Exercises on cardiac patient

Who are the cardiac patients?

Before talking about the exercises on cardiac patients we should introduce and get to know who these patients are and from what they suffer, a majority of

Patients admitted in these units are:

1) Patients who have cardiovascular disease

Requiring medical treatment including coronary artery disease, heart attack

(myocardial infarction), chest discomfort (angina), congestive heart failure

(CHF), and/or irregular heartbeat (arrhythmia) problems

2) Patients who have had a diagnostic or therapeutic cardiac procedure.

Types of cardiac diseases and symptoms:

There are many different types of heart disease. Some are congenital (people are born with heart problems), but a majority of heart diseases develop over the course of time and affect people later in life. You’ll find some of the most common heart diseases listed below:

Cardiomyopathies diseases that damage the heart muscles))

Coronary Artery Disease.

Diseases of the Heart Valves.

Heart Defects present at Birth.

High Blood Pressure.

Lung Disease such as Emphysema.

Past Heart Attacks.

Symptoms of Coronary Artery Disease:

The most common symptom of coronary artery disease is angina, or chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing, or painful feeling in your chest. It can be mistaken for indigestion or heartburn. Angina may also be felt in the shoulders, arms, neck, throat, jaw, or back.

Other symptoms of coronary artery disease include:

Shortness of breath

Palpitations (irregular heartbeats, or a "flip-flop" feeling in your chest)

A faster heartbeat

Weakness or dizziness



Symptoms of a Heart Attack

Symptoms of a heart attack can include:

Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone

Discomfort radiating to the back, jaw, throat, or arm

Fullness, indigestion, or choking feeling (may feel like heartburn)

Sweating, nausea, vomiting, or dizziness

Extreme weakness, anxiety, or shortness of breath

Rapid or irregular heartbeats

During a heart attack, symptoms typically last 30 minutes or longer and are not relieved by rest or oral medications. Initial symptoms may start as a mild discomfort that progresses to significant pain.

Some people have a heart attack without having any symptoms, which is known as a "silent" myocardial infarction (MI). It occurs more often in people with diabetes.

most areas). Immediate treatment of a heart attack is very important to lessen the amount of damage to your heart.

Symptoms of Arrhythmias

When symptoms of arrhythmias, or an abnormal heart rhythm, are present, they may include:

Palpitations (a feeling of skipped heart beats, fluttering or "flip-flops" in your chest)

Pounding in your chest

Dizziness or feeling light-headed


Shortness of breath

Chest discomfort

Weakness or fatigue (feeling very tired)

Symptoms of Atrial Fibrillation

Atrial fibrillation (AF) is a type of arrhythmia. Most people with AF experience one or more of the following symptoms:

Heart palpitations (a sudden pounding, fluttering, or racing feeling in the heart)

Lack of energy

Dizziness (feeling faint or light-headed)

Chest discomfort (pain, pressure, or discomfort in the chest)

Shortness of breath (difficulty breathing during normal activities)

Some patients with atrial fibrillation have no symptoms. Episodes may be brief.

Symptoms of Heart Valve Disease

Symptoms of heart valve disease may include:

Shortness of breath and/or difficulty catching your breath; you may notice this most when you are doing your normal daily activities or when you lie down flat in bed.

Weakness or dizziness

Discomfort in your chest; you may feel a pressure or weight in your chest with activity or when going out in cold air.

Palpitations (this may feel like a rapid heart rhythm, irregular heartbeat, skipped beats, or a flip-flop feeling in your chest.)

If valve disease causes heart failure, symptoms may include:

Swelling of your ankles or feet; swelling may also occur in your abdomen, which may cause you to feel bloated.

Quick weight gain (a weight gain of two or three pounds in one day is possible.)

Symptoms of heart valve disease do not always relate to the seriousness of your condition. You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have severe symptoms, yet tests may show minor valve disease.

Symptoms of Heart Failure

Symptoms of heart failure can include:

Shortness of breath noted during activity (most commonly) or at rest, especially when you lie down flat in bed

Cough that produces white sputum.

Rapid weight gain (a weight gain of two or three pounds in one day is possible.)

Swelling in ankles, legs, and abdomen


Fatigue and weakness

Rapid or irregular heartbeats

Other symptoms include nausea, palpitations, and chest pain.

Like valve disease, heart failure symptoms may not be related to how weak your heart is. You may have many symptoms, but your heart function may be only mildly weakened. Or you may have a severely damaged heart, with few or no symptoms.

Symptoms of Congenital Heart Defects

Congenital heart defects may be diagnosed before birth, right after birth, during childhood, or not until adulthood. It is possible to have a defect and no symptoms at all. Sometimes, it can be diagnosed because of a heart murmur on physical exam or an abnormal EKG or chest X-ray in someone with no symptoms.

In adults, if symptoms of congenital heart disease are present, they may include:

Shortness of breath

Limited ability to exercise

Symptoms of heart failure (see above) or valve disease (see above)

Congenital Heart Defects in Infants and Children

Symptoms of congenital heart defects in infants and children may include:

Cyanosis (a bluish tint to the skin, fingernails, and lips)

Fast breathing and poor feeding

Poor weight gain

Recurrent lung infections

Inability to exercise

Symptoms of Heart Muscle Disease

Many people with heart muscle disease, or cardiomyopathy, have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which progress and worsen as heart function worsens.

Symptoms of cardiomyopathy may occur at any age and may include:

Chest pain or pressure (occurs usually with exercise or physical activity, but can also occur with rest or after meals)

Heart failure symptoms (see above)

Swelling of the lower extremities



Palpitations (fluttering in the chest due to abnormal heart rhythms)

Some people also have arrhythmias. These can lead to sudden death in a small number of people with cardiomyopathy.

What does physical therapy have to do with cardiac patients?

Physical therapy plays a big role for cardiac patients, as physical therapy is a huge field that has a whole branch that’s taking care of cardiac patients.

The structured program of exercise and education known as "cardiac rehabilitation" is designed to help patients return to optimal fitness and function following an event such as a heart attack. The program begins immediately after treatment, in a hospital room or ICU, and progresses through recovery in a skilled-nursing facility and, if that is the plan, the return home.

The cardiac rehabilitation team will include the doctor, nurses, and physical and occupational therapists, who will work together to help improve the patient’s functional mobility, decrease risk factors related to the cardiac injury, and help the patient and his or her family manage the psychosocial effects that may influence recovery after a heart attack.

The role of the physical therapist is to help to evaluate cardiac function, assess impairments that may limit mobility, and prescribe progressive exercise and physical activity to help the patient return to a normal lifestyle after a cardiac event.

The physical therapist’s role begins during the acute phase, in the hospital after the cardiac event. The following three phases will occur in a skilled nursing facility, a cardiac rehab center, or home.

Phase One: The Acute Phase

The initial phase of cardiac rehabilitation occurs soon after the cardiac event. An acute care physical therapist will work closely with doctors, nurses, and other rehabilitation professionals to help the patient start to regain his or her mobility.

In the case of severe cardiac injury or surgery, such as open heart surgery, the physical therapist may start working with the patient in the intensive care unit. The initial goals of phase one cardiac rehabilitation include:

Assess the patient’s mobility and the effects that basic functional mobility has on the cardiovascular system

Work with doctors, nurses and other therapists to ensure that appropriate discharge planning occurs

Prescribe safe exercises to help the patient improve mobility and improve cardiac fitness.

Help the patient maintain sternal precautions in the case of open heart surgery.

Address any risk factors that may lead to cardiac events

Prescribe an appropriate assistive device, like a cane or a walker, to ensure that the patient is able to move around safely

Work with the patient and family to provide education about the patient’s condition and the expected benefits and risks associated with a cardiac rehabilitation program

Phase Two: The Subacute Phase

When the patient is ready to leave the hospital, the cardiac rehabilitation program will continue at an outpatient facility or a skilled-nursing facility. Phase two of cardiac rehabilitation begins

here and usually lasts from 3-6 weeks; it involves continued monitoring of the patient’s cardiac responses to exercise and activity.

Upon admission, the physical therapist will evaluate and assess the patient’s condition. Various tests and measures will be assessed by the physical therapist, including but not limited to:

 Heart rate

 Blood pressure

 Respiration rate

 Sternal precautions and scar tissue mobility assessment (if necessary)

 Upper and lower body strength

 Range of motion (ROM) of various joints

 Overall endurance level

 Balance

The physical therapist may choose to perform a specific outcome measure test to assess the patient’s general functional mobility or endurance. Common tests in phase 2 cardiac rehab include the 6-Minute Walk Test and the Timed Up and Go Test.

The main treatment offered by the physical therapist during phase 2 cardiac rehab is exercise. He or she will work closely with the doctor, nurses, and other healthcare providers to ensure that the patient safely improves exercise and activity tolerance. The PT will also teach the patient various methods to measure heart rate and to monitor exercise and activity tolerance.

Another important aspect of phase two cardiac rehabilitation is education about proper exercise procedures, and about how to self-monitor heart rate and exertion levels during exercise.

While the patient exercises, the physical therapist will monitor the body's physiological response to movement. Heart rate, blood pressure, and oxygen saturation rate will be measured. Typical exercises during phase 2 cardiac rehab may include:

 Treadmill walking

 Stationary biking

 Using an upper body ergometer (UBE)

 Rowing

 Using upper and lower body strengthening machines or free weights

 Stretching

A closely monitored exercise and activity program is optimal during the initial sessions of phase 2 cardiac rehabilitation, but as the sessions progress, the physical therapist will likely introduce more independent activities and exercises to prepare the patient for phases 3 and 4 of cardiac rehabilitation. The main focus of these phases is independent exercise and activity and a full return to a normal, healthy lifestyle.

Phase Three: Intensive Outpatient Therapy

Phase three of cardiac rehabilitation involves more independent and group exercise. The patient should be able to monitor his or her own heart rate, symptomatic response to exercise, and rating of perceived exertion (RPE). The physical therapist will be present during this phase to help the patient to increase exercise tolerance and to monitor any negative changes that may occur.