CARDIAC REHABLITATIONCARDIAC REHABLITATION

During the past 20 to 25 years, there have been During the past 20 to 25 years, there have been major changes in the medical management of major changes in the medical management of myocardial infarction patients or patients who myocardial infarction patients or patients who follow coronary artery bypassfollow coronary artery bypass..

The changes includingThe changes including::

Shortened hospital staysShortened hospital stays..--

More aggressive progression of activityMore aggressive progression of activity..--

--Earlier initiation of an ex. program (based on a Earlier initiation of an ex. program (based on a low- level stress test prior to patient's low- level stress test prior to patient's dischargedischarge..

An aerobic conditioning program, in An aerobic conditioning program, in addition to risk factor modification, is a addition to risk factor modification, is a dominant part of cardiac rehabilitationdominant part of cardiac rehabilitation..

N.B.: DECONDITIONINGN.B.: DECONDITIONING::

means changes that take place in means changes that take place in cardiovascular, neuromuscular, and cardiovascular, neuromuscular, and metabolic functions as a result of metabolic functions as a result of prolonged bed rest or activityprolonged bed rest or activity..

INPATIENT PHASE (PHASE ӏ)INPATIENT PHASE (PHASE ӏ)-:-:

--This phase of program occurs in the hospital This phase of program occurs in the hospital following stabilization of the patient's following stabilization of the patient's cardiovascular status after M I or coronary cardiovascular status after M I or coronary bypass surgery for a period may be limited bypass surgery for a period may be limited

to 3 to 5 daysto 3 to 5 days . .

--When hospital stays longer, this phase often When hospital stays longer, this phase often lasted to 7 to 14 days and referred to as lasted to 7 to 14 days and referred to as phase ӏ of the cardiac rehabilitation programphase ӏ of the cardiac rehabilitation program..

Purpose is toPurpose is to::

--Initiate risk factor education and address future modification of Initiate risk factor education and address future modification of certain behaviors, such as eating habits and smokingcertain behaviors, such as eating habits and smoking..

--Initiate self- care activities and progress from sitting to standing Initiate self- care activities and progress from sitting to standing to minimize deconditioning (1 to 3 days post event)to minimize deconditioning (1 to 3 days post event)..

--Provide an orthostatic challenge to the cardiovascular system (3 Provide an orthostatic challenge to the cardiovascular system (3 to 5 days post event). This is usually accomplished by to 5 days post event). This is usually accomplished by supervised ambulationsupervised ambulation..

Ambulation is usually monitored electrocardiography as well as Ambulation is usually monitored electrocardiography as well as manually using the heart rate, ventilation rate, and blood manually using the heart rate, ventilation rate, and blood pressurepressure..

--Prepare patients and family for continued rehabilitation and for Prepare patients and family for continued rehabilitation and for life at home after a cardiac eventlife at home after a cardiac event..

OUTPATIENT PHASE (PHASE ӏӏ)OUTPATIENT PHASE (PHASE ӏӏ)::--This phase is initiated either upon discharge This phase is initiated either upon discharge

from the hospital or depending on the severity from the hospital or depending on the severity of the diagnosis from 6 to 8 weeks laterof the diagnosis from 6 to 8 weeks later..

--This delay allows time for the myocardium to This delay allows time for the myocardium to heal as well as time to monitor the patient's heal as well as time to monitor the patient's

response to a new medical regimenresponse to a new medical regimen . .--Participants are monitored via telemetry to Participants are monitored via telemetry to

determine heart rate, rhythm responses, blood determine heart rate, rhythm responses, blood pressure, at rest and during ex. and pressure, at rest and during ex. and ventilation responses are noted, these ventilation responses are noted, these programs usually last from 6 to 8 weeksprograms usually last from 6 to 8 weeks..

Prupose is toPrupose is to::--Increase the person´s ex. capacity in a safe, Increase the person´s ex. capacity in a safe,

progressive manner so adaptive progressive manner so adaptive cardiovascular and muscular changes occurcardiovascular and muscular changes occur..Enhance cardiac functions and reduce the Enhance cardiac functions and reduce the cardiac cost of workcardiac cost of work..--

Determine the effect of medication on Determine the effect of medication on increasing the levels of activityincreasing the levels of activity..--Relive anxiety and depressionRelive anxiety and depression..--

Progrese the patient to an independent ex. Progrese the patient to an independent ex. programprogram..--

OUTPATIENT PROGRAM (PHASE ӏӏӏ)OUTPATIENT PROGRAM (PHASE ӏӏӏ)::

This phase includes a supervised ex. This phase includes a supervised ex. conditioning program, which is often conditioning program, which is often continued in a hospital or community continued in a hospital or community settingsetting..

Purpose of this phase: is to continue to Purpose of this phase: is to continue to improve or maintain fitness levels improve or maintain fitness levels achieved during the phase ӏӏ programachieved during the phase ӏӏ program..