Dr. MOCH. RIDWAN, Sp. KFR ILMU KEDOKTERAN FISIK & REHABILITASI FAKULTAS KEDOKTERAN UNIVERSITAS BRAWIJAYA / RSU Dr. SAIFUL ANWAR MALANG
Cardiovascular Diseases:
Effort to restore the function of heart and the health of the patient according to the level of physical and mental activity as the level of heart function Etiology: Defect in coronary system Defect in heart valve and muscle of the heart Defect in increment of resistance of blood flow of resistance
Rehabilitation Medicine of
Medical Problem
Heart diseases, hypotension, increase pulse rate Complication of long standing immobilization : Muscle atrophy Joint Contracture Decubitus
Rehabilitation Problem:
Disability of mobilization Restricted of daily activity. Defect of Vocational Defect in working Defect in communication Defect in psychosocial
Class 2 : Heart disease patient with few physical activity. Class 3 : Heart disease patient with limited physical
Taking a rest there is no symptom but with daily activities there is palpitation, short of breath, chest pain activities. Taking a rest there is no symptom, but with light activities, there is symptoms Taking a rest, there is symptom. All activities will worsened symptoms
The oxygen demands in condition body take a rest and quite sitting
1 Kilo calory ( KKal ) EQUIFALENT with using 200 CC O2 1 METS EQUIFALENT 3,5 CC O2/ Kg BB/ minute 1 METS EQUIFALENT 1,5 CC Calory / minute
Protocols: STADIUM & Level of Disease Approximate the heart capacity Classification of activities The foundation of activities program Programs recipe 220 age ( Years ) = Frequency Heart MAX / minute
Level I
Stadium I
ICCU / CVCU
Level II
Ward
STADIUM I A. Level I : In ICCU / CVCU ( 1 3 Day ) 1. Approximate the capacity of the heart : Class IV
3. Type of activities: Change body position Passive movement ROM extremities Active movement ROM extremeties 4. Intensity Heart pulse target : 40 50 % from maximal HEART RATE TENTION SISTOLE 20 mmHG TENTION DIASTOLE 10 mmHG MONITOR SUBYEKTIF / OBJEKTIF SIGN ABNORMALITY OF ECG 5. Frequency and Duration 5 times, 2-3 times a day Duration 2 5 Minutes, take a rest 10 minute
B. Level II : In Ward
( 3 14 days)
1. Approximate the capacity of the heart : Class III 1, 5 - 2,7 CAL 1,2 - 2,2 METS 2. Classification of Activities: Minimal 1,5 2,5 METS 10th 15th Days 3. Type of activities Sitting position Eat, drink, wash face Active Activities etremities Defecation Standing Exercise Slow walking 4. Intensity
5. Frequency and Duration Exercise : 5 - 10 Minutes Rest : 5 - 10 Minutes Frequency : 2 3 Times / Day
Level II C. Level III : At Home ( 2 8 weeks ) 1. Approximate the capacity of the heart : Class II 2, 7 - 4 CAL 1,2 - 2,2 MET 2. Classification of Activities MODERAT 2, 5 3,5 METS 3. Type of activities Previous exercise to be continued Working exercise 2 MILE / hour Take a bath in bathroom Cycling without resistance 4. Intensity
70 80 % MHR
5. Frequency and Duration Exercise 2 times/ day Deconditioning 5 10 minutes Duration 15 20 minutes Cool down 5 minutes
STADIUM III D. LEVEL IV : ( POST RECOVERY ) 1. Approximate the capacity of the heart : Class I 4 - 6,6 CAL 3,2 - 5,3 METS 2. Classification of Activities Severe 3, 5 5 METS 3. Base Program: STRESS TEST 4. Type Activities According the result of STRESS TEST Walking activities, gynamctic, cycling Sexual intercourse can be considered
Stop Exercise:
Tension is not up nor down, or up more than systole
20 mmHg/Diastole 10 mmHg. Excess than hearth rate target. Chest pain Cyanosis, pale, vomiting Hypotension, diaphoresis Short of breath ARITMIA
Stress test
Ischemia: 61%