Cardiac Rehab: Post MI & CABG Flashcards
Phase I
-‘in hospital’ acute stage: constantly changing
-begin as soon as vitals & angina are stable
(2-3 days or 5 days after MI)
Contraindications for cardiac rehab
- unstable angina
- MI or extension of infarction in past 2 days
- HTN (resting SBP>200, DBP >110)
- Hypotension (SBP <80)
- Hemodynamic instability
- uncompensated CHF
- uncontrolled HTN
- Serious arrhytmias
- dissecting aortic aneurysm
- unstable psychological condition
Cardiac rehab
-process to restore & maintain individual with coronary problems to optimal physiological, sociological, psychological, educational, vocational status
Indications for inpatient &/or outpatient cardiac rehab
- Acute post MI (w/n 12 months)
- Stable angina
- post CABG
- post valve repair/replacement
- post PTCA/stent
- post heart/lung transplant
- CHF (w/n guidelines)
- at risk for CAD
cardiac rehab program phases
- Phase I
- Phase IB
- Phase II
- Phase III
- Phase IV
Post Surgery vs. Post MI
- surgery:
- -heal faster
- -shorter hospital stay
- -UE & trunk stretching
- -Cough/breathing ex’s important
- -restricted lifting 6 weeks
- MI:
- -slower recovery
- -longer hospital stay
Lifting Restrictions
Surgery & MI
restricted for 6 weeks:
- Surgery: 8-10#
- MI: 15-20#
Phase I Goals
- screen for complications
- prevent deconditioning
- prevent pneumonia
- edu pt/family
- measure effectiveness of meds
Phase I Ex’s
-Resting HR, BP, EKG, SO2, lung Auscultation
-warm up, ambulate, aerobic ex’s
MONITOR VITALS
Phase II Ex’s Intensity
- RPE </= 120
- or RHR + 20 (MI)/ RHR + 30 (surgical)
- 1-2 METS
Phase I PT Session
- edu
- ROM
- breathing ex’s
- Self-care
- monitored walking
- stairs (2 flights=same METS required for sex)
Phase I
ex’s frequency
- days 1-3=3-4x/day
- day 4+=2x/day
Phase I ex’s time
- intermittant (3-5 min bouts)
- total daily time 20 min
- Goal: 10-15 min (then increase ex’s intensity)
Phase I
mod/term ex’s
- RPE >/=13
- HTN
- Hypotension
- decr PP to <20mmHg
- unusual incr HR
- PVC couplet or 3+ PVC in row
- PVC w/ R-onT phenomenon
- Onset of 2* or 3* heart block
- 1+ angina/3+ angina?
- 3+ claudication
- fatigue
- dizziness
- pallor
- cold sweat
- ataxia
Phase I begins:
- as soon as vitals & angina stable
- uncomplicated MI=2-3 days post
- complicated MI=5 days post
- begin at 1-2 METS
Phase I Discharge Planning
- Sx to monitor
- Ex’s Rx
- Dietary guidelines
- meds
- referral to outpt phase II
- ideally involves LLGXT
Phase IB
-done in home with goal to get ready for phase II
Phase II goals
- monitor cardiovascular response to mild-mod workload & communicate w/ docs
- return to prior activities
- condition heart & respiratory systems
- help pt cope with psychological stresses
- develop lifestyle ex’s habit modificaiton
- edu to pt/fam on 2* prevention
Phase II
- ‘out of hospital’
- begin soon after discharge from hospital
- must be w/n 6 months for insurance to cover
- in hospital or satellite setting
Phase II session components
- warm up
- stretch
- endurance conditioning
- cool down
Phase II ex’s goals
I:
T:
- up to 9 METS
- 20-30 min continuous ex’s then increase intensity
Phase II resistance ex’s time frame
- 5 weeks post MI
- 8 weeks post CABG
- 2 weeks post PTCA
Phase II Ex’s
- SUPERVISED
- monitor vitals
- about 36 visits
- 3 days/week + home ex’s
Phase II Ex’s Intensity
If SLGXT Prior:
- 10 bpm lower than anginal threshold
- 80% last ex’s test (HR)
- incr HR 10 bpm after 2-3 weeks
If no SLGXT Prior:
- RPE 11-13
- THR=60-70% PMHR
- Karvonen (HRR): 40-60 % HRR
- by 3-6 months burn 1,000 KCal/week
Phase II criteria for resistance ex’s
- mod-good L ventricle function
- ex’s capacity >5 METS w/o angina or ST segment depression
Phase II Resistance Ex’s Guidelines
- start w/ low weight (RPE 11-14)
- 1 set of 10-15 reps
- incr 2-3 #/week arms
- incr 5-10#/week legs
- RPP not > RPP during aerobic
- Full ROM
- No valsalva
- Exhale during exertion
Phase II Contraindications for Resistance Ex’s
- symptomatic CHF
- uncontrolled arrhythmias
- severe valvular disease
- unstable Sx
- uncontrolled HTN
What questions to rule out Angina?
- what are the Sx?
- where is it located?
- What’s the effect of palp?
- deep breath/cough?
- body position/ROM?
- cardiovascular Ex’s?
- rest?
- NTG?
Phase III
- out of hospital
- not covered by insurance
- purpose: fitness, endurance, incr knowledge & independence
Phase III Ex’s
- incr time from 30 to 40-60 min
- check p GXT periodically
- call in their EKG
- discharge in 6-12 months
