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Cardiac Rehabilitation

Cardiac Rehabilitation. Presented By: Dr. Ramesh Tharwani Consultant Cardiologist Choithram Hospital. “Integrated Treatment to regain physical function, promoting emotional adjustment, secondary prevention of cardiac events and lead active life.”. Target Patient Groups.

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Cardiac Rehabilitation

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  1. Cardiac Rehabilitation Presented By: Dr. RameshTharwani 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 NAUGHTON’S > 5-7 METS > 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 ECG’s 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 : > 3-5 METS Self Care/Daily activities > 5-7 METS Sedentary Work (Table Work) > 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 >Unstable Angina >Resting BP more than 200 mm/ 100 mm Hg >Postural BP drop to more than 20 mm Hg >Aortic Stenosis >Acute illness or fever >Uncontrolled Atrial or Ventricular Arrhythmias >Uncontrolled CHF >Recent ST Displacement(More than 3 mm Hg) >Musculo-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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