Patient Profile: Mr. Rakesh Sharma | Age: 51 years | Post-MI Date: 31.05.2025 Intervention: Primary PTCA & Stent to RCA | LV Function: Normal (EF 59%) Risk Factors: DM, HTN, Obesity (BMI 30) | CAG: Triple Vessel Disease by
Raghu C
Cardiac rehabilitation is a comprehensive, medically supervised program designed to optimize cardiovascular health following acute coronary events. This protocol addresses the specific needs of post-MI patients with multiple cardiovascular risk factors, emphasizing safe exercise progression, risk factor modification, and psychological support.
Low Risk 7 (Current Patient Classification)
EF g 50% (Patient: 59%)
Successful revascularization (Primary PTCA completed)
No significant arrhythmias
Stable clinical condition
Diabetes mellitus
Hypertension
Obesity (BMI 30)
Triple vessel disease
Age > 50 years
Objectives:
Prevent deconditioning
Early mobilization
Patient and family education
Discharge planning
Exercise Protocol:
1 Day 1-2 Post-Procedure:
Bed rest for 4-6 hours post-catheterization
Deep breathing exercises
Ankle pumps and range of motion exercises
Passive leg exercises
2
Corridor walks (100-200 meters)
Climb 1 flight of stairs before discharge
Activities of daily living independently
Monitoring Parameters:
Heart Rate: <120 bpm or <70% age-predicted maximum
Blood Pressure: Systolic increase <20 mmHg from baseline
Symptoms: Monitor for chest pain, dyspnea, dizziness
Oxygen Saturation: >90%
Sitting at bedside (15-20 minutes, 2-3 times)
Short walks in room (2-3 minutes)
Self-care activities (feeding, grooming)
Week 1-2 (Immediate PostDischarge):
Exercise Prescription:
Frequency: Daily
Duration: 10-15 minutes, 2-3 sessions
Intensity: 40-50% HRR (Heart Rate Reserve)
Type: Walking on level ground
Target Heart Rate Calculation:
Age-predicted maximum HR = 220 51 = 169 bpm
Resting HR = 70 bpm (assumed)
HRR = 169 70 = 99 bmp
40% HRR = 70 + (0.4 × 99) = 110 bmp
50% HRR = 70 + (0.5 × 99) = 120 bmp
Activities:
Level walking: 1-2 km at comfortable pace
Light household chores
Sexual activity (if comfortable, after 2 weeks)
Week 5-8:
Exercise Protocol:
Duration: 30-45 minutes
Intensity: 60-70% HRR (130-140 bpm)
Activities:
Treadmill walking (gradually increase incline)
Cycling (moderate resistance)
Swimming (if comfortable)
Week 3-4:
Exercise Progression:
Duration: 20-30 minutes
Intensity: 50-60% HRR (110-130 bpm)
Activities: Brisk walking, stationary cycling (low resistance)
Week 9-12:
Advanced Training:
Duration: 45-60 minutes
Intensity: 70-80% HRR (140-150 bpm)
Resistance Training: Begin light weights (Week 8)
Exercise Prescription (FITT Principle):
Frequency: 4-6 days per week
Intensity: 60-80% HRR or 12-16 RPE (Borg Scale)
Time: 45-60 minutes per session
Type: Aerobic + Resistance training
Aerobic Exercise:
Primary: Walking, jogging, cycling, swimming
Target: 150-300 minutes moderate intensity per week
Or: 75-150 minutes vigorous intensity per week
Exercise Safety Guidelines
Absolute Contraindications:
Unstable angina
Uncontrolled cardiac arrhythmias
Acute myocarditis or pericarditis
Symptomatic severe aortic stenosis
Acute pulmonary embolism
Acute systemic illness
Resistance Training (2-3 times/week):
Week 8-12 Progression:
Start with body weight exercises
Light dumbbells (1-3 kg)
1-2 sets, 10-15 repetitions
Major muscle groups
After 3 Months:
Progressive resistance training 2-3 sets, 8-12 repetitions
60-70% of 1 RM (Repetition Maximum)
Relative Contraindications:
Resting SBP >180 mmHg or DBP >110 mmHg
Recent change in ECG
High-grade AV block
Uncontrolled diabetes (glucose >300 mg/dL)
Stop Exercise If:
Chest pain or anginal equivalent
Severe dyspnea
Dizziness or lightheadedness
HR >85% age-predicted maximum
SBP >250 mmHg or DBP >115 mmHg
Decrease in SBP >10 mmHg with increasing workload
Baseline Assessment (Week 1-2):
Exercise stress test (6-8 weeks post-MI)
Echocardiography
Blood chemistry (lipids, HbA1c, renal function)
Body composition analysis
Ongoing Monitoring:
Weekly (First Month):
Weight, blood pressure
Exercise tolerance assessment
Medication compliance review
Monthly:
Functional capacity evaluation
Risk factor assessment
Psychological screening
Secondary Prevention Strategies
Medication Optimization:
Antiplatelet therapy: Dual antiplatelet therapy (DAPT)
Statin therapy: High-intensity (Atorvastatin 80mg or equivalent)
ACE inhibitor/ARB: Optimize dose for heart protection
Beta-blocker: Continue unless contraindicated
Diabetes management: Optimize HbA1c <7%
Every 3 Months:
Comprehensive medical evaluation
Exercise stress test (if indicated)
Laboratory investigations
Risk Factor Modification:
Smoking cessation: Counseling and pharmacotherapy
Blood pressure control: Target <130/80 mmHg
Lipid management: LDL <70 mg/dL, Non-HDL <100 mg/dL
Diabetes control: HbA1c <7%, consider SGLT2 inhibitors
Weight management: Target BMI <25 kg/m²
Educational Components:
Understanding heart disease and recovery process
Medication compliance and side effects
Dietary modifications and meal planning
Exercise safety and progression
Stress management techniques
Return to work guidelines
Psychological Assessment:
Depression screening (PHQ-9)
Anxiety assessment (GAD-7)
Quality of life evaluation
Sexual counseling if needed
Support Systems:
Family involvement in education
Peer support groups
Online resources and applications
Regular follow-up with cardiac team
Timeline Recommendations:
Desk work: 2-4 weeks post-MI
Physical labor: 6-8 weeks post-MI
Driving: 1-2 weeks (local), 4-6 weeks (commercial)
Air travel: 2-4 weeks
Sexual activity: 2-3 weeks
Functional Capacity Requirements:
Sedentary work: 2-3 METs
Light physical work: 4-5 METs
Moderate physical work: 5-7 METs
Heavy physical work: >7 METs
Warning Signs to Report:
New or worsening chest pain
Severe shortness of breath
Irregular heartbeat or palpitations
Excessive fatigue
Dizziness or fainting
Rapid weight gain (>2 kg in 2 days)
Emergency Contacts:
Cardiologist: [Contact Information]
Emergency Services: 102/108
Cardiac Rehabilitation Team: [Contact Information]
Exercise Capacity Goals:
6-minute walk test: >400 meters
Peak VO2: >20 mL/kg/min
Functional capacity: >7 METs
Clinical Targets:
LDL cholesterol: <70 mg/dL
Blood pressure: <130/80 mmHg
HbA1c: <7%
BMI: <25 kg/m²
Smoking: Complete cessation
Cardiac Rehabilitation Team:
Week 1: Initial assessment
Week 2-4: Weekly sessions
Month 2-3: Bi-weekly sessions
Month 4-6: Monthly sessions
Beyond 6 months: Quarterly sessions
Multidisciplinary Team:
Cardiologist: Monthly initially, then every 3 months
Endocrinologist: Every 3 months (for diabetes)
Nutritionist: Monthly for first 3 months
Exercise physiologist: As per rehabilitation schedule
Pharmacist: Medication review as needed
Protocol Duration: Minimum 12 weeks intensive phase + Lifelong maintenance
Expected Outcomes: 15-25% improvement in functional capacity, significant risk factor reduction
Success Rate: >80% completion rate with proper patient selection and motivation
cardiac rehabilitation