Medical Rehabilitation of Heart Disease (Bhs.inggris)

7/27/2019 Medical Rehabilitation of Heart Disease (Bhs.inggris)

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Rehabilitation of

Cardiovascular Diseases

Dr. MOCH. RIDWAN, Sp. KFRLAB. ILMU KEDOKTERAN FISIK & REHABILITASI

FAKULTAS KEDOKTERAN UNIVERSITAS BRAWIJAYA /

RSU Dr. SAIFUL ANWAR MALANG
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Rehabilitation Medicine ofCardiovascular Diseases:

Effort to restore the function of heart and thehealth of the patient according to the level ofphysical 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


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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.


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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


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Classification of NEW YORK HEARTASSOCIATION

Class 1 : Patient with heart disease but there is nolimitation of physical activity

Class 2 : Heart disease patient with few physical activity.

Taking a rest there is no symptom but with daily activitiesthere is palpitation, short of breath, chest pain

Class 3 : Heart disease patient with limited physicalactivities. Taking a rest there is no symptom, but with lightactivities, there is symptoms

Class 4 : Heart disease patient with all limited activitiesTaking a rest, there is symptom. All activities will worsenedsymptoms


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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


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

For those able to return to work:

. Return to productive employment as soon as possible

. Improve and maintain as good cardiovascular fitnessFor 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


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Stadium I

Stadium II

Stadium III

ICCU / CVCU

Home

Post Recovery

Ward

Level I

Level III

Level II

Level IV

Hospital

The Pillars of Rehabilitation Programs


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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


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Sitting 2 Mets Walking 3 5 Mets

Upstairs 6 8 Mets Bicycling 3 8 Mets Dancing 3 7 Mets


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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


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Stadium IIC. 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


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STADIUM IIID. 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 ActivitiesAccording 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 15 - 20 minutes Or 25 - 30 minutes three times a week


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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


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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


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Cardiac Rehabilitationpatients studied(n=88)

Holter Monitoring during intercourse Ischemia during intercourse: 31% (77%

symptomatic)

Stress test Ischemia: 61%
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Exercise is important for cardiovascular health.Exercise-based cardiac rehabilitation is associated with lower totaland cardiac mortality rates compared to usual medical care. 3


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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


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Medical Rehabilitation of Heart Disease (Bhs.inggris)

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