Overview of Cardiac PT Rehabilitation

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Safety

Withold treatment

  • Decompensated CHF
    • Compensated= taking meds, currently stable
    • Or they come in w their CHF, and are not stable, meds aren’t appropriate, increased edema in LE, all being worked out in the hospital
  • Heart block
    • 2nd degree heart block w/ PVCs or v tach at rest
    • 3rd degree heart block
  • Ventricles

    • 10 PVCs per min at rest

    • Multifocal PVCs, unstable angina with recent (24 hrs) changes in symptoms, ECG changes showing injury
  • Atria
    • New onset (24 hrs) of a fib w/ rapid ventricular response at rest (>100 bpm)
  • Dissecting aortic aneurysm
  • Chest pain w new ST segment changes on ECG

Withhold or modify treatment

Note

This depends on the individual hospital

  • Resting HR >100 BPM
  • HTN resting BP >160/90
  • Hypotensive resting systolic <80
  • MI within previous 2 days
  • Ventricular ectopy at rest
  • A fib w/ rapid ventricular response at rest (HR >100 bpm)
  • Uncontrolled metabolic disease
  • Psychosis or other unstable psychological condition

Activity Monitoring

Heart Rate

  • Linear relationship between HR and work
    • 20-30 beat increase from resting during activity
  • Heart rate recovery (HRR) - 1 min after treadmill test
  • Beta blockers - HR no greater than 20 above rest (also use RPE BORG scale) Can NOT be used with heart transplant (heart is denervated, not same response you would expect)

Blood Pressure

Normally systolic increases 5-12 mmHg per increase in METS Disproportionate responses with activity If Systolic decreases 10 mmHg from rest Systolic >180 mmHg Diastolic >110 mmHg

BORG RPE scale

Preferred method w/ Beta blockers Keep intensity at 5 on ten point scale Keep intensity at 13 on the 6-20 scale

ECG

Watch baseline Or take a minute to look before starting Declining status ST changes Increased freq of PVCs Unifocal to multifocal PVCs Premature atrial contractions to a flutter or a fib Progression in heart blocks (hard to see)

Activity Monitoring

  • Know signs of decompensation
  • Other signs and symptoms
    • Weakness
    • Fatigue
    • Dizziness
    • Lightheadedness
    • Angina
    • Palpitations
    • Dyspnea

Citation

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