Upload
joliboom
View
223
Download
0
Embed Size (px)
Citation preview
7/23/2019 Rehab guidelines
1/32
1
Guideline .. 2539 reviseguideline references
guideline
cardiac rehabilitation guideline cardiac rehabilitation
cardiac rehabilitation
( )
7/23/2019 Rehab guidelines
2/32
2
1. 5
-
-
-
2. 9
3.1 () 11
4.2 () 16
- 3 () 19
5.Resistance training 20
6. 23
7. Heart Failure 25
7/23/2019 Rehab guidelines
3/32
3
.. 2552
7/23/2019 Rehab guidelines
4/32
4
..2553
7/23/2019 Rehab guidelines
5/32
5
(Cardiac Rehabilitation Guideline)
1.
(coronary heart disease)
(physiological conditions) (psychological conditions)(social conditions)(vocational conditions)
2. (Director) /
(Staffs)- - - - - --
7/23/2019 Rehab guidelines
6/32
6
3. - - - -
4.
5.
6. -
- (defibrillator)-
7/23/2019 Rehab guidelines
7/32
7
- (ECG telemetry)-
(stationary bicycle or arm ergometry) (treadmill)
7. 1. Stable angina
2. Post myocardial infarction3. Controlled congestive heart failure
4. Post percutaneous coronary intervention (PCI)
5. Post cardiac surgery including heart transplantation
6. Patient with high risk for coronary artery disease
7. Patient with peripheral vascular disease
8. Others
8. 1 2 8-12
3 4 3
9. 1. Unstable angina
2.3.
7/23/2019 Rehab guidelines
8/32
8
4. 5. Recent pulmonary embolism severe pulmonary arterial
hypertension
6.(thrombophlebitis)7.> 200 .
> 100 .8. > 20 .
9. ST displacement > 3 .
10.11. 12. Third degree A-V block
13.14. 15.16. Hypertrophic obstructive cardiomyopathy
10. 1. 2. 3. 4. 5. Supraventricular tachycardia 6.ST displacement > 3 . (horizontal down
sloping)
7. Ventricular tachycardia
8. Left bundle branch block
7/23/2019 Rehab guidelines
9/32
9
9. second third degree A-V block10. R on T PVCs
11. Multifocal PVCs (30% of the complexes)
12.13.(220
110 .)14. 10 /
11. (Risk stratification) (Monitoring)
(left ventricular ejectionfraction) (arrhythmias)
(risk stratification) (1)
1.
2. 3.
3.1
3.2
3.3
7/23/2019 Rehab guidelines
10/32
10
Degree of Supervision
1. (home program)(low risk)
2.
(supervised cardiac exercise program)
2.1
(Borgs rate of perceived exertion)
2.2
2.2.1
2.2.2
defibrillator
7/23/2019 Rehab guidelines
11/32
11
12.
1 (Phase 1)(Inpatient Phase)1
1.2.3.
4.
(METs)
7/23/2019 Rehab guidelines
12/32
12
1.2.3.
(mode) calisthenic exercise (intensity)
(post-myocardial infarction)
20
30 (duration)
5-10 20-30 (frequency)2
1 5 METs
(3)
7/23/2019 Rehab guidelines
13/32
13
ICU
CCU
ICU
CCU
7/23/2019 Rehab guidelines
14/32
14
7/23/2019 Rehab guidelines
15/32
15
1.
2.
3.
4.
5.EKG (
)
-
-13
-120 /--20 -30 /
-10/
-
200/100 .--20 ..
- Supraventricular tachycardia- ST
displacement (3 mm.)-Ventricular
tachycardia-Left bundle branch
block- 2-3 degree AV-block-PVC
-
-
-
-
- ST segment
-PVC3 -R on T PVC-Multifocal
PVC (30%)
7/23/2019 Rehab guidelines
16/32
16
2 (Phase 2)
(Outpatient Phase)2
8-12
1.
2.3.
4.
5.
2 (monitoring) 1 (ECG telemetry)
7/23/2019 Rehab guidelines
17/32
17
8-12
3 3(Mode)
4-6 post-MI, post-PCI 8 post cardiac surgery
resistance trainingdumbbell
(intensity)Exercise Stress Test
20-30 70 /70+30 = 100
KarvonenMethod
( ) x 0.4 0.85 +
= 220 ()
(moderate intensity) 0.4 0.6
7/23/2019 Rehab guidelines
18/32
18
Borg (Rating of Perceived Exertion Scale)
(2)11-13
Exercise Stress Test
Karvonen Method (exercise stress test -) x 0.4 0.85 +
[VO2max
] 40-85% VO
2max
(moderate intensity) 40-60%Borg (Rating of Perceived Exertion Scale)
11-13
(Duration)60
stretching, warmup, aerobic /resistance training,cool down stretching aerobic exercise20-30
(Frequency)3-5
7/23/2019 Rehab guidelines
19/32
19
(Progression)
intensity (intensity)
3 (Phase 3)
3 2 3 2
3
33
1.2 6 2.2
5 METs
3. (selfmonitor)
31.3 3-6
32.8 METs
intensity
7/23/2019 Rehab guidelines
20/32
20
3.4.
Resistance trainingResistance training1.
2.Exercise stress test ischemic response3.
-congestive heart failure -valvular heart disease -(> 160 .
> 100 . )
-- Aerobic capacity 5 METs-(LVEF < 0.35)
Resistance training1.myocardial infarction CABG 6
PCI 4 2.resistance training
resistance training
3. resistance training 2(2 )3 resistance training
resistance training 2
7/23/2019 Rehab guidelines
21/32
21
4.resistance training
aerobic (/RPE Scale)5.
resistance training6.resistance training
aerobic training 7.8.
biceps
9.dumbbell 10.1 11.
resistance training
Resistance training(Mode) dumbbell (Intensity)
1.21 (
)2.3 2
1 repetition maximum (1 ) 90% repetition maximum 2-3 30-50% 1 repetition maximum
3. RPE Scale
7/23/2019 Rehab guidelines
22/32
22
(Duration)- 12-15 2 2-3
(Progression)- 12-15
2 3 12-15 1
13.
1. warm upcalisthenic exercise 10 10
2.
(Borg scale) 5 - 2 10
- 3 15
- 4 15
7/23/2019 Rehab guidelines
23/32
23
- 15
20 3. cool down
cool down 5-10
1.2.300 ..3.4.5.() 100 /
200/100 .
6.7.8.
- 1-2
- - - -
-
7/23/2019 Rehab guidelines
24/32
24
- ()
- - -
-
- 20-30
- 30 3-5
1.2.50 3., 4.5.(
)
1.(warm up) 10
7/23/2019 Rehab guidelines
25/32
25
2.3.(cool down)
10 1.2. 3. 4. 5. 6.
-
- - - - -
14. supervised exercise(interval training)
..
7/23/2019 Rehab guidelines
26/32
26
neurohormone
1 24 1.8 1-3
dobutamine continuous intermittent New York Heart Association Functional Class IV
Complex ventricular arrhythmia 100 (Pre-existing co-morbidities)
(compensated heart failure)
3 30
110 (less than moderate
fatigue)
Cardiac index of 21 min-1.m
-2(for invasively monitored patients)
Central venous pressure of < 12 mmHg (for invasively monitored
patients)
7/23/2019 Rehab guidelines
27/32
27
(RPE 14) 40 S
3pulmonary rales
pulmonary rales second component second sound (P
2)
Poor pulse pressure (
< 10 .) 10 .
supraventricular ventricular ectopy
10-60 3-7 5
7/23/2019 Rehab guidelines
28/32
28
(VO
2peak) submaximal exercise capacity
6 minute walk test
ventilatory threshold
1. American Association of Cardiovascular and Pulmonary Rehabilitation.
Guidelines for cardiac rehabilitation and secondary prevention programs
4thedition. Champaign, IL: Human Kinetics ; 2004
2. Goble AJ. Worcester MUC. Best Practice guide lines for cardiac
rehabilitation and Secondary prevention, 1stedition. Melbourne.
Department of Human Services 1999:52-6
3. Guidelines for cardiac rehabilitation and secondary prevention programs,
Human Kinetics Publisher3rd edition , 1999 ,39-52
4. Pashkow FJ, Dafoe WA: Clinical cardiac rehabilitation-A Cardiologists
guide 2ndedition :Baltimore; Williams@Wilkins: 1999:458-66
5. Pina IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha
BD, et al. Exercise and Heart Failure: A statement from American
7/23/2019 Rehab guidelines
29/32
29
Heart Association Committee on exercise, rehabilitation, and prevention.
Circulation 2003;107:1210-1225
6. Pollock ML, Ward A, Foster C. Exercise Prescription for rehabilitation
of the cardiac patient In: Pollock ML, Schmidt DH. Editors. Heart Disease
and Rehabilitation. Boston: Houghton Mifflin 1979: 415-20
7. Rees K, Taylor RS, Singh S, Coats AJS, Ebrahim S. Exercise based
rehabilitation for heart failure(Review). The Cochrane Database of
Systematic Review 2004, Issue 3
8. Whellan DJ, OConnor CM, Lee KL, Keteyian HJ, Cooper LS, Ellis SJ,
et al. HF-ACTION Trial Investigators. Heart failure and a controlled trial
investigating outcomes of exercise training (HF-ACTION): design and
rationale. Am Heart J 2007;153:201-11
9. Working group on Cardiac Rehabilitation & Exercise Physiology and
Working Group on Heart Failure of the European Society of Cardiology.
Recommendations for exercise training in chronic heart failure patients.
European Heart Journal 2001;22:125-135
10. , , .
1.
, 2546: 141-148
7/23/2019 Rehab guidelines
30/32
30
-(left ventricular ejection fraction> 0.5)
-
ST(ST displacement)
--
-6 METs 3
- ( leftventricular ejection fraction 0.31 0.49)
- 5-6 METs 3
--
ST 1-2 . (1-2 mm.ST depression)
11.
7/23/2019 Rehab guidelines
31/32
31
- (left ventricular ejectionfraction < 0.3)
-
-15 .
--
(complex ventricular arrhythmias)-
ST 2 . (2 mm. ST depression)
7/23/2019 Rehab guidelines
32/32
32
3
6. NOTHING AT ALL 7. VERY VERYLIGHT 9. VERY LIGHT 11. LIGHT 12.
13. SOME WHATHARD 15. HARD 16.
17. VERY HARD 18.
19. VERY VERY HARD ()20.
2Borg
(Borgs rating of perceived exertion) RPE