Cardiac1

• Cardiac rehabilitation


  • Mostly focuses on the development of functional capacity
• Treatment approaches in the past

  1. 1960: Passive joint movement and bed edge seating (chair treatment)

  2. Long stay in hospital

  3. Walking in room after days

  4. 1970: External patient cardiac rehabilitation services after 8-12 weeks

  5. 2000: Hospital stay too short, Fast and aggressive mobilization
• Cardiac rehabilitation mandates patient and family education
• Treatment of risk factors is the most important component of cardiac rehabilitation
• Cardiopulmonary Rehabilitation Team

  • Program coordinator
  • Doctor
  • Physiotherapist
  • Nurse
  • Ergotherapist
  • ECG technician
  • Nutritionist
  • Pharmacist
  • Social worker
  • Clinical Psychologist
  • Vocational rehabilitation counselor
• What the physiotherapist should know the most basic

  • Cardiopulmonary anatomy and physiology, atherosclerosis and pathophysiology of coronary artery disease
  • Normal and abnormal cardiac hemodynamic responses
  • Pharmacological effects of heart drugs
  • Electrophysiology
• Basic Elements of Cardiac Rehabilitation

  • Evaluation
  • Exercise
  • Follow up
  • Patient Education
  • Psychosocial Approach
• Exercise


  Individual workout plan, Restoring physical activity and suitability, Long-term activity plan, Self-monitoring
• Secondary protection


  • Regulation of cholesterol
  • Regulation of blood pressure
  • Regulation of blood sugar
  • Regulation of nutrition
  • Weight control
• Patient Education

  • Proper nutrition
  • Daily life activities
  • Panic control
  • Energy economy
  • Raising awareness of patients about the modification of risk factors
  • Gaining exercise habits
  • Behavior modification
  • Relaxation training
• Psychosocial Approach


  • Support system and dependency issues
  • Anxiety approaches
  • Depression treatment
  • Coping methods
  • Developing self-sufficiency for related behaviors
  • Effects of role change
• Patient Selection


  1. Evaluation (subjective and objective)

  2. Determination of short and long term targets

  3. Program planning

  4. Application

  5. Review of data with re-evaluation

  6. Effect of the results of the program on quality of life

  7. Short and long term follow-up
• Structure of Cardiac Rehabilitation

  • Hospital period
  • Early post-discharge period
  • External patient period
  • Long-term follow-up
• Hospital Period


  • 3-4 days stay
  • Progressive activity program
  • Risk factors and symptoms training
• Early Post-Discharge Period


  • Home program
  • Phone or home visits
• Long-Term Follow-Up

  • Orientation to social sports centers
  • Phone calls
  • Self-monitoring
• Involvement in cardiac physiotherapy and rehabilitation in health policies will ensure scientific development and economic efficiency in preventive approaches and treatment studies
• Clinical Outcomes of Cardiac Rehabilitation-1

  • Work capacity increases
  • To maintain independence and achieve self-care in elderly patients
  • Coronary blood flow develops left ventricular function; heart rate, blood pressure, myocardial oxygen uptake, improvement in maximum cardiac output
• Clinical Outcomes of Cardiac Rehabilitation-2

  • To slow down the progression of the disease or to regress
  • Shorten hospital stay
  • Reduce medical expenses
  • Improve the quality of life
• Heart

  Power for blood flow, This 4-chambered, muscular organ
• Heart Muscle (Myocardium)


  The heart muscle or myocardium is a striated muscle like skeletal muscle, The individual fibers are multicore cells and these cells are connected with each other, When a cell is stimulated or depolarized, the action potential spreads across all cells of the myocardium to allow the heart to function as a unit
• The cavities forming the right side of the heart

  1. It collects blood from the body

  2. Ventilate the blood with the pulmonary circulation and send it to the lungs to clean it
• The left heart


  Takes oxygenated blood from the lungs and pushes the blood into the thick-walled muscular aorta, Thus, systemic circulation is distributed throughout the body
• A thick muscular wall or septum separates the heart into the right and left parts
• Atrioventricular caps: provides passage from the atrium to the ventricle in the right heart with the tricuspid valve, allowing passage of the mitral or bicuspid valve from the left atrium to the left ventricle in the left heart
• Atrium


  The relatively thin-walled atrial chambers perform blood collection and storage during ventricular contraction, 70% of the blood returned to the atria is directly into the ventricles before the atrium contraction, The simultaneous contraction of each 2 atrium ensures that the remaining blood passes to the ventricles
• Heart caps remain closed for 0.02-0.06 seconds


  This short range increases ventricular tension, The heart volume and fiber length do not change. This is called the isometric phase of the heart. When ventricular pressure increases and exceeds arterial pressure, blood is removed from the heart
• Arteries


  High pressure tubes that carry oxygenated blood to tissues, No gas change
• Arterioles


  The walls of the arterioles consist of smooth muscles which are placed in circular layers, Arterioles regulate peripheral blood flow through contraction and relaxation, Vascular bed that regulates blood flow quickly and effectively by changing the inner diameter of the vessels, Redistribution function is especially important during exercise
• Blood pressure


  A blood flow enters the aorta with every contraction of the left ventricle, Some of the blood pumped from the heart is stored in the aorta, This creates a pressure in the entire arterial system and causes a pressure wave to reach distant branches of the arterial down from the aorta, During a cardiac cycle, this tension and then rebound of the arterial wall is heard as a characteristic pulse in any superficial artery of the body in healthy individuals
• Systolic pressure


  The maximum pressure on the heart during each systole or contraction of the left ventricle is 120 mmHg at rest, Systolic pressure gives an idea about the load of the heart and its tension against the arterial wall during ventricular contraction
• Diastolic pressure


  During diastole or during the relaxation phase of the cardiac cycle, the arterial blood pressure drops to 70-80 mmHg, Diastolic pressure is an indicator of peripheral resistance or shows the ease of blood flow from the arterioles to the capillaries
• Capillaries

  Arterioles form metarteriols. They terminate with capillaries, a microscopic network. It contains a single layer of endothelial cells in the capillary wall, Some capillaries are so narrow that they allow 1 blood cell to pass, The capillary density in human skeletal muscle is 2000-3000 capillary / mm tissue2
• Precapillary sphincter


  The diameter of the capillary opening is controlled by a smooth muscle ring called a precapillary sphincter, Sphincter is very important during exercise. Because it provides localized capillary blood flow regulation to meet metabolic requirements in a particular tissue
• Veins


  The continuity of the vascular system continues where the capillaries are fed with oxygen-free blood and opened to venules or small veins, The pressure in the systemic circulation is different. In the aorta and large arteries, blood pressure ranges from 120-80 mmHg throughout the cardiac cycle. Then the pressure decreases in proportion to the resistance encountered in the vascular circuit, The average pressure at the end of the arterioles of the capillaries is 30 mmHg. As the blood enters the veins, the resistance to the blood flow completely disappears. In time, the blood reaches the right atrium. Pressure has dropped down to zero
• Venous Return


  Veins have thin membranous flap covers. They are located at short intervals along the vein. Allow one-way flow to the heart, Because the veins are under pressure, they compress with the smallest muscular contraction and even the smallest pressure change in the chest cavity during breathing
• At rest, the venous system contains 65% of the total blood volume. Veins are considered as capacitance vessels and act as blood reservoirs
• Varicose Veins

  Sometimes the flaps are faulty and may not be successful in a one-way shot of the blood. For example, the varicose vein is caused by the inability of the blood flow to resist gravity especially in the vertical veins of the lower extremities. Blood is collected in these veins, The veins are stretched and painful. In severe cases, the venous wall is degenerated. In this case, the vessel should be surgically removed
• Compelling exercise should be avoided. In such contractions, the muscle and the ventilatory pump are significantly inadequate to assist with venous return. It causes pooling of the lower extremities and agitation of the varicose veins
• Cardiac Output


  The amount of blood pumped from the left ventricle in 1 min, The primary indicator of the functional capacity of circulation, Cardiac output= Heart Rate x Stroke Volume