Medical rehabilitation

after myocardial
infarction

AMEENA MUMTHAS
M1956
• Medical rehabilitation(cardiac rehabilitation )
can be defined as: Coordinated,
multifaceted interventions designed to
optimize a patient’s physical, psychological,
and social functioning so that they may, by
their own efforts, resume and maintain as
normal a place as possible in the
community
Goals of medical rehabilitation
after myocardial infarction

Retard or reverse atherosclerosis

by instituting programs for
The pathophysiologic and
exercise training, education,
psychosocial effects of heart
counseling, and risk factor
disease Limit the risk for
alteration Reintegrate heart
reinfarction or sudden death
disease patients into successful
Relieve cardiac symptoms
functional status in their families
and in society
Benefits of rehabilitation

Enable patients to return to

PROGRAM Offset activities of daily living
deleterious pyschologic within the limits imposed by
and physiologic effects of their disease and Reduces
bed rest during cardiovascular and total
hospitalization mortality Improves
myocardial perfusion
 Av block

Contraindications of Recent thromboembolism

medical
rehabilitation Acute systemic illness

Orthopedic problem
 Nutritional
• Counseling Weight Management, Blood Pressure
core Management ,Lipid Management ,Diabetes Management
Tobacco Cessation ,Psychosocial Management Exercise
components Training Physical Activity Counseling

parents • REDUCTION IN RISK FACTORS Blood lipids

assessment • Significant reductions of total cholesterol, LDL-cholesterol,
and triglycerides
an increase in HDL-cholesterol with training
 Core components

• Hypertension control
• Regular exercise helps keep arteries elastic (flexible)
• This ensures good blood flow and normal blood pressure Consistent long term exercise
can reslut in atleast 10 to 20mmhg decrease in both resting and exercise blood pressure
of hypertension
• Glucose intolerance
• Lower serum insulin level after training because of increase in insulin sensitivity at the
cellular level
• Decreased serum triglycerides and body fat levels
Assessment before exercise training
• Clinical risk stratification is suitable for low to moderate risk patients undergoing low
to moderate intensity exercise
• Exercise testing and echocardiography are recommended for high risk patients
and/or high intensity exercise
• Functional exercise capacity should be evaluated before and on completion of
exercise training.
• Vitals:PR, RR, BP, Sp02
• Exercise capacity
 Phase l
Rehabilitati
on
Phase ll
program
Phase lll

Phase lV
 Phase l

• Phase I relates to the period of hospitalization following an acute cardiac event. The duration of this phase
may vary depending on the initial diagnosis, the severity of the event and individual institutions, usually one
week acute event/post-operative.
• During this phase: Early mobilization and adequate discharge planning.
• Individuals typically undergo a risk factor assessment and risk stratification
• Receiving information regarding their diagnosis, risk factors, medications and work/ social issues.
• Involvement and support of the partner and family is facilitated and encouraged.
• Functional goals – Exercise training under supervision/ at home
• Psychosocial goals – Anxiety/depression managment
 Phase ll

• Immediate post discharge period, which is typically a period of four to six weeks. It focuses on health
education and
• resumption of physical activity, however the structure of this phase may vary dramatically from centre to
centre.
• telephone follow up,home visits,
• individual or group education sessions.
• Either way, some form of contact is maintained with the patient, facilitating ongoing education and
exchange of information.
• Functional goals – Exercise training under supervision ,
• Psychosocial goals – Return to work – Return to hobbies and lifestyle – Anxiety/depression management ,
Secondary preventive targets
 Phase lll

The patient has stabilized and requires ECG monitoring only if signs and symptoms necessitate. Duration : 6
weeks to 12 weeks Begins with symptom limited ETT Result of this test are used to determine a target HR for
exercise training
Goals
• Improve and maintain physical fitness
• Provide professional supervision for exercise
• Continue with educational and behavioral program
Types of Training
• Steady State Training: – Is a sustained activity, where workload and HR are maintained at a constant sub-
maximal intensity. – Jogging, walking, stepping and cycling.
• Interval Training: – The exercise is followed by a rest interval. – Is perceived to be less demanding than
continuous – High-intensity work can be achieved as there is appropriate spacing of work- relief intervals.
Phase lll
• • Circuit Training:
• Employs a series of exercise activities.
• At the end of the last activity, the individual starts from the beginning and again
moves through the series.
• – Improves strength and endurance by stressing both the aerobic and anaerobic
system
• Exercise Program
Frequency: 3-4 times/week
Cool-down period
Phase lV
Goals
• Continued improvement and maintenance of fitness.
• Unsupervised exercise program
• Self exercise
• Long term behavioral modifications
• Exercise Program
• Frequency: one session/day; 3-4 days/week
• Intensity: 60-80% of VO2 ; 70-85% of HRR; RPE 12-15
• Time: desired 30-60 minutes continuous workout
• Type: dancing, hill walking, resistance exercise.
Thank you