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Cardiac Rehabilitation

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Cardiac Rehabilitation Presented By: Dr. Ramesh Tharwani Consultant Cardiologist Choithram Hospital Integrated Treatment to regain physical function, promoting ... – PowerPoint PPT presentation

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Title: Cardiac Rehabilitation


1
Cardiac Rehabilitation
  • Presented By
  • Dr. Ramesh Tharwani
  • Consultant Cardiologist Choithram Hospital

2
  • Integrated Treatment to regain physical
    function, promoting emotional adjustment,
    secondary prevention of cardiac events and lead
    active life.

3
Target Patient Groups
  • Following Myocardial Infarct
  • Post PTCA/CABG
  • Chronic Stable Angina
  • Congestive Heart Failure
  • Pacemaker/Valve surgery

4
Coronary artery bypass surgery
5
Coronary Intervention
6
Long Term Mortality Benefits
7
GOALS
  • Daily Activities ?Active lifestyle
  • Emotional/Psychological adjustment
  • Diet/Exercise
  • Sexual Activity
  • Risk Factor Reduction
  • Smoking cessation

8
Assessment
  • SYMPTOMS Chest Pain, SOB, Palpitations
  • EXAMINATION CHF, Wound, Concurrent Illness,
    Musculo-Skeletal disease, Emotional
    Status(Anxiety/Depression)
  • DIAGNOSTIC STUDIES Lipid Profile, Hb A1C, PFT
  • ECG before exercise/Telemetry
  • STRESS TEST Sub maximal modified NAUGHTONS
  • gt 5-7 METS
  • gt 80-85 THR

9
  • ERGOMETER Knee/Lower limb problems, Neuro/Ortho
    Limitation
  • ECHO LV functions, RWMA
  • STRESS THALLIUM Viable Myocardium
  • Useful in patients with abnormal ECGs like
    LBBB, WPW
  • VO2 Max with Stress Test to differentiate between
    Cardiac and Pulmonary dyspnoea.

10
Initial Phase
  • Risk Factor Reduction Optimal Medical
    Management Avoid Increase/Decrease BP, No Angina
    on daily activities
  • Smoking Cessation Psycho Counseling Drugs
    (Buprobion HCL, Nicotine Patch)
  • Diet Advice Low Cholesterol, Less than 30
    calories from fats
  • Decrease Emotional Stress Relaxation
    Techniques, YOGA

11
Initial Phase contd..
  • Sexual Activities 3-5 METS, 2 flight stair Test
  • Return to Work/ Recreational Activities
  • gt 3-5 METS Self Care/Daily activities
  • gt 5-7 METS Sedentary Work (Table Work)
  • gt More than 7 METS Normal Vocational activities
    (Back To Work). Avoid Heavy physical work.
  • Playing Tennis 4-7 METS
  • Golf 2-5 METS
  • Volley ball 3-4 METS

12
Exercise Training (Rehabilitation)
  • Walking for 15-30 mins /3-5 times a week
  • Patient can still talk while walking (Brisk Walk
    for initial 2 weeks)
  • Contra indication to exercise training
  • gtUnstable Angina
  • gtResting BP more than 200 mm/ 100 mm Hg
  • gtPostural BP drop to more than 20 mm Hg
  • gtAortic Stenosis
  • gtAcute illness or fever
  • gtUncontrolled Atrial or Ventricular Arrhythmias
  • gtUncontrolled CHF
  • gtRecent ST Displacement(More than 3 mm Hg)
  • gtMusculo-Skeletal Disorders

13
Exercise Prescription
  • Aerobic Exercise preferred than resistive or
    weight training
  • Walking/Cycling
  • Intensity/Frequency/Duration will depend on
    tolerance
  • THR (220- Age in years) try to achieve 80-85 THR
  • 66 MET of level of completed TMT or 25 watts
    less than completed stage on cycle Ergometer
  • Borg scale target 11-15

14
Exercise Prescription contd.
  • Exercise session
  • ? Warm Up (2-5 mins)
  • ? Stimulus (conditioning 20-30 mins)
  • ? Cool Down (5-10 mins, slow speed,
    prevents low BP and joint pains)
  • Graded Exercise with telemetry in high risk
    population recommended.
  • 1-3 months Target 7-8 METS followed by self
    directed maintenance

15
Benefits of Cardiac Rehabilitationin old age
16
Benefits of Exercise Training
  • ? work capacity ? fatigue
  • ? Heart rate during Exercise
  • ? RPP
  • ? symptoms of CHF
  • ? Atherogenicity by maintaining body weight ? HDL
    ? TG ? platelet aggregation
  • Improve blood glucose level
  • Improves coronary blood flow and myocardial
    perfusion

17
Benefits of Exercise Training contd.
  • Endurance Training
  • ? VO2 max 10-40, ? BP, ? HR
  • ? BMD
  • Positive changes in body composition
  • ? body weight (1-3 kg), ? fat (1-3)
  • Positive metabolic changes
  • ? insulin sensitivity, ? cholesterol
  • Resistance Training
  • ? strength 150

18
Conclusions
  • Cardiac rehab is feasible and safe in an
    octagenarian patient population
  • Exercise training yields clinically significant
    functional and metabolic improvements for both
    men and women
  • 33 ? in exercise time
  • 20 ? in functional capacity (est. METs)
  • 9 ? in HDL cholesterol

19
Potential Treatment complications
  • MACE ( Massive Adverse Cardiac Events)
  • 1 per 300,000 hours of exercise
  • SCD ( Sudden Cardiac Death )
  • 1 per 800,000 person hours of exercise
  • Proper Selection of cases/ avoiding Contra
    indications to exercise training can minimize the
    risk.

20
Thank you all
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