HEART PROBLEM: MYOCARDIAL INFARCTION

PHT455
PHYSIOTHERAPEUTIC EXERCISE III
NAME OF LECTURER: DR. NOOR AZLIYANA BINTI AZIZAN

NO. NAME STUDENT ID

1. NURARINA SYAHIRAH BINTI NURDIN 2018680032
2. NOR IZZATI BINTI RAMLI 2018414574
3. NUR AMALIN SYAUQINA BINTI ROZAIMIN 2018226534
4. NUR SYAZWANI BINTI ABDUL GHANI 2018438796
5. NURUL SYUHADA BINTI MOHD SOBRI 2018654454
 PREVALENCE

• In Malaysia, 20.1% of death is caused by

Coronary Artery Disease (CAD) which
contribute the highest percentage.
• In general, CAD is most common in men rather
than women.
• Murty et al. found that the most common
cardiac-death related cases were prevalence
toward females which contribute 83 out of 936
female deaths.
• CAD is more prevalence in Indians compared to
Malays and Chinese.
 Unhealthy Atherosclerotic
plaque slowly Plaque
diet, stress Causing
builds up in the suddenly
and smoking thrombosis
inner lining of a ruptures
coronary artery

Preventing Totally
Myocardial Sudden chest
blood flow occluding the
Infarction pain
downstream artery
DIFFERENCES BETWEEN NORMAL HEART AND
INFARCTED HEART

Normal Heart Infarcted Heart

Normal coronary arteries Blockage (occlusion) of
coronary arteries
Normal muscle heart Muscles of the heart
become ischemic
(prolonged lack of oxygen
supply)

Blood flow from the left Blockage results in

atrium to the left preventing blood flow
ventricle and from the downstream
right atrium to the right
ventricle normally

(American Heart Association, 2019)

Table 1 | Differences between Normal Heart and Infected Heart Figure 1 (Adapted from Charles A. Goldthwaite, Jr.)
GOAL STANDARD

To diminish the chance of a future cardiac occasion by stabilizing, abating, or indeed

switching the movement of cardiovascular disease

To increase functional capacity and perseverance slowly and progressively

To allow heart rate to extend proportional to the escalated of action
To improve muscle strength
To increase muscle endurance
To increase range of motion (ROM)
To restore blood circulation
To improve energy level
To increase muscle endurance
To motivate patient spirits
(Rehabilitation Guideline After Myocardial Infarction, 2013)
RISK FACTOR OF MYOCARDIAL INFARCTION

Figure 2 | Risk Factor of Myocardial Infarction (Adapted from

http://prathameshdiagnostics.com/heart-disease-2/)
 SYMPTOMS OF MYOCARDIAL INFARCTION

Figure 3 | Symptoms of Myocardial Infarction https://www.cwimedical.com/common-heart-

attack-warning-signs
 Aim: counterbalance the impact of bedrest (hospital care) TRAINING
10 days PROGRAMME
Early rehabilitation (mobilization)

Intensity:
- Depend on the patient’s tolerance Home exercise programme

6 to 12 weeks in duration
Duration:
- Discontinuous sessions enduring 3 to 5 mins Detail:
- Resting periods enduring from 1 to 2 mins (must be
Phase 1 shorter than the activity sessions) - Vitals assessed
- Total duration 20 mins - Warm up 10 to 15 mins
Phase 3
- Exercise for 30 to 35 mins
Frequency: - Cool down for 10 mins
- 3 to 4 times daily (early first 3 days)
- 2 times daily (the next day 4)
Relax for 15 mins (reassessment of vital)
Progression:
10 to 15 mins of sessions, and increase the intensity
Aim: encourage for long term support of
Aim: to improve their ordinary activities of daily living and lifestyle changes, and checking any
mobility Phase 4 changes of risk factor and secondary
Phase 2 prevention
ACSM suggest for 4 to 6 weeks
 PHASE 1 (1-3 WEEKS)
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

In-bed passive REST In-bed active REST In-chair active REST Standing and
mobilization cycle (arms and mobilization assisted walking
Bed Mobility Diaphragmatic Sliding board
(upper and lower legs) using parallel bar
Transfer breathing exercise  20 minutes transfer from bed
limb)
 20 minutes to chair  20 minutes
(Rehabilitatio (Kulur et al., 2009)  10 repetitions
 20 minutes
n Guideline  10 repetitions (Rehabilitation (Rehabilitation
 2 minutes rest-
 10 repetitions After Guideline After Guideline After
 2 minutes rest- interval
Myocardial Myocardial Myocardial
 2 minutes rest- interval
Infarction,  3 sets per day Infarction, 2013) Infarction, 2013)
interval
2013)  3 sets per day
(Rehabilitation
 3 sets per day
(Rehabilitation Guideline After
(Rehabilitation Guideline After Myocardial
Guideline After Myocardial Infarction, 2013)
Myocardial Infarction, 2013)
Infarction, 2013)
 PHASE 2 (4-6 WEEKS)

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Balance exercise- REST Strengthening REST – to prevent Strengthening lower REST Light aerobic
static & dynamic upper limb – active muscle fatigue limb – active
Brisk Any activity daily  30 minutes
balance exercise exercise exercise
walking (Rehabilitation living (ADL)
(Ribeiro, et al.,
 30 minutes  30 minutes Guideline after  30 minutes
 30 min per (Rehabilitation 2017)
Myocardial
(Rehabilitation day  8-12 repetitions  8-12 repetitions Guideline after
Infarction, 2013)
Guideline after Myocardial
(Thompson,  2 minutes rest-  2 minutes rest-
Myocardial Infarction, 2013)
2005) interval interval
Infarction, 2013)
 3 sets (3 times  3 set (3 times per
per day) day)

(Rehabilitation (Rehabilitation
Guideline after Guideline after
Myocardial Myocardial
Infarction, 2013) Infarction, 2013)
 PHASE 3 (6-8 WEEKS FOLLOWING DISCHARGE)

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

10-meter REST Static cycling REST Strengtheni Strengthenin REST

waking Window (progression Gardening ng upper g lower limb Any activity
(progression shopping with increase limb (increase daily living
- decrease resistance) (increase repetition, (ADL)
duration, repetition, increase
increase increase duration,
speed) duration, increase load)
increase
load)

(Rehabilitation Guideline After Myocardial Infarction, 2013)

 PHASE 4 (LONG TERM MAINTENANCE)

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Aerobic Self-practice Cycle REST – to Swimming REST- for Jogging

exercise of yoga ergometerprevent  30 recovery phase  30 minutes
 30  25 minutes  30 minutes muscle fatigue minutes (Olson, n.d.)
(Thompson,
minutes (Rehabilitation
(Chandraseka (Ribeiro, et (Tao, et al., 2005)
including 5 Guideline
ran, et al., al., 2017) 2015)
minutes after
2019)
warming up Myocardial
and cooling Infarction,
down 2013)
(Thompson,
2005)

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