

optimize the patients physiologic, phychosocial, and
vocational function, as well as to reduce the morbidity
and mortality of cardiac disease .

The cardiac patient is given :

- educational program (eg, lifestyle modification such as lowcholesterol diet, stress-reduction, and smoking cessation) to
reduce the risk factor for heart disease
- reconditioning exercises to improve safety and tolerance of
daily activities (vocational, recreational, and sexual activity)

Benefits of exercise post-MI

improvement in functional capacity (strong

evidence);
improved cardiovascular efciency;
reduction in atherogenic and thrombotic risk
factors;
improvement in coronary blood ow, reduced
myocardial ischaemia and
severity of coronary atherosclerosis;
reduction in risk of cardiovascular disease
mortality.

CARDIAC REHABILITATION GOALS

Medical Goals
Psychological goals
Social Goals
Health Service
Goals

Medical Goals :
To improve cardiac function
- To reduce the risk of sudden death and reinfarction
- To increase work capacity
- To prevent progression of the underlying
atherosclerotic process
- To reduce mortality and morbidity
-

Psychological goals :

Restoration of self-confidence
Reduce of anxiety and depression
Improved stress management
Restoration of good sexual health

Social Goals :

Return to work
Independence in activities of daily living

Health Service Goals :

Reduction in direct medical cost

Early mobilisation and early discharge
Fewer medications
Fewer re-admissions

Cardiac rehabilitation tim :

Involving :

Physicians
Nurses
Physical therapists
Occupational therapists
Exercise physiologists
Nutritionist
Psychologists
Social worker
Vocational counselors

Coronary heart disease risk factors

Modifiable CHD risk factors :

Hypertension, cigarette smoking, obesity, habitually
sedentary lifestye, hypercholesterol, high level LDL,
low level HDL, hypertriglyceridemia, DM , stres .

Unmodifiable CHD risk factors:

Advance age, gender, family history

Cardiac Evaluation

History :
- Chief complain
- Past history
- Medication history
- Functional and occupational history
- Personal history
- Social history
- Family history

Physical Examination

Vital sign
Cardiovascular:

Inspection
Palpation
Percution
Auscultation :

Heart sounds
Heart murmur
Pericardial rub

Pulmonary
Neurologic and
musculoskeletal

Diagnostic tests
1. Chest radiograph
2. Cardiac tests :
ECG
Echocardiography
3. Laboratory tests
blood tests

4. Cardiac stress tests

5. Catheterisation

Cardiac rehabilitation

Consists of four distinct phase.

Each phase of cardiac rehabilitation has

specific goals with educational or lifestyle
modification component

Phase I : Inpatient

In-patient acute phase of cardiac rehabilitation (generally

lasting from 3-6 days) .
Started as soon as the patients condition has stabilized
The goals :
To prevent immobilization and assist the patient in
tolerating self-care activities and early ambulation
To prepare the patient ( and family ) for a healthy lifestyle
To reduce psychologic and emotional disorders
To facilitate adjustment to the acute event and to the
hospital environment
To motivate the patient to make a long-term commitment to
the cardiac rehabiliatation program

Step in phase I inpatient OF MCI

Phase I program include :

Education and risk-modification program :

Hyperlipidemia control
Hypertension control
Smoking cessation
DM control
Stress management

Exercise training

Exercise program

Low dose exercise and activities.

5-10 minute (progressed up to 20-30 minutes), 3 - 4 times daily,
Activity 3 - 4 mets
Not raise HR above 20 bpm
Passive or active assistive ROM exercise active exercise in
supine, sitting, upright position
Ankle pumping exercise
Exercise parameter : pulse, BP, ECG, activity-induce symptoms

Exercise testing

At the end of phase I to six minute walk test

Stop exercise if
- angina
- light-headedness
- nausea, dyspnea
- fatigue
- cyanosis
- ataxia
- hypoxia
- peripheral circulatory

bradicardia
activity-induce BP changes :
SBP > 220 mmHg,
DBP >110 mmHg
- activity-induced ECG change
-

Phase II : Outpatient

start within 1 - 2 weeks and last 4 to 8 weeks

By end of phase II :
- patient should be able to perform the daily selfadministered exercise program safely
- have adequate knowledge of his or her disease
and symptoms to persue vocational ,
recreational, and sexual activities safely

Fase II: Outpatient

Dimulai 1 minggu setelah pasien pulang RS

Berlangsung selama 4-8 minggu
Dosis latihan: Frek 3-4 x/minggu, Int 60-70%,
Durasi 30-40 menit
Pasien mampu latihan jalan aerobik 3000 m
dalam 30 menit

The goal :

To enhance cardiovascular function and physical

work capacity .
To detect ECG changes during exercise
To teach the patient proper techniques of exercise and
provide him or her with guidelines for long-term
exercise
To establish healthy lifestyle in patient and family
To enhance the patients psychologic function
To return to work savely
To normal familial and social roles

Phase II program include :

Education and risk-modificarion program

Exercise :

The patient is given individualized prescription of

intensity,duration, frequency, mode activity
Aerobic exercise training at a level of 6 mets
Exercise involve upper and lower limb
Equipment : treadmills, bicycle ergometers, arm
ergometers, etc
Exercise session performed last 1 hour (including warmup and cool-down), 3 times a week
Goal exercise : target HR for at least 20-30 min for training
adaptation, predict 70 80 % HR Max
Intensity is increased on a weekly basis .

Return to work program

Patient are prepared to return to their original job

7 Metswithout any abnormal responses, generally

patients should be able to return to most jobs
except heavy industrial work

Phase III : Maintenance

Phase III usually last from 3 - 6 month and

generally includes clinical supervision and
intermittent ECG
Exercise in outpatient setting, then
progress to a community or home setting
Terget activity levels 6 8 Mets .

Fase III: Maintenance

Fase III berlangsung 3-6 bulan

Latihan dilakukan dengan supervisi minimal
Dosis latihan: F 3-4 x/mgg, I: 70-80%, D 3040 mnt
Latihan pembebanan
Pasien mampu jalan 3000-4000 m/30 mnt

Phase III

Goal phase III are similar to those of phase II

Phase III is designed to provide a smooth transition
from structured, closely supervised to minimally
supervision
Program include :
- Education and risk modification
- Exercise : aerobic exercise, resistance
training, aquatic exercise program (26-33 C)

Phase IV : Long term cardiac rehab

Phase IV program include :

Education and risk-modification program

Exercise (at least 3 times per week for 30-60
min, target HR 80% max HR, progress gradual
until 85%)

Aerobic exercise
Resistance training
Aquatic exercisewater exercise

Goal : to continue in improving and maintaining fitness

and a healthylifestyle

Fase IV: Rehabilitasi Jantung Jangka

Panjang
Mencakup:
Edukasi dan modifikasi resiko kontiu
Latihan (minimal 3-4 x/mgg), selama 30-60 min,
target latihan intensitas 80%-85% HR max.
Goal:

Melanjutkan program seumur hidup

Mempertahankan kebugaran fisik
Meningkatkan performane
Gaya hidup sehat

PROGRAM EDUKASI

STOP MEROKOK !!!

E K G

OPERASI JANTUNG

OBESITAS

FIVE-STEP PROGRAM OF INPATIENT

CARDIAC REHABILITATION
FOR SURGICAL PATIENT

Protokol rehabilitasi kardiovaskular

Pasca Operasi jantung

POD - 1
Active assisted ROM exercise
Chest physical therapy
Up in chair
Level activity 1 2 Mets

Source: AHA 2004, Krusen 1990

POD - 2
Active ROM exercise
Self feeding
Bed side commode
Walking short distance
Level activity 1 3 Mets

Source: AHA 2004, Krusen 1990

POD - 3

Partial self bath in bed

Walk in hall (3 times)
Level activity 1 4 Mets

Source: AHA 2004, Krusen 1990

POD - 4
Out of bad 3 -4 hours
Walking ad lib
Partial self bath
Self care
Level activity 2 4 Mets

Source: AHA 2004, Krusen 1990

POD - 5
Walk ad lib increasing distance
Level activity 3 4 Mets
Planning discharge
Counseling program

Source: AHA 2004, Krusen 1990

TERIMA KASIH