cardiac rehab

-improves exercise tol without sig cardiovascular complications or other adverse outcomes

-improves skeletal muscle strength and endurance in clinically stable coronary pts
-

-pts with cardiac dz but without resulting limitations of physical activity
-ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain

-pts with cardiac dz resulting in slight limitation of physical activty
-they are comfortable at rest
-ordinary physical activity results in fatigue, palpation, dyspnea or anginal pain

-pts with cardiac dz resulting in marked limitation of physical activity
-they are comfortable at rest
-less than ordinary physical activity results in fatigue, palpitaiton, dyspnea or anginal pain

-pts with cardiac dz resulting in inability to carry on any physical activity without discomfort
-sx of cardiac insufficiency or the anginal syndrome may be present even at rest

-actue phase: early mobilization exercises - from hospital admission to hospital discharge
-low level, dynamic, ambulation, calisthenics, ADLs, closely monitored
-indications: uncomplicated- no ischemia, dysrhythmia, CHF; post MI or post surgical

-convalescent phase: from hospital discharge to 6 wks post MI
-pts home, but not back to work
-pt cont walking protocol and exercises that were begun in hospital
-self-pulse monitoring
-follow guidelines for activities

-training phase: 6 wks to ? 14 wks post MI
-scar formation
-max symptom-limited exercise test
-aerobic endurance training

-maintenance phase: ? 14 wks to ? years
-venue
-recreational activities
-minimal monitoring

1. overt CHF
2, MI extention within previous 2 days
3. vtach; >10 to 15 PVCs/ min
4. HTN: syst >160, diast >105
5. hypotension: syst <80
6. sever AoS gradient >80
7. unstable angina within 24 hrs
8. dissecting aortic aneurysm
9. uncontrolled metabolic disease
10. psychosis

-response to low level exercise withint physiologically safe limits
-tolerance to 5 MET level workloads
-begin pt edu
-reduce depression

1. holter monitor
2. nuclear scan
3. GXT

1. walk outside in the mildest part of the day
2. hills
3. do not exceed 20 bpm above resting HR
4. eat multiple small meals during the day, avoid large meals at one sitting
5. take rest periods
6. avoid unpleasant or emotional situations
7. resume passive sexual activities

1. avoid sternal dehissance!
2. precautions for 6-8wks
3. no lifting >10lbs
4. no driving
5. no forward elevation >90 degrees, no bilateral horizontal abd, ER
6. can do unilateral activities

-phase I- IV blended and compressed
-in-hospital phase 3-4 days
-emphasis on hospital discharge preparations
-self-monitoring
-home exercise program
-outpt CR for complicated pts

-HR
-BP
-ECG radiotelemetry
-ssx
-use of the hypothesis-oriented algorithm

1. Disproportionate increase in HR, BP
2. Disproportionate decrease in HR, BP
3. Appearance of symptoms
-Chest pain, SOB, claudication
4. Appearance of signs
-Pallor, heart / lung sounds, ST segment changes, dysrhythmia