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Dr.Aminuddin Arifin,SpRM
THE ULTIMATE GOAL OF CORONARY REHABILITATIVE SERVICES IS TO HELP PATIENTS WITH CORONARY HEART DISEASE (CHD) RESUME ACTIVE AND PRODUCTIVE LIVES FOR AS LONG AS POSIBLE,WITHIN THE LIMITATIONS IMPOSED BY THEIR DISEASE PROCESS.
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Attainment of optimal physiologic,psychosocial,vocational and recreational status. Prevention of progression or reversal of the underlying atherosclerotic process. Reduction of risk of reinfarction and sudden death and alleviation of angina pectoris.
CATEGORIES OF CORONARY PATIENTS WHO ARE POTENTIAL CANDIDATES FOR REHABILITATIVE EXERCISE TRAINING
1.Patients after Myocardial Infarction 2.Patients after CABG 3.Patients after PTCA 4.Patients with Angina Pectoris 5.Patients with Left Ventricular Dysfunction and Congestive Heart Failure 6.Patients after Heart Transplantation 7.Patients with Implanted Pacemakers
GUIDELINES FOR RISK STRATIFICATION FOR PATIENTS IN CORONARY REHABILITATIVE EXERCISE PROGRAME
LOW - Uncomplicated clinical course in hospital - No evidence of myocardial ischemia - Functional capacity >/= 6 METs - Normal left ventricular function (EF>/=50%) - Absence of significant ventricular ectopy
INTERMEDIATE - ST segment depression >/= 2mm flat or downsloping - Reversible thallium defects - Moderate to good left ventricular function (ejection fraction 35 49 %) - Changing patterns of or new development of angina pectoris
HIGH - Prior myocardial infarction or infarct involving >/=35% of the left ventricle - EF < 35% at rest - Fall in exercise systolic blood pressure or failure of systolic blood pressure to rise >/= 10 mmHg on exercise test - Persistent or recurrent ischemic pain 24 hours or more after hospital admission
Functional capacity < 3 METs with hypotensive blood pressure response or 1mm ST segment depression Congestive heart failure syndrome in hospital >/= 2mm ST segment depression at peak heart rate </= 135 beats/min High-grade ventricular ectopy
Absolute contraindication :
Unstable angina pectoris Recent acute myocardial infarction and unstable condition Uncontrolled hypertension with resting systolic blood pressure of >200 mmHg or diastolic blood pressure of >110 mmHg Inappropriate asymptomatic postural or exertional blood pressure response Serious atrial or ventricular arrhythmias Second- or third-degree heart block Recent embolism (systemic or pulmonary) Acute or chronic thrombophlebitis Dissecting aneurysm Fever of >100F Exercise sternal movement after CABG (contraindication for upper-extremity and trunk ROM exercise) Uncompensated heart failure Active pericarditis or myocarditis Severe aortic stenosis (>50mmHg gradient) and idiopathic hypertrophic subaortic stenosis Acute systemic illness
Relative contraindication :
Resting diastolic blood pressure of >100mmHg or resting systolic blood pressure of >180mmHg Inappropriate increase in blood pressure during exercise Hypotension Moderate aortic stenosis (25-50mmHg gradient) Compensated heart failure Significant emotional stress or psychological disorder Pericarditis associated withv CABG Resting ST segment depression of >2mm Poorly controlled diabetes mellitus Neuromuscular, musculoskeletal, or arthritic disorders that would prevent activity Excessive incisional drainage after CABG Sinus tachycardia (>120 beats/min) at rest New ECG change after CABG or acute myocardial infarction that are diagnostic or suggestive of new infarction Ventricular aneurism Symptomatic anemia (hematocrit of < 30%)
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Sda, duduk ditepi tempat tidur, duduk di kursi AROM, latihan peregangan, berdiri, duduk di kursi, jalan pelan-pelan Berjalan diawasi sejauh 25 m, berpakaian mandiri Berjalan bebas di ruang rawat, berjalan 30 100 m, naik sepeda statis selama 3 menit tanpa tahanan, senam ringan. Berjalan 150 m 2 set, sepeda statis 5 menit, belajar menghitung nadi
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2 x 8 mnt ergometer lengan 45% MET dari treadmil 15 mnt treadmil 75% MET dari treadmil
15 mnt sepeda statis 3.7 MET 2 x 8 mnt ergometer lengan 4.5 MET 14 mnt treadmil 3.9 MET 3 5 mnt mesin dayung tahanan rendah
15 mnt sepeda statis 4.9 MET 2 x 8 mnt ergometer lengan 5.5 MET 20 mnt treadmil 3.9 MET 15 mnt sepeda statis 4.9 MET 2 x 8 mnt ergometer lengan 6.4 MET 22 mnt treadmil 6 MET 15 mnt sepeda statis 6.1 MET 2 x 8 mnt ergometer lengan 6.4 MET 25 mnt treadmil 6 MET 15 mnt sepeda statis 6.1 MET 25 mnt ergometer lengan 6 MET
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12 Mgg
15 mnt sepeda statis 6.1 MET 25 mnt ergometer lengan 6 MET 27.5 mnt treadmil 6 MET 15 mnt sepeda statis 6.1 MET 25 mnt ergometer lengan 6 MET 30 mnt treadmil 6 MET
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13 Mgg
LAMANYA
7 14 hari 8 12 minggu hidup
AKTIVITAS
Perawatan diri sendiri, berjalan jarak dekat; target 1.5 km dlm 30mnt (3MET) Pemeliharaan jantung progresif 1 jam 3 x per minggu; target 3 km dlm 30 mnt (6 MET) Pemeliharaan jantung 1 jam 3 x seminggu
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TERIMA KASIH