Dr.

Benny TM Togatorop SpJP

CARDIAC REHABILITATION PROGRAM
CONSIST OF :
 Primary preventions
Focus on the reduction of cardiac risk factors :
- education, ideally started in schools with parental support
- physical activity ( decrease obesity, lower SBP, modifies lipid
profiles )
- should begin in childhood
- in order to establish healthy behavior patterns of life
 Secondary prevention
- include all of the features of primary prevention programs
- decreases second cardiac event
- lowers mortality post-MI
- improve management of hypertension and Diabetes
DEFINITIONS:

Cardiac Rehabilitation is a multidisciplinary

program of education and exercise established to assist
individuals with heart disease in achieving optimal
physical, psychological, and functional status within
the limits of their disease
GOALS OF THE CARDIOVASCULAR
REHABILITATION
 To prevent the harmful effects of prolonged immobilization.
 To develop cardiovascular fitness after acute illness
 To maximize exercise tolerance and ADL (Activity Daily Living)
performance
 To control risk factors for coronary artery disease (CAD)
 To provide guidelines for safe activities and work ( to achieve a active
and productive life )

 To help patiens cope with perceived stressor, ( psychological goals :

self confidence, decrease anxietas and depression, stress
management, sexual function )

 To improve quality of life

through program : - education

- behavior modification
- secondary prevention and exercise--→ to resume
activities of normal life without significant cardiac-symptom
CONTRA INDICATION EXERCISE

 Heart rate increase > 50 / minute

 BP systolic > 210 mmHg, Diastolic > 110 mmHg
 Unstable angina
 Heart failure acute
 Uncontrolled arrhytmias
 Moderate / severe aortic stenosis
 Decompensated CHF
 Acute systemic illness/ fever
 Active pericarditis/myocartitis
 Embolism
 Thrombophlebhitis acute
 Resting ST diplacement > 3 mm
 Uncontrolled diabetes
CORONARY ARTERY DISEASE RISK FACTORS
Reversible risks :
• Sedentary lifestyle
• Cigarette smoking
• Hypertension
• Low HDL cholesterol ( < 0.9
mmol/L [35 mg / DL ] )
• High LDL Cholesterol
• Hypercholesterolemia ( > 5.20
mmol/L [200 mg / DL ])
• High lipoprotein A
• Abdominal obesity
• Hypertriglyceridemia ( >2.8
mmol/L [250 mg / DL] )
• Hyperinsulinemia
• Diabetes mellitus
Irreversible risks :
• Age
• Male gender
• Family history of premature
CAD ( before age 55 in a parent
or sibling )
• Past history of CAD
• Past history of occlusive
peripheral vascular disease
• Past history of cerebrovascular
disease
WHEN DID THE CARDIAC
REHABILITATION START :

 Hemodinamic condition are stable.

 No repeated chest pain in last 8 hours
 No sign of decompensated heart failure .
 No significant change of ECG in last 8 hours.
POST MYOCARD INFARCT
REHABILITATION

Classic model as first described by Wenger et al :

 Phase I (acute phase)
 Phase II (convalescent phase)

 Phase III (training phase)

 Phase IV (maintenance phase)

PHASE I :
ACUTE PHASE REHABILITATION

Immediately following the MI up to discharge :

 Early mobilization to prevent complication of
prolonged immobilization ( deconditioning )
 Alleviation of anxiety and depression

 Establish modifiable risk factor reduction

strategies
 Prescription and education with guidelines for
activity and work after discharge
 Target activities level : 3 Mets
PHASE II :
CONVALESCENT PHASE
REHABILITATION
Is done at home
Continues the program started in phase I
until the myocardial scar has matured :
 To achieve cardiovascular conditioning and fitness
via aerobic exercise
 To achieve control modifiable risk factors using
physical activity,psychosocial and pharmacologic
interventions and lifestyle changes
 To an early return to work

 Target activities level : 3-6 Mets

PHASE III
THE TRAINING PHASE
 Usually starts after 4 – 6 weeks
 Conditioning exercise program and education

 Completed programe : physical,mental,diet

 Return to community

 Target activities level : 6 – 8 Mets

PHASE IV
THE MAINTENANCE PHASE
 To keeping the aerobic conditioning gains
 Be taught risk-factor modifications
GENERAL SEXUAL COUNSELING
FOR PATIENT AFTER A CARDIAC EVENT
 Maximal activity ( orgasmic ): 4,7 -5,5 Mets (for < 30 “)
 Pre and post orgasmic periods: - 3,5 Mets

 Non coital activity ( e.g : masturbation ) < coitus

 When ? 3 – 6 weeks after cardiac event

if can exercise at level of 5 – 7 Mets

test : two-fligh stair climbing test ( 3 mph )
 position : patient at the bottom,side by side, sitting etc

 Precaution : suddent death during coitus :

illicit sexual affairs, after large meal ,

high alcohol intake,
soon after physical or emotion stress
WARNING SIGNS
 Tachycardia
 Dyspneu

 Tachypneu

that persist for 10 – 15 minuts after coitus

 Extreme fatigue

 Arrytmias

 Dizziness

 Blacking out

 Chest pain during or after coitus

CHF REHABILITATION
EFFECT EXERCISE:

 Improvement exercise tolerance

 Improvement cardiopulmonary function

 Reduce patient symptoms

GUIDELINE FOR EXERCISE IN CHF
 Aerobic exercise
 Intensity : sub maximal
 Duration : 20 – 45 min
 Frequency : 2 – 5 X/week
 Prolonged warm ups and cool downs

 Avoided isometric exercise

OUTCOME CARDIOVASCULAR REHAB
 Decreased length of hospital stay.
 More rapid and complete resumption of usual
activities
 Increased self confident

 Fewer readmission

 Less psychological distress

 Improve quality of life