Cardiac rehabilitation block 2.3 college
The burden of established cardiovascular disease may be reduced by:
- early diagnosis.
- Appropriate disease management.
- Rehabilitation
- Prevention and lifestyle counselling.
Cardiac rehabilitation is care that is given to a patient after an acute event, intervention or diagnosis
of a chronic heart condition.
Goals:
- to restore quality of life.
- To maintain or improve functional capacity.
- Multifaceted and multidisciplinary intervention.
Coronary artery disease
Angina pectoris
When there is a narrowing of a coronary vessel, the flow is diminished. Patients will get complains:
angina pectoris. Often caused by exercise. It is caused by a mismatch of supply and demand to the
coronary arteries.
Myocardial oxygen demand:
Dependent on:
- Heart rate: high: higher demand.
- Systolic blood pressure: afterload.
- Myocardial wall tension and stress.
- Contractility.
Increased demand caused by:
- Some medications can cause an increased demand: catecholamine analogues: bronchodilators,
tricyclic antidepressants, cocaine.
- Tachycardia.
- Hypertension.
- Thyreotoxicosis.
- Heart failure.
- Valvular heart disease.
Myocardial oxygen delivery: supply
“- Diameter and tonus in coronary arteries.
- Collateral blood flow.
- Perfusion pressure.
- Heart rate.
Decreased supply caused by:
- anemia
- Hypoxia.
- CO poisoning.
- Hypotension.
, - Tachycardia.
Consequences
- Stable angina pectoris.Stable plaque: blocking a part of your coronary artery, but blood is still
flowing through it. When a patient has an increased demand, the supply may not be enough: angina
pectoris.
- Instable angina pectoris: The fibrous cap can rupture. It grows and flow is even worse than before:
instable angina.
- Myocardial infarction: When there is a blood clot forming on top if this ruptured cap.
Revascularisation
Patient in hospital gets medication and revascularisation:
- PCI
- CABG: coronary artery bypass grafting.
The medication is to relief symptoms, and to prevent occurrence of vascular events:
- asprine.
- bete blocker, calcium channel blockers.
- statin
- short working nitrates.
The patients are being classified in groups: canadin cardiac society function classification of angina.
Class Activity evoking angina Limits to physical activity
I Prolonged exertion None
II Walking > 2 blocks or > 1 flight of stairs Slight
III Walking < 2 blocks or > 1 flight of stairs Marked
IV Minimal or at rest Severe
Class III patients has complains at home, inside his house. Class II patient has the complaints has the
complains outside the house (difficult to distinguish).
Cardiac rehabilitation
Warming up: first start with warming up.
Who is going to attend?:
- post acute coronary syndrome and post primary coronary angioplasty.
- Stable coronary artery disease and elective coronary angioplasty.
- Following cardiac surgery: coronary artery or valve heart surgery.
- Chronic heart failure.
- After recuscitation.
- Cardiac transplantation: new heart but rest of the body is still malfunctioning.
- Congenital heart disease: earlier they died at young age, but now they go in rehab if necessary, and
they become much older.
- Peripheral artery disease.
- Others with comorbidities: ICD, older people, women, COPD, renal failure, diabetes mellitus.
- Cardiac neuroses: patients who are very afraid of being sick in their heart.
Goals of rehabilitiation:
The burden of established cardiovascular disease may be reduced by:
- early diagnosis.
- Appropriate disease management.
- Rehabilitation
- Prevention and lifestyle counselling.
Cardiac rehabilitation is care that is given to a patient after an acute event, intervention or diagnosis
of a chronic heart condition.
Goals:
- to restore quality of life.
- To maintain or improve functional capacity.
- Multifaceted and multidisciplinary intervention.
Coronary artery disease
Angina pectoris
When there is a narrowing of a coronary vessel, the flow is diminished. Patients will get complains:
angina pectoris. Often caused by exercise. It is caused by a mismatch of supply and demand to the
coronary arteries.
Myocardial oxygen demand:
Dependent on:
- Heart rate: high: higher demand.
- Systolic blood pressure: afterload.
- Myocardial wall tension and stress.
- Contractility.
Increased demand caused by:
- Some medications can cause an increased demand: catecholamine analogues: bronchodilators,
tricyclic antidepressants, cocaine.
- Tachycardia.
- Hypertension.
- Thyreotoxicosis.
- Heart failure.
- Valvular heart disease.
Myocardial oxygen delivery: supply
“- Diameter and tonus in coronary arteries.
- Collateral blood flow.
- Perfusion pressure.
- Heart rate.
Decreased supply caused by:
- anemia
- Hypoxia.
- CO poisoning.
- Hypotension.
, - Tachycardia.
Consequences
- Stable angina pectoris.Stable plaque: blocking a part of your coronary artery, but blood is still
flowing through it. When a patient has an increased demand, the supply may not be enough: angina
pectoris.
- Instable angina pectoris: The fibrous cap can rupture. It grows and flow is even worse than before:
instable angina.
- Myocardial infarction: When there is a blood clot forming on top if this ruptured cap.
Revascularisation
Patient in hospital gets medication and revascularisation:
- PCI
- CABG: coronary artery bypass grafting.
The medication is to relief symptoms, and to prevent occurrence of vascular events:
- asprine.
- bete blocker, calcium channel blockers.
- statin
- short working nitrates.
The patients are being classified in groups: canadin cardiac society function classification of angina.
Class Activity evoking angina Limits to physical activity
I Prolonged exertion None
II Walking > 2 blocks or > 1 flight of stairs Slight
III Walking < 2 blocks or > 1 flight of stairs Marked
IV Minimal or at rest Severe
Class III patients has complains at home, inside his house. Class II patient has the complaints has the
complains outside the house (difficult to distinguish).
Cardiac rehabilitation
Warming up: first start with warming up.
Who is going to attend?:
- post acute coronary syndrome and post primary coronary angioplasty.
- Stable coronary artery disease and elective coronary angioplasty.
- Following cardiac surgery: coronary artery or valve heart surgery.
- Chronic heart failure.
- After recuscitation.
- Cardiac transplantation: new heart but rest of the body is still malfunctioning.
- Congenital heart disease: earlier they died at young age, but now they go in rehab if necessary, and
they become much older.
- Peripheral artery disease.
- Others with comorbidities: ICD, older people, women, COPD, renal failure, diabetes mellitus.
- Cardiac neuroses: patients who are very afraid of being sick in their heart.
Goals of rehabilitiation:
