Scribd
Upload
2K views9 pages

Cardiac Rehabilitation

Cardiac rehabilitation involves lifestyle changes like exercise training and education to address risk factors for heart disease. It can improve health, reduce medications and hospitalizations, prevent future heart problems, and increase longevity. Cardiac rehab occurs in outpatient clinics or hospitals and involves a team of doctors, nurses, and other specialists. It follows patients through phases focusing on conditioning, health education, resuming activity, and long-term maintenance.

Uploaded by

Jisha Janardhan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
2K views9 pages

Cardiac Rehabilitation

Cardiac rehabilitation involves lifestyle changes like exercise training and education to address risk factors for heart disease. It can improve health, reduce medications and hospitalizations, prevent future heart problems, and increase longevity. Cardiac rehab occurs in outpatient clinics or hospitals and involves a team of doctors, nurses, and other specialists. It follows patients through phases focusing on conditioning, health education, resuming activity, and long-term maintenance.

Uploaded by

Jisha Janardhan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 9

CARDIAC REHABILITATION

INTRODUCTION
Cardiac rehabilitation involves adopting heart-healthy lifestyle changes
to address risk factors for cardiovascular disease. To help in adopting
lifestyle changes, this program includes exercise training, education on
heart-healthy living, and counseling to reduce stress and help in return to
an active life. Cardiac rehab can improve our health and quality of life,
reduce the need for medicines to treat heart or chest pain, decrease the
chance of hospitalization or emergency room for a heart problem,
prevent future heart problems, and even help to live longer. Cardiac
rehab is provided in an outpatient clinic or in a hospital rehab center.
The cardiac rehab team includes doctors, nurses, exercise specialists,
physical and occupational therapists, dietitians or nutritionists, and
mental health specialists.
DEFINITION OF CARDIAC REHABILITATION
1. Cardiac rehabilitation (CR) is a branch of rehabilitation medicine or
physical therapy dealing with optimizing physical function in patients
with cardiac disease or recent cardiac surgeries.
2. Cardiac rehabilitation is defined by the World Health Organization
(WHO) as "The sum of activity and interventions required to ensure the
best possible physical, mental, and social conditions so that patients with
chronic or post-acute cardiovascular disease may, by their own efforts,
preserve or resume their proper place in society and lead an active life".
INDICATIONS FOR CARDIAC REHABILITATION
i. Myocardial Infarction
Myocardial infarction (MI), also known as a heart attack, occurs
when blood flow decreases or stops to a part of the heart, causing
damage to the heart muscle. The most common symptom is chest
pain or discomfort which may travel into the shoulder, arm, back, neck
or jaw.  Often it occurs in the center or left side of the chest and lasts for
more than a few minutes.
ii. Angina (stable)
Angina is a type of chest pain that results from reduced blood flow to the
heart. A lack of blood flow means our heart muscle is not getting enough
oxygen. The pain is often triggered by physical activity or emotional
stress. Stable angina, also called angina pectoris, is the most common
type of angina.
iii. Coronary artery bypass surgery
CABG is an open-heart surgery in which the rib cage is opened and a
section of a blood vessel is grafted from the aorta to the coronary artery
to bypass the blocked section of the coronary artery and improve the
blood supply to the heart.
iv. Compensated heart failure
The inability of the heart to pump blood adequately to fulfil the
metabolic demands of peripheral tissues is known as the heart failure.
When there is a reduction in the cardiac output in the initial stage of
heart failure, it triggers several structural and functional changes in the
cardiac tissues as a measure of restoring the cardiac output. This is
known as the compensated heart failure.
v. Cardiac surgery
Any heart surgery.
Eg. CABG
vi. High risk for CAD
Coronary artery disease, also called coronary or atherosclerotic heart
disease, is a serious condition caused by a build-up of plaque in our
coronary arteries, the blood vessels that bring oxygen-rich blood to your
heart.
vii. High risk for high blood pressure
In patients with a history of high blood pressure.
viii. End stage renal failure
It occurs in advance stage of chronic kidney disease. The kidney loses
its function completely.
ix. Status post pacemaker insertion
After pacemaker insertion, cardiac rehab is recommended.
x. Cardiomyopathy
Cardiomyopathy is a group of diseases that affect the heart muscle. Early
on there may be few or no symptoms. As the disease worsens, shortness
of breath, feeling tired, and  swelling of the legs may occur, due to the
onset of heart failure. An irregular heart beat and fainting may occur.
Those affected are at an increased risk of sudden cardiac death.
xi. PVD
It is a blood circulation disorder that causes the blood vessels outside of
our heart and brain to narrow, block or spasm.
xii. Heart transplant
In patients after a heart transplantation, cardiac rehab is needed.
xiii. High risk for diabetes
Those who are at a high risk for diabetes mellitus, cardiac rehab may be
helpful.

PHASES OF CARDIAC REHABILITATION


Phase 1
Objectives of Phase I Cardiac Rahabilation

 Conditioning from acute event / post- CABG


 To make patient functionally independent.
 To adjust with discharge from the hospital.
 Psychological counselling
 Nutritional counselling
 Secondary prevention targeting
Phase 1
Phase 1 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.
Phase 2
Objectives
i. Functional goals
Exercise training under supervision/ at home
ii. Psychosocial goals
Anxiety/depression management
iii. Secondary preventive targets
Phase 2
This phase encompasses the immediate post discharge period, which is
typically a period of 4-6 wks. It focuses on health education and
resumption of physical activity, however the structure of this phase may
vary dramatically from centre to centre. It may take the format of
telephone follow up, home visits or individual or group education
sessions.
Phase 3
Objectives
i. Functional goals
Exercise training under supervision
ii. Psychosocial goals
- Return to work
- Return to hobbies and lifestyle
- Anxiety/depression management
iii. Secondary preventive targets
Phase 3
This phase is sometimes referred to as the ‘ Exercise’ phase. It
incorporates exercise training in combination with ongoing education
and psychosocial and vocational interventions. The duration of phase 3
may vary from six to 12 weeks, with patients required to attend a CR
unit two to three times weekly for structured exercise and other lifestyle
interventions.

Phase 4
Objectives
i. Maintenance of achieved functional status
ii. Return to work – return to hobbies and lifestyle modifications
iii. Secondary preventive targets
Phase 4
This phase constitutes the components of long term maintenance of
lifestyle changes and professional monitoring of clinical status.
PROCEDURE
Patients typically enter cardiac rehabilitation in the weeks following an
acute coronary event such as a myocardial infarction (heart
attack), coronary artery bypass surgery, with a diagnosis of heart failure,
replacement of a heart valve, percutaneous coronary intervention (such
as coronary stent placement), placement of a pacemaker, or placement of
an implantable cardioverter defibrillator.
Inpatient programme
Patients receiving Cardiac Rehabilitation in the hospital after surgery are
usually able to begin within a day or two.
Simple motion exercises that can be done sitting down, such as lifting
the arms and legs. Heart rate is monitored and continues being
monitored as the patient begins to walk.
Outpatient program

 Most patients wishing to participate in outpatient CR are able to


begin within 4–6 weeks after surgery. In order to participate in an
outpatient program, the patient must first obtain a physician's
referral.
 Participation typically begins with an intake evaluation that
includes measurement of cardiac risk factors such
as lipid measures, blood pressure, body weight, and smoking
status. An exercise stress test is usually performed both to
determine if exercise is safe and to allow for the development of a
custom exercise program. During exercise, the patient's heart rate
and blood pressure are monitored to check the intensity of activity.
 Short and long-term risk factors and goals are established, and
patients are closely monitored by a "case-manager" who may be a
cardiac-trained Registered Nurse, Physiotherapist, respiratory
therapist, or an exercise physiologist.
 A dietitian helps create a healthy eating plan, and a counselor may
help to alleviate stress or, for smokers, may give counseling on
how to quit.
The duration of the program varies from patient to patient and can range
from six months to several years.  Even after CR is finished, there are
long-term maintenance programs that should not be minimized, as
benefits are maintained only with long-term adherence.
Obesity
Weight loss is a tool used to aid in cardiac rehabilitation. There is a
strong correlation between obesity and cardiovascular disease. Obesity is
associated with excessive fat accumulation in the body, which can
inhibit bodily functions, such as blood flow through veins and
arteries. When adipose tissue expands, the number of pro-
inflammatory cytokines also increases. As the name suggests, cytokines
have an inflammatory reaction to this, in which they induce the build-up
of plaques in veins and arteries.
Obesity stems from a diet high in saturated fats, processed food and
excess alcohol. These have all been shown to increase the inflammatory
response to produce the plaque-building cytokines in the blood. In a
randomized meta-analysis, scientists found a 47% reduction in mortality,
following a change in lifestyle, regarding diet.
Another factor in obesity is sedentary lifestyle. Physical activity is
associated with a plethora of benefits, especially blood flow and
inhibition of plaque build-up.
BENEFITS OF CARDIAC REHABILITATION

 Offset deleterious psychologic and physiologic effects of bed rest


during hospitalization.
 Provide additional medical surveillance of patients
 Enable patients to return to activities of daily living within the
limits imposed by their disease.
 Prepare the patient and the support system at home to optimize
recovery followed by hospital discharge.
 No consistent effects on cardiac arrhythmias
 Improves exercise tolerance without significant CV complications.
 Improves skeletal muscle strength and endurance in clinically
stable patients
 Promotes favourable exercise habits
 Decreases angina and CHF symptoms

CONCLUSION

Cardiac rehab involves adopting heart-healthy lifestyle changes to


address risk factors for cardiovascular disease. To help in adopting
lifestyle changes, this program includes exercise training, education on
heart-healthy living, and counseling to reduce stress and help in return to
an active life. Cardiac rehab can improve our health and quality of life,
reduce the need for medicines to treat heart or chest pain, decrease the
chance to go back to a hospital or emergency room for a heart problem,
prevent future heart problems, and even help to live longer. Cardiac
rehab is provided in an outpatient clinic or in a hospital rehab center.
The cardiac rehab team includes doctors, nurses, exercise specialists,
physical and occupational therapists, dietitians or nutritionists, and
mental health specialists. Medicare and most insurance plans cover a
standard cardiac rehab program that includes 36 supervised sessions
over 12 weeks.

You might also like