Post cardiac transplant rehabilitation .pdf

Post cardiac transplant rehabilitation focuses on restoring physical function, improving cardiovascular fitness, and enhancing the overall quality of life after a heart transplant surgery.
It includes gradual exercise progression, monitoring of heart rate and blood pressure, patient education about medication and infection control, and psychological support to help patients return safely to their daily activities.

1. POST-TRANSPLANT CARDIAC REHABILITATION
PT INTERN: SUNDOS ALOSAIMI

2. Cardiac transplantation is a treatment option for
patients with end-stage heart failure. After surgery,
patients often experience muscle weakness,
deconditioning, and exercise intolerance. Physiotherapy is
essential in the recovery process as it helps improve
functional mobility, restore endurance, and prevent
complications related to inactivity and medications. A
tailored rehabilitation program supports patients in
regaining independence and enhancing their quality of life INTRODACTION

3. PHYSIOLOGICAL CONSIDERATIONS
POST-TRANSPLANT
Exercise Intolerance
Effects of Steroids &
Immunosuppressive
Medications
Denervated Heart
Orthostatic
Hypotension
Rejection
TIP Rejection after heart transplant does not occur in all patients

4. Completely denervated after transplant (loss of sympathetic
& parasympathetic innervation).
Resting HR: elevated (≈90–110 bpm).
Exercise response:
Slow HR increase during activity.
Slow recovery post-exercise.
DENERVATED HEART
Heart relies on:
Circulating catecholamines (Epi, NE) → HR &
contractility.
Frank–Starling mechanism → maintain cardiac
output.
Intrinsic conduction system → preserve rhythm

5. If the immune system is able to attack the transplanted
heart, it is called rejection.
Rejection is usually detected by a combination of clinical
presentation + biopsy (endomyocardial biopsy reports) REJECTION
Signs & Symptoms:
Fatigue
Dyspnea
Hypotension
Arrhythmias
Edema
Fever
Exercise intolerance

6. 1 2 CONTRAINDICATIONS / PRECAUTIONS – POST HEART
TRANSPLANT REHAB Hemodynamic instability

Postoperative complications Systemic contraindications 5
Rejection episodes
Sternal precautions
Infection control 4 3 6

7. Duration: typically recommended for 4–12 weeks. No lifting more than 5–10 lbs No reaching overhead with one or both arms No reaching behind the back TRADITIONAL STERNAL PRECAUTIONSNo pushing or pulling through the arms No driving

8. Duration: typically recommended for 6–8 weeks. MODIFIED STERNAL PRECAUTIONS
Seven Recommendations (Brocki et al.)
Bilateral arm movements: Only within pain-free limits during the first 10 days or
until the wound heals.
Loaded arm movements: Should only be performed at a pain-free level.
Keep arms close to the body.
Patients with BMI ≥ 35, frequent coughers, or large breasts: Should wear a full
supportive sternal vest or a supportive front-fastening bra.
Teach patients to hug a pillow over the incision when coughing or sneezing.
.

9. Heart:
Improves LV contractility & calcium handling.
Positive remodeling (hypertrophy,
cardiomyocyte growth).
Vascular:
↑ EPCs & CECs → angiogenesis & endothelial
repair.
↓ Oxidative stress, ↑ NO → better
vasodilation & aerobic capacity.
Skeletal Muscle:
Resistance → ↑ mass & strength.
Endurance → ↑ mitochondrial function, ↓
fatigue.
PHYSIOLOGICAL BENEFITS OF EXERCISE AFTER
HEART TRANSPLANT

10. PHYSICAL THERAPY EVALUATION IN CARDIAC
TRANSPLANT PATIENTS

11. PHYSICAL THERAPY EVALUATION IN CARDIAC
TRANSPLANT PATIENTS
General Examination for Cardiac Transplant Patients:
Body Build: Cachexia, Cushingoid
Level of Consciousness: Alert, Confused
Skin: Pallor, Cyanosis, Peripheral Edema
Neck: Jugular Vein Distension
Extremities: Clubbing, Edema, Muscle Weakness
Vital Signs:
Heart Rate (HR): 90-110 bpm
Blood Pressure (BP): Monitor response to activity
SpO₂: Monitor desaturation
Temperature: May indicate rejection or infection
Respiratory Rate: Rapid/shallow due to muscle weakness

12. PHYSICAL THERAPY EVALUATION IN CARDIAC
TRANSPLANT PATIENTS
History Taking:
Personal History, Past History, Family History.
Present History:
Reason for admission (primary heart transplant or readmission due to complications).
Symptoms of rejection: edema, shortness of breath, fever.
Drug-related symptoms: myopathy, muscle weakness, tremors.
Course & Duration: onset and progression of symptoms post-surgery.

13. PHYSICAL THERAPY EVALUATION IN CARDIAC
TRANSPLANT PATIENTS
B. Local Examination (Chest & Cardiopulmonary)
Inspection:
Chest shape and surgical wound (sternotomy site).
Breathing pattern (use of accessory muscles).
Chest expansion (may be limited due to pain or weakness).
Palpation:
Chest expansion (often reduced postoperatively).
Tactile fremitus (to assess secretions/obstruction).
Percussion:
Detects fluid accumulation or atelectasis.
Auscultation:
Breath sounds: crackles → pulmonary congestion; wheezing → obstruction.
Heart sounds: elevated, steady HR; absent immediate response to exertion.
Functional Assessment:
Bed mobility, transfers, ambulation tolerance.
Sit-to-stand

14. PHYSICAL THERAPY EVALUATION IN CARDIAC
TRANSPLANT PATIENTS
4. Investigations & Monitoring
• 6-Minute Walk Test (6MWT): to determine exercise tolerance.
• Balance & Gait Measures: Berg Balance Scale, Timed Up and Go (TUG), gait speed.
• Endomyocardial biopsy (rejection status).
• Continuous Monitoring: HR, BP, SpO₂, RPE during activity (note: HR response is delayed due
to denervation).

15. PHYSICAL THERAPY REHABILITATION IN CARDIAC
TRANSPLANT PATIENTS

16. Purpose of these exercises in the pre-transplant phase
(Pre-rehabilitation):
Improving cardiovascular fitness.
Increasing muscle strength.
Improving body flexibility.
Reducing risks associated with surgery, such as muscle
weakness or breathing difficulties.
PRE-REHABILITATION EXERCISES FOR
HEART TRANSPLANT PATIENTS:

17. 1. Aerobic Exercise:
Frequency: 3-5 days per week.
Intensity: Moderate to low (around 40-60% of the maximum heart rate).
Goal: To improve cardiovascular endurance and overall physical fitness.
2. Strength Training
Frequency: 2-3 days per week.
Intensity: Low to moderate.
Goal: To strengthen major muscles such as the legs and back, improving overall muscle strength.
3. Stretching Exercises:
Frequency: Daily or 3-5 days per week.
Intensity: Light.
Goal: To improve muscle and joint flexibility, and reduce muscle stiffness. PRE-REHABILITATION EXERCISES FOR
HEART TRANSPLANT PATIENTS:

18. 1. Initial Mobility:
• Bed mobility, Transfers and Ambulation
2. Passive and Active Range of Motion (ROM):
• Supine exercises to improve joint flexibility.
• Active-assisted range of motion (AAROM) for extremities.
3. Breathing Exercises:
• Focus on deep diaphragmatic breathing, Incentive Spirometer
PHASE 1: EARLY POST-TRANSPLANT PHASE
(IMMEDIATE POST-SURGERY)

19. 1. Walking Program:
• Increase walking distance gradually. Start with 10-15 minutes, increasing up to 30 minutes per session.
• Monitor heart rate and oxygen saturation closely.
2. Strengthening Exercises:
• Light resistance training with low weights
• Sit-to-stand exercises and partial squats to strengthen lower body.
3. Functional Mobility:
• Stair climbing with assistance, progressing to independent stair navigation.
• Balance training to improve stability.
PHASE 2: POST-HOSPITAL DISCHARGE PHASE (6-8
WEEKS POST-TRANSPLANT)

20. 1. Endurance and Aerobic Training:
• Increase the duration of walking to 30-45 minutes daily, aiming for moderate intensity.
• Cycling or light jogging can be introduced for variety and increased endurance.
2. Strength Training Progression:
• Increase weight resistance as tolerated for upper and lower body.
• Focus on compound exercises like leg presses, lunges, and upper body resistance
exercises.
3. Stair Climbing:
• Climbing stairs (2-3 floors) with progressively less assistance.
• Encourage independent stair use and balance.
PHASE 3: INTERMEDIATE POST-TRANSPLANT PHASE
(3-6 MONTHS POST-TRANSPLANT)

21. 1. Advanced Aerobic and Strength Training:
• Gradually increase intensity in aerobic exercises like jogging, swimming, or cycling.
• Resistance exercises with higher weights for both upper and lower body.
2. Functional Training:
• Complex functional movements such as carrying groceries, lifting objects, and squatting.
• Sports-specific exercises based on patient preference

PHASE 4: ADVANCED REHABILITATION (6 MONTHS AND
BEYOND)

22. 1. Regular Exercise Routine:
• Encourage participation in aerobic activities (e.g., walking, cycling, swimming) 3-5 times a
week.
• Strength training (2-3 days a week) to maintain muscle mass and prevent atrophy.
2. Health Maintenance:
• Monitor for long-term complications such as osteoporosis, muscle wasting, or joint issues
related to steroid use.
• Continue lifestyle modification including healthy diet, stress management, and mental
health support.
PHASE 5: LONG-TERM MAINTENANCE PHASE (1 YEAR
POST-TRANSPLANT)
PHASE 5: LONG-TERM MAINTENANCE PHASE (1 YEAR
POST-TRANSPLANT)

23. THANK YOU Do you have any questions?