Rehabilitation after Heart Surgery
After heart attack: Death rate has
been reduced substantially during the last decade. Mortality has been reduced from 25% to only 7-10%. Though heart attack is very frustrating but patient can
lead almost a normal life after the episode if he takes medicines regularly and
modify the risk factors. One should know that many patients are living more
than 20 years after the heart attack. Formal rehabilitation programs have been
shown to effectively improve functional capacity, promote compliance, decrease
emotional distress, and reduce cardiovascular death and improve quality of
life. Now a days early ambulation is recommended after myocardial infarction
(heart attack).
1. When there is no
complication the patient can sit in a chair on the second day.
2. Walk to the toilet on
the third day.
3. Return home in 5-7
days.
4. Gradually increase
activity with the aim of returning to work in 6-8 weeks.
5. May resume driving
after 4-6 weeks
6. When the patient will
be able to resume his sexual activity after heart attack is an important issue.
The most common sexual problems of heart attack patients are reduction or
absence of sexual urge and sometimes avoiding tendency in spite of having
urge. In some patients even impotency may be seen. The causes of sexual
dysfunction include fear of precipitating another heart event, depression and
side effects of the medicines used by the patient. In addition, the sexual
partner may believe that intercourse or other sexual acts could precipitate a
cardiac event and may avoid sexual activity. During sexual activity heart rate
may rise more than 120 per minute and during this time heart muscle will
require more blood supply. But due to presence of critical obstruction in
coronary circulation patient may experience heart pain during intercourse. So,
this issue requires thorough evaluation.
After myocardial infarction the
patient may resume his sexual life after heart attack. Exercise test can be
used to gauge the potential cardiac stress of sexual activity. If the patient
does not have any significant abnormality during stress test, it is unlikely to
have chest pain during intercourse. But patients with significant ECG
abnormality during stress test must start sexual activity gradually.
Masturbation and mutual caressing can be initiated first followed by
progression to sexual intercourse. Cardiac stress of intercourse is not very
high if the patient performs sexual acts with his or her spouse. But cardiac
stress to sexual activity is far greater with unfamiliar than a familiar
partner, in illegitimate relationships and in unfamiliar settings. Cardiac work
load associated with sexual intercourse can be minimized by avoiding
traditional top and bottom postures and adopting side to side positions. Intercourse
in top and bottom posture increases the heart work load. If the patient
experiences chest pain during sexual acts the patient must inform it to his or
her doctor. Increasing the dose of nitrates or sublingual nitroglycerine tablet
or spray use during the act may give relieve of symptoms. Sometimes patients
are shy or reluctant to discuss sexual dysfunction with the doctor. So the
physician should address issues of sexuality and consider the effects of
medications on sexual drive. Sometimes a simple change in medication solves the
problem. Widely used drugs like beta blockers or diuretics may cause temporary
sexual dysfunction. Mere stoppage of the drug or reducing the dose of the drug
may be beneficial.
After heart attack the dead muscle
takes 4-6 weeks to become replaced with fibrous tissue. Accordingly, it is
conventional to restrict physical activities during this period. Emotional
problems such as denial, anxiety and depression are common and must be
recognized and dealt with accordingly. Many patients are severely and even
permanently incapacitated as a result of the psychological rather than the
physical effects of heart attack and all benefit from thoughtful explanation,
counseling and reassurance at every stage of the illness. The patient’s spouse
will also require emotional support, information and counseling. Formal
rehabilitation programmes based on graded exercise and counseling have been
shown to improve the long-term outcome.
