Rehabilitsai Jantung

REHABILITASI

JANTUNG

Sutrisno

STIKes Surya Mitra Husada Kediri

Definisi Rehab Jantung

“Serangkaian aktivitas yang dibutuhkan untuk

mencapai kondisi fisik, mental dan sosial

terbaik. Agar mereka dapat mencapai kehiduan

optimal di masyarakat dengan upaya sendiri”

(WHO 1993)

Kandidat Rehabilitasi Jantung

Post MCI

Pasca CABG

Pasca PTCA

CHF Stabil

Aritmia Jantung

Pasca Operasi Katup

Penyakit Jantung

Bawaan

Pasca Transplantasi

Rehabilitasi Jantung

Evaluasi Medis

Peresepan Latihan

Edukasi

Counselling

Modifikasi faktor

resiko

Goal rehabilitasi jantung

Optimalisasi fungsi

Fisik

Psikologis

Sosial

Menurunkan

morbiditas dan

mortalitas

PENATALAKSANAAN

REHABILITASI

OPERATIF OBAT

Rehabitilasi Jantung

Fase I : Inpatient

Fase II : Out Patient

Fase III : Maintenance

Fase IV : Long term CR

Goals of cardiac rehabilitation

The general goals of cardiac rehabilitation are to optimize the patient’s physiologic, phychosocial, and vocational function, as well as to reduce the morbidity and mortality of cardiac disease .

The cardiac patient is given : - educational program (eg, lifestyle modification such as low-

cholesterol diet, stress-reduction, and smoking cessation) to reduce the risk factor for heart disease

- reconditioning exercises to improve safety and tolerance of daily activities (vocational, recreational, and sexual activity)

Benefits of exercise post-MI

improvement in functional capacity (strong evidence);

improved cardiovascular efficiency;

reduction in atherogenic and thrombotic risk factors;

improvement in coronary blood flow, reduced myocardial ischaemia and

severity of coronary atherosclerosis;

reduction in risk of cardiovascular disease mortality.

CARDIAC REHABILITATION GOALS

Medical Goals

Psychological goals

Social Goals

Health Service

Goals

Medical Goals :

- To improve cardiac function

- To reduce the risk of sudden death and re-

infarction

- To increase work capacity

- To prevent progression of the underlying

atherosclerotic process

- To reduce mortality and morbidity

Psychological goals :

- Restoration of self-confidence

- Reduce of anxiety and depression

- Improved stress management

- Restoration of good sexual health

Social Goals :

- Return to work

- Independence in activities of daily living

Health Service Goals :

- Reduction in direct medical cost

- Early mobilisation and early discharge

- Fewer medications

- Fewer re-admissions

Cardiac rehabilitation tim :

Involving :

Physicians

Nurses

Physical therapists

Occupational therapists

Exercise physiologists

Nutritionist

Psychologists

Social worker

Vocational counselors

Coronary heart disease risk factors

Modifiable CHD risk factors :

Hypertension, cigarette smoking, obesity, habitually

sedentary lifestye, hypercholesterol, high level LDL,

low level HDL, hypertriglyceridemia, DM , stres .

Unmodifiable CHD risk factors:

Advance age, gender, family history

Cardiac Evaluation

History :

- Chief complain

- Past history

- Medication history

- Functional and occupational history

- Personal history

- Social history

- Family history

Physical Examination

Vital sign

Cardiovascular: Inspection

Palpation

Percution

Auscultation :

Heart sounds

Heart murmur

Pericardial rub

Pulmonary

Neurologic and musculoskeletal

Diagnostic tests

1. Chest radiograph

2. Cardiac tests :

ECG

Echocardiography

3. Laboratory tests

blood tests

4. Cardiac stress tests

5. Catheterisation

Cardiac rehabilitation

Consists of four distinct phase.

Each phase of cardiac rehabilitation has

specific goals with educational or lifestyle

modification component

Phase I : Inpatient

In-patient acute phase of cardiac rehabilitation (generally lasting from 3-6 days) .

Started as soon as the patients condition has stabilized

The goals :

To prevent immobilization and assist the patient in tolerating self-care activities and early ambulation

To prepare the patient ( and family ) for a healthy lifestyle

To reduce psychologic and emotional disorders

To facilitate adjustment to the acute event and to the hospital environment

To motivate the patient to make a long-term commitment to the cardiac rehabiliatation program

Step in phase I inpatient OF MCI

Phase I program include :

Education and risk-modification program :

Hyperlipidemia control

Hypertension control

Smoking cessation

DM control

Stress management

Exercise training

Exercise program

Low dose exercise and activities.

5-10 minute (progressed up to 20-30 minutes), 3 - 4 times daily,

Activity 3 - 4 mets

Not raise HR above 20 bpm

Passive or active assistive ROM exercise – active exercise in

supine, sitting, upright position

Ankle pumping exercise

Exercise parameter : pulse, BP, ECG, activity-induce symptoms

Exercise testing

At the end of phase I to six minute walk test

Stop exercise if

- angina

- light-headedness

- nausea, dyspnea

- fatigue

- cyanosis

- ataxia

- hypoxia

- peripheral circulatory

- bradicardia

- activity-induce BP changes :

SBP > 220 mmHg,

DBP >110 mmHg

- activity-induced ECG change

Phase II : Outpatient

start within 1 - 2 weeks and last 4 to 8 weeks

By end of phase II :

- patient should be able to perform the daily self-

administered exercise program safely

- have adequate knowledge of his or her disease

and symptoms to persue vocational ,

recreational, and sexual activities safely

Fase II: Outpatient

Dimulai 1 minggu setelah pasien pulang RS

Berlangsung selama 4-8 minggu

Dosis latihan: Frek 3-4 x/minggu, Int 60-70%,

Durasi 30-40 menit

Pasien mampu latihan jalan aerobik 3000 m

dalam 30 menit

The goal :

To enhance cardiovascular function and physical

work capacity . To detect ECG changes during exercise To teach the patient proper techniques of exercise and

provide him or her with guidelines for long-term exercise

To establish healthy lifestyle in patient and family To enhance the patients psychologic function To return to work savely To normal familial and social roles

Phase II program include :

Education and risk-modificarion program

Exercise :

The patient is given individualized prescription of intensity,duration, frequency, mode activity

Aerobic exercise training at a level of 6 mets

Exercise involve upper and lower limb

Equipment : treadmills, bicycle ergometers, arm ergometers, etc

Exercise session performed last 1 hour (including warm-up and cool-down), 3 times a week

Goal exercise : target HR for at least 20-30 min for training adaptation, predict 70 – 80 % HR Max

Intensity is increased on a weekly basis .

Return to work program

Patient are prepared to return to their original job

7 Metswithout any abnormal responses, generally

patients should be able to return to most jobs

except heavy industrial work

Phase III : Maintenance

Phase III usually last from 3 - 6 month and

generally includes clinical supervision and

intermittent ECG

Exercise in outpatient setting, then

progress to a community or home setting

Terget activity levels 6 – 8 Mets .

Fase III: Maintenance

Fase III berlangsung 3-6 bulan

Latihan dilakukan dengan supervisi minimal

Dosis latihan: F 3-4 x/mgg, I: 70-80%, D 30-

40 mnt

Latihan pembebanan

Pasien mampu jalan 3000-4000 m/30 mnt

Phase III

Goal phase III are similar to those of phase II

Phase III is designed to provide a smooth transition from structured, closely supervised to minimally supervision

Program include :

- Education and risk modification

- Exercise : aerobic exercise, resistance training, aquatic exercise program (26-33 C)

Phase IV : Long term cardiac rehab

Phase IV program include :

Education and risk-modification program

Exercise (at least 3 times per week for 30-60 min, target HR 80% max HR, progress gradual until 85%) Aerobic exercise

Resistance training

Aquatic exercisewater exercise

Goal : to continue in improving and maintaining fitness and a healthylifestyle

Fase IV: Rehabilitasi Jantung Jangka

Panjang

Mencakup:

Edukasi dan modifikasi resiko kontiu

Latihan (minimal 3-4 x/mgg), selama 30-60 min,

target latihan intensitas 80%-85% HR max.

Goal:

Melanjutkan program seumur hidup

Mempertahankan kebugaran fisik

Meningkatkan performane

Gaya hidup sehat

PROGRAM EDUKASI

STOP MEROKOK !!!

E K G

OPERASI JANTUNG

OBESITAS

FIVE-STEP PROGRAM OF INPATIENT

CARDIAC REHABILITATION

FOR SURGICAL PATIENT

Protokol rehabilitasi kardiovaskular

Pasca Operasi jantung

POD - 1

Active assisted ROM exercise

Chest physical therapy

Up in chair

Level activity 1 – 2 Mets

Source: AHA 2004, Krusen 1990

POD - 2

Active ROM exercise

Self feeding

Bed side commode

Walking short distance



POD - 3

Partial self bath in bed

Walk in hall (3 times)



POD - 4

Out of bad 3 -4 hours

Walking ad lib

Partial self bath

Self care



POD - 5

Walk ad lib increasing distance


Planning discharge

Counseling program


TERIMA KASIH

Documents

Rehabilitsai Jantung