Fase Rehabilitasi Jantung

1. Fase 1/ Fase Inpatient

program carried out at the time patient Still in maintenance . Objective of the rehabilitation program in phase I are For avoid
patient from effect disease , effect action , effect prolonged bed rest or effects deconditioning , and working on it mobilization
early to get it quick go out from House sick , 5 able do daily activities day and care self in a way independent .

1. Penilaian 2. Education
patient will operate test following : Patient start accept education and training about :
• Beat heart •Incident heart That Alone
• Pressure blood •Aspect Specific of diagnoses and conditions
• Saturation oxygen patient
• Function extremities above , incl power and •Manage reaction psychological patient to incident
range motion (ROM)
the
• Strength extremities lower
•Manage painful heart or symptom other
• Mobility functional like walking and errands
•Monitoring
maintenance self

2
3. Therapy Physique
designing a monitored exercise
program in a way careful ,
progressive , and very limited in
order for the patient can rise return .
This matter Possible initially only
done by sitting in place sleep , stand
and test range motion patient , before
continue to go for a walk short all
around part House Sick .
4. Plan Return
evaluate ability patient For walking ,
necessity patient will oxygen at home ,
and assess training addition or need
medical anything is possible patient
have before leave . Work The same
with family or people closest to you
patient For make sure of it get
adequate care and support _ when go
out from House Sick .
3
 Phase 2: Subacute Outpatient Care (Post Discharge , Period Pre Exercise )
monitoring strict For ensure progress recovery patient . the patient will too accept more training _ extensive about method manage condition patient
. Rehabilitation team heart patient will review How heart patient respond enhancement level sports and activities in a way gradually . patient will
accept guide about method use drug patient and method reduce risk incident heart . During stage this , the goal is For reach the point where the
patient can exercise and get started journey going to recovery full .

1. Strengthen learning from Phase 1 2. Move going to maintenance independent self _

• Aspect important other from rehabilitation heart
• Target main Stage 2 is For support
phase second This is help patient become more
learning patient from Stage 1—and
independent and earned information . patient
confirm that patient has understand all must Study How monitor Alone beat heart and
information new . patient will monitored level power patient during exercising . Objective
moment patient do change style necessary mainly is For increase level independence

life and start _ develop pattern sport patient and possible patient For move to Phase

patient . 3.

4
 Phase 3: Intensive Outpatient Rehabilitation

1. Practice 2. Education
• During phase this is important For ensure patient
• During rehabilitation heart , exercise program
own all patient information _ need For
patient will supervised in a way strictly by
maximizing quality live , manage symptoms ,
professionals medical For ensure safety patient
and feelings Certain that patient can guard self
. Sports level patient will depending on how
Alone regardless from condition heart patient .
much fit patient before condition heart patient ,
Training in stages This Possible will focus on:
stamina and ability patient moment This is the
nutrition , style life , stress management
patient 's symptoms natural , and a number of
factor health other .

5
 Level 4: Maintenance

During Phase 4, patient must Keep going follow guide exercise , nutrition , and style alive , as
determined by the team rehabilitation patient . patient can continue in a way independent , or
patient can decide For fund Alone training more carry on with expert therapy physique For help
support patient along progress patient . There are also qualified gym instructors who can offer
training sport sustainable . patient must do regular check-ups with provider service health patient
For ensure that patient manage condition heart patient in a way effective and avoidable relapse
disease

6
 1. Fardy PS, Yanowitz FG, Wilson PK. The
exercise prescription. In: Fardy PS,
Yanowitz PG, Wilson PK, editors.
Cardiac Rehabilitation, Adult FItness,
and Exercise Testing. Third ed.
Baltimore, Maryland: Williams &

Referensi Wilkins; 1995. p. 245-276.

2. ACSM. General Priciples of Exercise

Prescription. In: Lupash E, Klinger AM,
editors. ACSM's Guidelines for Exercise
Testing and Prescription. Philadelphia:
Wolters Kluwers. Lippincott Williams &
Wilkins. p.152-182.
 komponen
Rehabilitasi Jantung
1. Assessment Patient : Assessment about history diseases , actions and treatments that have been / have been experienced , factors risk disease ,

condition Lastly , possible problems _ become program and stratification barriers risk patient .

2. Education and counseling : recognize factor risk , way prevention , method overcome pain _ or other complaints as a result the disease , pattern

life Healthy period long , rehabilitation program , medication cardiovascular .

3. Control factor risk with pattern life Healthy or drug medicine For achieve the expected targets , management nutrition , weight , pressure blood ,

blood sugar , cholesterol , stop smoking and afctors risk other

4. Counseling activity physical and work post Sick .

5. Practice test For measure level fitness , set risks , create an exercise program and determine readiness return Work .

6. Create an exercise program physique or activity physically appropriate , effective and safe _ For each type patient based on diseases and

conditions , namely :

• Conditioning exercises cardiovascular progressive

• Strengthening exercises muscle progressive

• ECG monitoring

• Monitoring pressure blood

9
 1. Adamapoulos S, Fountoulaki K, Parissis
JT. Exercise testing in coronary heart
disease. In: Perk J, Mathes P, Gohlke H,
et al., eds. Cardiovascular prevention
and rehabilitation. London: Springer-
Verlag London; 2007:88- 98.

Referensi 2. Pashkow FJ, Dafoe WA. Cardiac

rehabilitation as a model for integrated
cardiovascular care. In: Pashkow FJ,
Dafoe WA, eds. Clinical cadiac
rehabilitation : A cardiologist's guide.
Second ed. Baltimore, Maryland:
Williams & Wilkins; 1999:3-25.
 Indications and
contraindications
Rehabilitation Heart
 Indication
a. Post infarction stable myocardium _ in a way medical
b. Angina pectoris stable
c. Post action surgery heart (CABG, surgery valves , surgery on abnormalities heart congenital , operation
vessels aortic blood , and surgery heart other )
d. Post non- surgical action heart ( coronary angioplasty transcutaneous , replacement or repair non-
surgical valves , and procedures transcatheter others , installation of a heart pacemaker ( including
implantable cardioverter defibrillator/ICD)
e. Fail heart compensated
f. Disease arteries peripheral
g. Disease cardiovascular which is not allowsor risky tall For done action intervention surgery
h. Post the event of sudden cardiac death can overcome .
i . Have risk tall caught disease heart coronary heart disease , with a diagnosis of diabetes mellitus ,
dyslipidemia , hypertension , obesity , or other diseases and conditions
j. Other patients can obtain benefit exercise physical and/ or patients referred by other doctors and are
consensus together team rehabilitation
12
k. Transplant heart-lung
contraindications
1. Angina pectoris No stable
2. Pressure blood systolic moment rest > 200 mmHg or pressure blood diastolic > 110 mmHg ( must evaluated
based on case by case )
3. Pressure blood orthostatic falls > 20 mmHg accompanied by with symptom
4. Critical aortic valve stenosis
5. Disease systemic I or fever
6. Atrial dysrhythmia or ventricles that do not controlled
7. Sinus tachycardia is not controlled (> 120x/ minute )
8. Fail heart not yet compensated
9. Atrioventricular block degrees three without have a heart pacemaker installed
10. Pericarditis active or myocarditis
11. Thromboembolism new
12. Depression or elevation segment STmoment break (> 2 mm)
13. Diabetes mellitus with blood sugar Not yet controlled
14. Condition orthopedics prohibited weight _ do exercise  physical
13
15. Kondisi metabolik lain, seperti tiroiditis akut, hipokalemia, hiperkalemia, atau hipovolemia
 1. Gibbons RJ, Balady GJ, Bricker JT,
Chaitman BR, Fletcher GF, Froelicher VF.
ACC/AHA 2002 guideline update for
exercise testing. A report of the American
College of Cardiology/American Heart
Association Task Force on Practice
Guidelines (Committee on Exercise
Referensi Testing). Circulation. 2002;106:1883-
1892.

2. Fletcher GF, Ades PA, Kligeld P, et al.

Exercise standards for testing and training.
A scientic statement from the American
Heart Association. Circulation.
2013;128:873-934.
Indikasi PCI
 1. Ellen C. Keeley, M.D., L.
David Hillis, M.D. 2007.
Primary PCI for Myocardial
Referensi Infarction with ST-Segment
Elevation. N Engl J Med (356)
47-54
PROSEDUR PCI
Preparation _ Before PTCA or PCI Action:
• Do inspection laboratory blood
• Do record heart / electrocardiography (EKG)
• Chest photo ( X-ray )
• Fast for 4 - 6 hours before action done , for consumption drug
like normal
• Get explanation about procedure action
• Sign form agreement action (informed consent)

20
 Procedure
• empty birth urinary
• Patient installed connected electrodes _ with machine electrocardiogram For recording and
monitoring condition heart during procedure
• There is a possibility patient given drug sedative For help to do more relax
• give anesthesia local
• enter catheter with balloon to vessels blood . Catheter Then directed to arteries in the heart
• After catheter installed , dye contrast will injected through catheter to in arteries For look at the
narrowed area or clogged
• When found narrowed arteries , catheter _ will advanced to location and balloons _ pumped For open
arteries
• Can inflate and deflate balloon several times. Patient Possible will feel No comfortable on his chest
• After arteries Already open , catheter released
• Place entry catheter closed with stitching and fixation
21
 • McNamara RL, Wang Y, Herrin J, Curtis JP,
Bradley EH, Magid DJ, Peterson ED,
Blaney M, Frederick PD, Krumholz HM.,
NRMI Investigators . Influence door-to-
balloon time against mortality in patients
infarction myocardium elevation ST
segment . J Am Coll Cardiol . 06 June 2006;
47 (11):2180-6.
• Capodanno D, Alfonso F, Levine GN,
Valgimigli M, Angiolillo DJ. ACC/AHA
Reference Versus ESC Guidelines re Dual Antiplatelet
Therapy : A Comparison JACC Guidelines .
J Am Coll Cardiol . December 11 , 2018; 72
(23 Pt A):2915-2931.
• Redfors B, Généreux P, Witzenbichler B,
McAndrew T, Diamond J, Huang X,
Maehara A, Weisz G, Mehran R, Kirtane AJ,
Stone GW. Intervention Coroner
Percutaneous Saphenous Vein Grafts . _
Interv Cardiovascular Circular . May 2017;
10 (5)
Relationship between
risk factors and
coronary heart
disease
1. Obesity
• obesity and disease heart own close relationship . _ Obesity can
increase risk somebody caught disease heart through a number of
mechanism , incl increase pressure blood , rise rate cholesterol ,
insulin resistance , inflammation , and sleep apnea
• excess weight makes _ heart must Work with more hard , especially
when phase relaxation or diastole phase . More belly fat _ _ big or
obesity stomach linked with more inflammation _ as big as it can be
damage heart .

24
2. Dyslipidemia
• Dyslipidemia is an abnormal accumulation of cholesterol or fat (lipid)
in the blood .
• High cholesterol levels _ be one _ factor risk reason disease heart .
Danger main from high cholesterol is the formation plaque that
reduces the diameter of the vessels blood so that cause obstruction
supply oxygen For network body .
• If it is excessive , cholesterol can piled up in the walls vessels blood
and raises something mentioned condition _ as atherosclerosis ie
narrowing and hardening vessels blood that becomes forerunner will
happen disease heart coronary heart disease and stroke.

25
3. Diabetes mellitus
• Diabetes is one of them disease marked metabolism _ with the height
blood sugar levels in the body . If not quick handled with right ,
diabetes is at risk give rise to a number complications , one of which is
disease heart .
• The reason is the high sugar content when left No controlled can
increase risk disease heart . This is because , glucose excess flowing in
the blood Diabetics can _ damage vessels blood and finally trigger
attack heart .

26
4. Hypertension
• hypertension that is not under control Can lead to disease heart , incl
disease heart coronary , enlargement of the heart organ , up to
condition fail heart .
• pressure blood height can crack crust ( plaque ) in the vessels blood
coroner . Missing fragments _ can clogging flow blood until happen
attack the heart

27
 • John M.F.A. Dyslipidemia
in Science Textbooks _
Internal Medicine Volume
III. Jakarta: FKUI,
2006:1948-54
• Anwar Djohan , Bahri .
Disease Heart Coronary and
Reference Hypertension . Medan. USU
e-Repository; 2004. 1.
Interpretation of
Cardiac Exercise
Tests
 2. Circumstances pretest and protocol
1. Identity Subject
• Complaints and estimates probability pre -test /
• identity subject with Name complete and dated
pretest probability
born .
• Indication or reason inspection
• Type sex
• The medicines are still there consumed ( esp beta
• Number record medical ( if There is ) blockers , digoxin , nitrates , drugs antiarrhythmic )

• Number registration ( if There is )
• Referring doctor
• Home address ( as addition )
• Estimation level fitness currently ( with ask activity
physique a day day or activity exercise done ) _
• Pressure blood Rest .
• Rate heart Rest .
• Current ECG description rest ( esp concerning
rhythm Basically , there is or not depression ST
segment when Rest )

30
3. Condition during testing and response to the test • Change pressure blood during test
• Type of training test carried out (Leg ergocycle / • Change rate heart during test
Treadmill) • Change QRS complex , ST segment or T wave

• Protocol used _ during test, when , at load / rate heart How many
happen .
• Complaints of angina during training , degree the
• Change conduction or rhythm during test, when
severity of angina and whether complaint cause
test termination ( for determine angina index ) , at load / rate heart How many happen .
• The reason the test was stopped
• There is Other complaints ( shortness of breath
shortness of breath , dizziness , floating , leg
• Time ( minutes and seconds ), rate heart ,

pain ) pressure blood and burden maximum when the

• Degrees its weight complaint based on the Borg

test is stopped

Scale ( if possible For applied )

31
4. Condition during recovery/ recovery 5. Results _ measurement / Interpretation

• There is complaints and degrees its weight • Estimation capacity aerobic (METS) or load that can

complaint moment recovery achieved , stated with ULJ time , then must stated the
protocol
• Disappearance complaint Because recovery
• Response ischemia based on ECG changes ,
• Pressure blood on recovery as well as furthermore
complaints and hemodynamics
every 3 minutes
• Prognosis measurement or stratification Good from
• Rate heart minutes 1, 2 and 3 seconds recovery ,
Duke Treadmil Score, there is whether there is
next every 3 minutes
chronotropic incompetence, heart rate recovery is 1
• Change QRS complex , ST segment or T wave minute or 2 minutes , response hypertension and

• Change conduction or rhythm moment recovery response hypotension .

• Timbulnya aritmia, jenis aritmia, dan ambang
• Changes others and conditions moment all ULJ
terpicunya.
completed .
32
 • Nishime EO, Cole CR, Blackstone EH,
Paskhow FJ, Lauer MS. Heart Rate
Recovery and Treadmill Exercise Score as
Predictor of Mortality in Patient Referred
for Exercise ECG. JAMA 2000;284:1392-
98.
• Lipinski MJ, Vetrovec GW, Froelicher VF.
Importance of the First Two Minutes of
Heart Rate Recovery after Exercise
Treadmill Testing in Predicting Mortality
Referensi and Presence of Coronary Artery Disease
in Man. Am J Cardiol 2004;93:445-9.
• Shulz MG, Otahal P, Cleland VR, Bizzard
L, Marwick TH, Sharman JE.
ExerciseInduced Hypertension,
Cardiovascular Event and Mortality in
Patients Undergoing Exercise Stress
Testing: A Systematic Review and Meta-
Analysis. Am J Hypertension
2013;26(3):357-66
 Penulisan resep
rehabilitasi jantung
• Gauge measuring intensity exercise covers 40–80% ( intensity currently until strong ) of reserve beat heart

(HRR) or reserve consumption oxygen (VO 2 R) apart intensity subjective , use ranking deployment

perceived exertion (RPE ) of light until severe (12 –16 on a 20 point scale ). Target the duration is the

activity exercise aerobics 20-60 minutes with frequency 3-5 days per week . Doctor recommended For do

titration intensity exercise with objective reach recommended target range namely 40–80%; however ,

guide about recipe exercise beginning For patient Still not enough clear .

• For undergoing patients _ test exercise level initial (GXT), reach intensity 40–80% far more easy For

defined and targeted during session exercise beginning . Guidelines currently pushing _ the entry of GXT

is due give accurate basis _ For set recipe exercises and allows doctors to catch results capacity functional

• Recommended using 20–30 beats per minute (bpm) above beat heart rest ( resting HR +20–30) as point

early , together with a target RPE of 11–14 (“ light ” to “ somewhat. ” difficult ” on a 20 - scale point )

35
 • Di Nora C., Guidetti F., Livi U.,
Antonini-Canterin F. Role of cardiac
rehabilitation after ventricular
assist device implantation. Heart
Fail. Clin. 2021;17:273–278.
doi: 10.1016/j.hfc.2021.01.008.
• Kerrigan DJ, Williams CT, Ehrman
JK, Bronsteen K., Saval MA, Schairer
JR, Swaffer M., Keteyian SJ Strength
Referensi muscle and fitness
cardiorespiratory relate with the
patient 's health status with a flow
LVAD new continuity _ just
implanted . J. Cardiopulm .
Rehabilitation . Previously 2013;
33 :396–400.