Cardic Rehab

• P wave- atrial Depolarization
• PR - interval - time required for conduction to go from SA node to AV node
• QRS complex - atrail repolarization and ventricle depolarization
• ST segment - delay before repolarization of ventricle, useful in assessing mycardial ischemia
• T wave - ventricular repolarization

• The amount of blood pumped out of the heart through the aorta each min
• Normal adult 5.6 (female 10% less)
• CO_ SV x HR

Amount of blood ejected from the ventricles each contraction

The amount of blood returning to the right atrium each minute similar in volume to cardiac output

• Unknown cause
• approximately 90-95%

• Related to another medical Problem
• Kidney disease
• Kidney failure

• An increase prssure load fon the left ventricle leading to left ventricular hypertropy
• Increased dependence on ative "atrial kick" for left ventricle filling. IF inadequate L ventricle filling, stroke volume is decreased, leading to symptoms of decreased CO and pumonary congrestion

CVA, CHF, ASHD, renal failure, aneurysm, PVD or retinopaty

• Generally Asymptomatic
• Adults do not know what their BP usually is

• weight reduction
• salt restriction
• aerobic exericse - at least 20mins 3-5 times per week has been shown to decrease BP
• Stress reduction/relaxation training
• Medication "anit-pyertensive" - beta blockers, diuretics, alpha adregergic blockers, calcium channel blockers. ACE inhibitors

• Many Pts are undiagnosed
• Need to monitor BP at rest and exercise - terminate exercise if SBP 220-250 or DBP 110
• Be aware of side effects of anit - hypertensive medicatons
• AVOID HOLDING BREATH and VALSALVA

• Atheroclerotic process
• Vasospasm
• Otehr disease processes taht affect coronary arteries

• 1. myocardiao ischemia (angina)
• 2. Myocardial Infarction
• 3. CHF
• 4. Sudden Death

• Patho - mayocardial O2 demand exceeds O2 supply
• Manifextations -
• Angina Pectoris
• Chest pain described as pressure, heaviness, tightness,
• last for minutes, relieve by rest and use of nitroglycerin
• Precipiated by exertion, stress, emotions, large meal

• Severes crushing pain with possible radiatin to shoulder, throat, jaw, arms or back
• lasts more than 30mins not relieved by rest or nitro
• Sweating, dyspnea, nausea/ vomiting, lightneaded, syncope, apprehension, weak, fatigues, DENIAL

• The Pt has classic S&S
• EKG changes - ST elevation with transural MI
• May see St depression with subendocradail MI
• Serum Enzymes

• Lifestyle Modifications - weight reduction, salt restriciton, aerobic exercise, stress reduction / relaxation training
• Medications - anti - angianl, anti- platelet, Anti -arthythmia, Thrombolytic Therapy

• PTCA - precutaneous transluminal coronary angioplasty (balloon)
• CABG
• Pacemaker
• AICD: automatic implantable cardiac defibillator
• Intracoronary atents
• Arhrectomy

• UE activities may cuase more symptoms than LE
• Use rest periods to decrease intensity of strenuous activites
• Use energy conservation techniques

• NO not lift more than 8 lbs (a gallon of milk)
• Do not push of pull with your armswhen moving in bed and getting out of bed
• DO not flex of extend your shoulder over 90
• Avoid reaching too far across your body
• Avoid twisting or deep bending
• Do not hold your breath during activity
• Brace your chest when caughing or sneezing
• No driving
• Avoid long periods of over the shoulder activity
• If you feel any pulling or stretching in your chest, stop what you are doing
• Report any clicking or popping noise around your chest bone to your surgeon right away

• Lifestyle modifications
• rest
• Sodium restriction
• Phlebotomy if HCT. 55-65%
• Thoracentese - for pleural effusions
• Exercise training to improve peripheral efficiency
• Meds - diuretics, vasodiliators
• Supplemental O2

• Cardiomyoplasty - wrap a portion of latismus around heart to increase contractility
• Organ Transplants

• Physiological responses to activity need to be carefully monitored
• Side effects of med may cuase problems
• Activity modification may be indicated
• Exercise low level and slow progression
• Frequent rest breaks
• Use energy conservation techniques
• GRADUAL exercise training
• NEED TO WARM UP

• Aortic - between the left ventricle and the aorta
• Mitral - between the left atrium and left ventricle
• Pulmonary - between the right ventricle and pulmonary artery
• Tricuspid - bwtween the right atrium and right ventricle

A restriced valve opening that creates a pressure load on the chamber preceding the abnoral valve which then develops compensatory hypertrophy

• Incomplete valve closer creates a volume load on the chambers or vessels on both sides of the affected valve
• Compensatory Hypertrophy

• Meds - digitalis, diurestics
• Salt resistriction
• Cardioversion - if arrhythmia is a problem
• Surgery - to repair or replacement

• Asymptomatic for years
• Aortic and mitral valve disease can produce S&S of left heart failure (pulmonary)
• Pulmonary and tricuspids valve disease can produce S&S of right side heart failure

• Activity and exercise precautions may be indicated
• Start Slow and Progress gradually
• Exercise training can improve functional status

• Increaed HR
• Decreased HR and possible decreased CO
• lack of effective atrial contractions
• Loss of effective ventricular contraction

• May be asymptomatic
• Palpitations skipped beats, fluttering
• Symptoms of decreased CO - lightheaded, weak, dyspnea, syncope, confusion
• Symptoms of MI or cardiac arrest

• No treatment may be necessary
• Treat the underlying cause
• Antiarrhyghmic drugs
• Cardioversion
• Pacemaker
• Automatic implantable cardioverter
• Defibrillatory
• Chemical or surgical ablation
• Surgical excision

• Stable ANgina
• MI, CABG
• Compensated heart failure
• Cardiac surgery
• High risk for coronary heart disease
• High risk for hypertension
• End stage renal disease
• Status post pacemaker insertion
• Cardiomyopathy
• PVD
• Heart transplant
• High Risk for Diabetes

• Uncontrolled arrhythmias, unstable angina
• Recent diagnosis of emmbolis
• Resking DPB > 110 or SBP > 200
• Thrombophlebities
• Orthostatic BP
• Acute Infection
• Resting ST segment displacement >2mm
• Uncompensated CHF

• inital assessment of vitals
• warm up
• Exercise (ambulate or bike)
• Cool down
• Monitor vitals S&S
• Pt Ed
• Rest -vitals, warm -up, training -vitals, cooldown -vitals

• Abnormal HR taht increase 50BPM with low level eercise
• SBP > 210 pr DBP 110
• Decrease in SBP with low level exercise
• any ST segment changes
• Severe LE claudication
• Angina, mental confusion, extreme fatigues
• Ventricular gallop

• Referred to cardiac rehab when medically stable
• Initiate risk factor education and need for lifestyle modification
• Initiate self care activities progress from sitting to standing
• Provide an orthostatic challenge to the pt
• Begin a supervied ambulation program
• AROM

• Target HR 18-24 bpm increase with ex
• RPE scale
• Monitoring the S&S of exercise intolerance
• Last 3-5 days while inpatient

• Risk factors & lifestyle modification
• How to take own HR and monitor exercise intensity
• Graded ambulation program
• Normal vs. adverse response and what to do if they have an adverse response

• Increasing function capacity through eercise
• Continued patient education about risk factors, modification and self monitorying
• Beings immediately after hospitalization
• Lasts 2-12 weeks
• Frequency 2-3 times per week

• Last 6-8 weeks and once a week
• Exercise training, physical fitness, level of endurance and risk factor modivication are typical goals

• last thoughout the patients lifetime
• Designed to promote optimal health
• Maintencance activities