Rehabilitation of Cardiovascular Diseases

Dr. MOCH. RIDWAN, Sp. KFR LAB. ILMU KEDOKTERAN FISIK & REHABILITASI FAKULTAS KEDOKTERAN UNIVERSITAS BRAWIJAYA / RSU Dr. SAIFUL ANWAR MALANG

Cardiovascular Diseases:

Effort to restore the function of heart and the health of the patient according to the level of physical and mental activity as the level of heart function Etiology: Defect in coronary system Defect in heart valve and muscle of the heart Defect in increment of resistance of blood flow of resistance

Rehabilitation Medicine of

Rehab might help you if you have: . Heart failure. . Peripheral artery disease (PAD). . Had or plan to have a heart transplant. . Had angioplasty to open a coronary artery. . Had another type of heart surgery, such as valve replacement.

Medical Problem

Heart diseases, hypotension, increase pulse rate Complication of long standing immobilization : Muscle atrophy Joint Contracture Decubitus

Rehabilitation Problem:

Disability of mobilization Restricted of daily activity. Defect of Vocational Defect in working Defect in communication Defect in psychosocial

Classification of NEW YORK HEART ASSOCIATION

Class 1 : Patient with heart disease but there is no
limitation of physical activity

Class 2 : Heart disease patient with few physical activity. Class 3 : Heart disease patient with limited physical

Taking a rest there is no symptom but with daily activities there is palpitation, short of breath, chest pain activities. Taking a rest there is no symptom, but with light activities, there is symptoms Taking a rest, there is symptom. All activities will worsened symptoms

Class 4 : Heart disease patient with all limited activities

METABOLIC EQUIFALENT ( METS ) :

The oxygen demands in condition body take a rest and quite sitting
1 Kilo calory ( KKal ) EQUIFALENT with using 200 CC O2 1 METS EQUIFALENT 3,5 CC O2/ Kg BB/ minute 1 METS EQUIFALENT 1,5 CC Calory / minute

Protocols: STADIUM & Level of Disease Approximate the heart capacity Classification of activities The foundation of activities program Programs recipe 220 age ( Years ) = Frequency Heart MAX / minute Karvonen method : THR = (HRmax HRrest) % intensity) + HRrest

The goal is to improve or maintain a good level of cardiovascular fitness, thereby returning the individual to a normal and productive life.

For those able to return to work: . Return to productive employment as soon as possible . Improve and maintain as good cardiovascular fitness For those not able to return to work: . Maintain as active a life as possible . Establish new areas of interest to improve quality of life
Patient Education and Reduction of Coronary Risk Factors

The Pillars of Rehabilitation Programs

Hospital

Level I
Stadium I
ICCU / CVCU

Level II
Ward

Level III Stadium II Home

Level IV Stadium III

Post Recovery

STADIUM I A. Level I : In ICCU / CVCU ( 1 3 Day ) 1. Approximate the capacity of the heart : Class IV

1, 5 CAL 1,2 METS ( 1 2 METS )

2. Classification of Activities: Minimal

1,25 1,5 METS

3. Type of activities: Change body position Passive movement ROM extremities Active movement ROM extremeties 4. Intensity Heart pulse target : 40 50 % from maximal HEART RATE TENTION SISTOLE 20 mmHG TENTION DIASTOLE 10 mmHG MONITOR SUBYEKTIF / OBJEKTIF SIGN ABNORMALITY OF ECG 5. Frequency and Duration 5 times, 2-3 times a day Duration 2 5 Minutes, take a rest 10 minute

 Sitting Walking Upstairs Bicycling Dancing

2 Mets 3 5 Mets 6 8 Mets 3 8 Mets 3 7 Mets

B. Level II : In Ward

( 3 14 days)

1. Approximate the capacity of the heart : Class III 1, 5 - 2,7 CAL 1,2 - 2,2 METS 2. Classification of Activities: Minimal 1,5 2,5 METS 10th 15th Days 3. Type of activities Sitting position Eat, drink, wash face Active Activities etremities Defecation Standing Exercise Slow walking 4. Intensity

60 % same with level I

5. Frequency and Duration Exercise : 5 - 10 Minutes Rest : 5 - 10 Minutes Frequency : 2 3 Times / Day

Stadium II C. Level III : At Home ( 2 8 weeks ) 1. Approximate the capacity of the heart : Class II 2, 7 - 4 CAL 1,2 - 2,2 MET 2. Classification of Activities MODERAT 2, 5 3,5 METS 3. Type of activities Previous exercise to be continued Working exercise 2 MILE / hour Take a bath in bathroom Cycling without resistance 4. Intensity

70 80 % MHR

5. Frequency and Duration Exercise 2 times/ day Deconditioning 5 10 minutes Duration 15 20 minutes Cool down 5 minutes

STADIUM III D. LEVEL IV : ( POST RECOVERY ) 1. Approximate the capacity of the heart : Class I 4 - 6,6 CAL 3,2 - 5,3 METS 2. Classification of Activities Severe 3, 5 5 METS 3. Base Program: STRESS TEST 4. Type Activities According the result of STRESS TEST Walking activities, gynamctic, cycling Sexual intercourse can be considered

5. INTENSITY : According the result of STRESS TEST

6. Exercise every day Duration Or 15 - 20 minutes 25 - 30 minutes three times a week

Dont do during exercise:

ISOMETRIK CONTRACTION HOLD BREATH VALSAVA MANUVER STEPPING UP

Stop Exercise:
Tension is not up nor down, or up more than systole
20 mmHg/Diastole 10 mmHg. Excess than hearth rate target. Chest pain Cyanosis, pale, vomiting Hypotension, diaphoresis Short of breath ARITMIA

 Sexual intercourse can be done if :

Blood pressure 160 / 89 mmHg Capacity > 5 METS Can step up (up stair) : 10 12 STEP Able to walk with velocity 6 KM / hour With definite position

 Cardiac Rehabilitation patients studied

(n=88) Holter Monitoring during intercourse
Ischemia during intercourse: 31% (77% symptomatic)

Stress test
Ischemia: 61%

Exercise is important for cardiovascular health. Exercise-based cardiac rehabilitation is associated with lower total and cardiac mortality rates compared to usual medical care. 3

Benefits of cardiac rehabilitation

Reduced mortality Reduced peripheral resistance Improves perfusion reserve in both infarcted and remote
myocardium Reduced cardiac risk improved cardiac conditioning Reduced re-hospitalization Reduced unplanned ER visite Improvement in psychosocial well-being and stress reduction