Cardiac Rehabilitation

Question 1

What is cardiac rehabilitation?

Answer 1

Specific program after index cardiac event/surgery/procedure undertaken to help patient recover and go back to his/her full life

Question 2

Indications (cardiac events/ surgery) for rehabilitation

Answer 2

1-Heart attack(STEMI/NSTEMI)
2-Coronary Angioplasty
3-Coronary artery bypass graft Surgery
4-Valve Surgery
5- heart surgery involving great vessels
6-Congenital heart disease corrective surgeries
7-Heart transplantation
8-Stable heart failure
9-Chronic stable angina

Question 3

Contraindications for rehabilitation

Answer 3

-Unstable angina
-Unstable heart rhythm: High degree heart block, arrhythmias
-Uncontrolled HTN(200/100mmHg)
-Inability to exercise
-Recent VTE
-Moderate to severe Valve disease (Aortic stenosis)
-Acute systemic illness or fever

Question 4

What is addressed in cardiac rehabilitation?

Answer 4

-Patient physical functioning: exercise training
-Patient Psychological functioning:
-Patient social functioning
-Cardiovascular risk factors modification:
=Smoking cessation
=Lipid control
=Diabetes management
=Blood pressure control
=Weight management
=Nutritional counselling

Question 5

Who does the program and where?

Answer 5

-Multidisciplinary team includes by expert trained nurse ,exercise physiologist, PT,OT, Cardiologist, psychiatrist and dieticians
-Start while patient in hospital and carried out after discharge

Question 6

Phases of cardiac rehabilitation

Answer 6

-Phase I: 1-7 Days, start in hospital: introduction, simple tasks, response to medication, setup discharge planning and follow up.

-Phase II-III:@ home from week 2-week12:
-Health education, staged exercise build up, anxiety /depression management.

-Phase IV : long term unsupervised ambulatory program

Question 7

Benefits

Answer 7

-10-40% improvement in aerobic exercise capacity.
-Improves symptoms of exercise intolerance like dyspnea and fatigue
-Improves Endothelium function
-Improves autonomic function
-Improves blood lipid profile
-Improves Insulin resistance
-Improves blood pressure control
-Improves prognosis, cost effective and reduces hospitalization
-Reduces cardiovascular mortality by 22-31%
-Those who complete CR have a 46% lower 10-year mortality than those who do not complete CR (13.6% vs. 18.9%)