Cardiac Rehabilitation

Cardiac Rehabilitation

Your cardiac rehabilitation is dependent upon your health situation. The rehabilitation programme should be tailor made specifically for an individual patient. This would help both your heart and general health.

In the Hospital

Rehabilitation starts, while you are still in the hospital.

ü  Motivate yourself by focusing on goals which are important to you e.g. returning to your work, spending time with your family, enjoying sports.  

ü  Though you are the person who has suffered from a heart attack, your family and close friends are also affected. Simply having people around you and you speaking to them can help you in recovery. Communicate you feelings. Do not bottle them up inside. By discussing, various emotions like anger, depression and the feeling of incompetence can be put to rest.

ü  Accept your condition that you are still at risk. You and your family can all modify risk factors to lead a healthier life.

ü  Certain non-strenuous activities like sitting up in bed and taking care of you like shaving should be started. Walking and slow climbing of stairs should also be down in the hospital.

On leaving the Hospital

Recovery- Early Phase

This phase starts when you leave the hospital and its duration is generally between 2-12 weeks. It does not matter if you had not exercised earlier. Exercise like walking and gentle calisthenics will improve the cardiac fitness. You should also start modifying your habits and have a healthy diet. While coping with you present condition sexual activity can be resumed.

Recovery- Later Phase

This is the maintenance programme of cardiac rehabilitation. It will go on life long. Your own exercise routine should start building up your confidence. Record your progress every day. This will give you a sense of achievement, which will boost your confidence to lead a normal life and slowly progress on it. You can also join a gym or fitness centre. It will be better if you join a recreational activity that will give you pleasure. Change your lifestyle for the better. Make healthier choice in food habits and modify your risks. Also take your medication regularly. See your doctor as advised.

Five Steps towards your Rehabilitation

It is a medically supervised programme to help heart patients recover faster. This helps in the improvement of physical and mental functioning, and regaining your strength. To maintain a healthier heart you would be enrolled in a cardiac rehabilitation programme. This programme is designed such as to reduce your risk for further development of atherosclerosis and coronary artery disease.

1.       Counseling

The patient in this session or sessions is made to understand and manage the disease process.

2.       Modification of Risk factors

The patient is helped to modify his risk factors like blood pressure, high blood cholesterol, diabetes and obesity.

Lower your Lipid profile: Elevated lipid cholesterol and triglycerides are important risk factors for developing cardiac disease. The currently accepted safe limit for LDL-C is 100mg/dl. It is known that levels below it can offer significant protection against heart disease. In people having two or more risk factors the accepted safe limit of cholesterol is under 70 mg/dl. You will be advised lipid lowering medication if you cannot keep them under control with lifestyle changes.

Control Blood Pressure: Hypertension or increased blood pressure makes the heart work harder to get the blood circulating through your body. Shortness of breath on exertion needs to be reviewed by your doctor. Keep your blood pressure under control with a proper diet, exercise and medication.

Stop Smoking: Your chances of having a heart attack triple with smoking. Quit smoking now.

Lose weight: Fat around the middle especially increases your chances of a heart attack or stroke. Obesity also leads to diabetes. A high fiber diet with whole grains, vegetables and moderate exercise is the answer for losing excessive weight.

Keep your Blood Sugar under Control: High blood sugar is a major risk factor in the development of cardiac disease. Burn off your sugar with exercise. Have a proper, nutritious and balanced diet. Avoid alcohol, juices, fruits, high in sugar content and sweets. Stick to products containing slow releasing sugars like complex carbohydrates.

Limit Salt Intake: The sodium in the salt helps your body to retain water. It increases the blood volume, in turn, raising your blood pressure.

3.       Lifestyle Education

ü  Guidance for the patient for a nutritious and balanced diet but with adequate calorific value required.

ü  Helping the patient avoid a sedentary lifestyle.

ü  To help in exercise and avoiding unnecessary stress.

4.       Vocational Guidance

Providing the patient vocational guidance, thus enabling him or her to return to work. It is especially important in patients who are below 60 years of age.

5.       Psychological Support

Physical limitations have to be explained to every individual patient. Emotional support or guidance with a positive outlook must be provided. 

Treatment for a Heart Attack: Coronary Artery bypass

Coronary Artery Bypass

Bypass surgery may be necessary increase blood flow to the heart. During this surgery, a vein is removed from the person’s leg and is used as a detour around the blocked portion of the affected coronary branch or branches. The surgeon therefore constructs an alternate route for the blood.

Another bypass method is in which the internal mammary artery is linked to the coronary artery. Three or four coronary branches can be bypassed during the same surgery. As the grafts are from the patient’s own body there is none of the rejection problems associated with heart transplant. Most patients undergoing a coronary artery bypass surgery, experience relief from their symptoms.

Bypass surgery usually requires a week’s stay in the hospital and another three mothers for complete recovery. Remember, surgery is not a cure for atherosclerosis. It is just a mechanical correction. To prevent atherosclerosis in your new artery reduce your risk factors. This can help you slow down the progression of coronary artery disease.

Robotically- assisted Endoscopic Heart Surgery

A three armed robot is placed approximately 8 feet from the patient. Three small incisions are made between the ribs. Two for insertion of inter changeable instruments and another for a thin cylindrical video camera. The surgeon manipulates the surgical instruments with the help of a computer. An endoscope is passed through a tiny incision in the chest wall, and two surgical instruments are passed through additional small incisions. The surgeon views the image provided by the endoscope on a computer screen. The surgeon manipulates them via a computer console. The computer interprets the surgeon’s hand movements and causes the surgical instruments to respond accordingly.

This technique has been limited to single bypass grafts in the left anterior descending coronary artery. The LAD is located on the front of the heart, and therefore is relatively accessible. It is predicted that with advances in technology, multiple grafts with robotic assistance will be possible.

Robotic procedures have been successfully performed, for instance, in mitral valve repair, in repairing atrial septal defects and in repairing patent ductus arterious. With technological advancements, robotic procedures will be applied to most other forms of heart surgery.

Balloon Angioplasty or Percutaneous Transluminal Coronary Angioplasty (PTCA)

Balloon Angioplasty or Percutaneous  Transluminal Coronary Angioplasty (PTCA)

After Assessing your reports and having studied your angiogram your doctor will evaluate the number, type and site of blockages. He might opt for an angioplasty. Angioplasty is conducted under local anesthesia. A balloon tipped catheter is inserted into the femoral artery. This catheter is slowly fed into the coronary artery under constant X-ray guidance. The balloon at the tip of the catheter is insufflated at the site of the blockage. As the balloon expands under high pressure, the opening of the blocked artery widens in most cases, relieving the obstruction. The purpose of this balloon is to compress the plaque, plastering it as a thin layer along the wall of the vessel. This clears the lumen permitting an increased flow of blood. This is also called “Balloon Angioplasty”. The balloon is then deflated and the catheter removed. The procedure normally takes less than an hour. It takes only one day of hospital recovery.

Regular Follow up

Once you get enrolled into the treatment programme, a regular evaluation is necessary to monitor your progress. The effectiveness of your medication needs to be monitored and if recovery is not to your doctor’s satisfaction, your treatment programme may need to be assessed and rescheduled. If you notice any change in the pattern or intensity of your angina episodes, inform your doctor. Reducing your risk factors, wherever possible, could lead to a comfortable and productive life.

Stents

In the past few years, stents have been introduced during an angioplasty to widen narrowed arteries. A stent is a wire mesh tube used to prop open an artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It is then moved into the area of the blockage. With the balloon inflation, the stent expands. The stent is left in the blood vessel to prevent it from narrowing. Over a period of time, it gets covered with tissue from the inner lining of the coronary artery. Ant platelet medication is given to stop the formation of a bloot clot in the newly opened artery. The stent stays in the artery permanently, helping it to remain open. It also improves blood flow to the heart muscles and relives symptoms like chest pain.

Treatment for a Heart Attack: Medication

Treatment for a Heart Attack: Medication

Once your heart attack is diagnosed, your treatment begins immediately. Some drugs are to be administered to a patient immediately after a heart attack. They are effective if given within 4-6 hrs of a heart attack. They are known to disintegrate the blood clot, blocking the artery and blood flow to the heart if administered on time, these drugs can keep the heart muscle damage to a minimum and can save a person’s life.

Medication is to be given and continued as soon as possible after a heart attack. The medication included can be:

 Aspirin, Heparin, Thrombotic Therapy, and other Ant platelet Drugs.

Combination of the above

Coronary artery disease is usually first managed with medication. If this option does not work, other alternatives like coronary angioplasty or coronary bypass procedures are conducted on you.

Remember these procedures help treat your disease. To remain healthy and not get into repeated coronary problems, you will need to reduce your risks. Along with this a proper diet and exercise regimen is essential.

Shortly after a heart attack the status of your hart, arteries and the amount of the heart damaged has to be assessed. In some cases, procedures like angioplasty or stents are used to open up blocked arteries. These procedures are often combined with thrombolytic therapy to open up narrowed arteries. At the same time clots blocking those arteries are broken.

Heart Disease and Psychosomatic Disorders

Heart Disease and Psychosomatic Disorders

Your Personality

There is an association between a Type A personality and heart disease. The person with a Type a personality juggles with events believes in doing two or more things at the same time, is ambitious, anxious and impatient. He or she wants things in life to move fast. Type A personalities besides being anxious can be angry, tense, pressurized and competitive. They are twice as likely to develop heart disease as compared to Type B personality.

Along with these personalities comes the modern era of competitive working, fast foods and sedentary lifestyles. Also added to it, is the party time. Many of us label it as “contact time”. Therefore the body and mind are not relaxed, but working overtime. At all working hours the whole body system is active and may be subconsciously too, while sleeping. Do you realize the pressure one is putting on oneself? How long will it last? Will you not crack down?

Depression

Depression is another area precipitation heart disease. Research shows that depression can trigger heart problems. Safeguarding mental health is also important for heart attack survivors. It was seen that depressed heart attack patients were more than twice as likely to die or have heart problems in the two years following a heart attack.

Perhaps, the most important way to deal with psychosomatic problems is to prevent heart disease.

Psychologists insist that it is our attitude and emotions which need to be tackled. Here are a few tips to help you achieve this:

ü  Write down what upsets you.

ü  Note your attitude towards things that disturb you.

ü  Take away negative thoughts from your mind, think of something pleasant or positive.

ü  Control your anger.

ü  Articulate what you feel.

ü  Don’t bottle up too much inside. Discuss your problems with people close to you (friends or relatives). Try solving them positively.

ü  Hear soothing music.

ü  Some people, when depressed or upset have a tendency to overeat. They become obese. Try and cut down on too many sweets and carbohydrates. If you feel like eating, combine some of them with salads, fruits, etc.

ü  Try to relax and meditate.

ü  Take nice long walks and exercise regularly.

ü  Stress management skills also help recognize and reduce emotional over reactions.

Help on the onset of a Heart Attack

Coronary Artery Disease and your Family History

In a member of your immediate family has developed heart disease, you are prone to the risk twice as much as the rest of the population.

                Genetic and environment differences determine the differences in our appearance and health. Your risk is higher if your relative had developed coronary disease at an early age. “Early age” is before age e.g. 55 in men and 65 in women. This follows a general rule in genetics: The earlier a disease occurs, the greater is the influence of genes in your life. While your genetics will determine your baseline likelihood for the disease, many factors in life will modify this risk. As in most common diseases, coronary artery disease results from an interaction between genes and environment.

Symptoms of a Heart Attack

A powerful crushing pain hits the chest. This pain seems to flow from the chest to the left arm, back, shoulder and heart. The patient experiences a cold, clammy sweat. Occasionally, vomiting due to severe pain can occur. Some people become unconscious. Urgent medical assistance is required. Call for your nearest doctor or rush the patient to a nursing home or a hospital nearest to you.

Silent Heart Attack

It is often mistaken for a usual bout of indigestion. About 25% of the heart attacks occurring are “Silent”. These silent heart attacks damage the heart muscles. Sometimes no noticeable symptoms occur.

Help on the onset of a Heart Attack

Ø   Immediately after the onset of a heart attack, the person needs to be made comfortable.

Ø  Place the person in a supine (Straight lying) position.

Ø  Loosen out any tight clothing (collar, belt, shirt cuffs, shoes).

Ø  If breathing seems to have stopped, start cardiopulmonary resuscitation (mouth to mouth breathing).

Ø  Next, call medical help, as advised earlier.

Women and Heart Attack

Heart Attack

In the lining of the coronary artery, a blood clot forms on the top of a plaque. This causes blockage of that artery. The blood full of oxygen required for that artery. The blood full of oxygen required for the heart muscles is blocked off. This leads to starvation of that portion of the heart muscles. As a result, this part of the heart muscle in the left ventricle gets severely damaged or dies. This is known as infarction. As this occurs in the myocardium or muscle, it is medically termed as Myocardial Infarction (MI) or heart attack.

Women and Heart Attack

Heart attack in women is on the rise. One reason for this can be that more women are entering the previously male dominated world of business, industry and also the irregular working schedules. Also, stress, tension, unhealthy eating habits smoking, alcohol and lack of exercise have come into play. Scientifically, it has been proven that after menopause women become more susceptible to heart disease. Lack of estrogen is responsible for this.

Angina and a Heart Attack

Angina and a Heart Attack

Angina- Not a Heart Attack, Confirmation of Diagnosis

It is necessary to place an oxygen demand on the heart to stimulate the conditions which normally precede a heart attack. Using certain special studies, evidence of ischemia is noted. Conduction of further tests can also locate precisely the site of an arterial blockage.

Stress Electrocardiogram or Treadmill Test

The stress electrocardiogram stimulates those conditions which are prevalent preceding an angina attack. Early signs of ischaemia are detectable. The test is performed on a treadmill or bicycle.

Stress Echography

Ultrasound waves are directed at the chest. These waves bounce off the heart’s wall and valves.

An analysis of these rebounding waves helps us with the calculations of the size, shape and movement of the structures within the heart.

Two echoes are usually taken- one of the heart at rest and the other of the heart under stress e.g. after the patient exercises on a treadmill. A comparison between the two images helps detect areas of the heart not receiving enough blood.

The limitations of this test

The limitations of the ultrasound are that the resolution of the ultrasound is not high enough to see the arteries. We can only detect and highlight the big change in structures, e.g. that of the heart chamber and heart muscles.

Some people may be genetically more prone to heart disease than others. Still, there are plenty of ways to reduce your risk factors.

The comprehensive treatment of angina- for the prevention of heart attack includes eliminating or reducing the risk factors.

Stop Smoking: Smoking is known to contribute to coronary artery disease. Throw away your pack of cigarettes. It’s never too late to stop.

Lose Weight: Less weight in the body means less strain on your heart. Avoid fat and fatty products e.g. red meat, fried food, dairy products, sugar and sweet foods e.g. cakes pastries etc. Lower your cholesterol levels and other lipids in the body. This may help slow down the formation of fatty deposits and hardening of the arteries.

Exercise: Take guidance from your doctor for a fitness programme. A regular exercise programme will help you lose weight and improve your body fitness. You will feel good once you have adjusted to the exercise regime.

Reduce Your Stress: Take small breathers at work e.g. getting up for a glass of water or just stretching your legs after finishing a part of your job. Try stress busting exercises.

Meditation and Yoga: Meditation and yoga are other tools to relax your body. If you had a change in your angina pattern recently or your discomfort or pain is not relieved by medication and rest, consult your doctor.

Medical Treatment for Angina

Anti-anginal medication is prescribed to reduce your heart’s workload. The medication can be:-

Nitrates

Nitrate containing medications have been used for years and give prompt relief to the angina patient. Nitrates are small tablets which can be kept under the tongue, chewed or swallowed. They may also come in spray form.

Action: Nitrates ease the strain on the heart by reducing the blood pressure. Long acting nitrates include patches placed on the skin. These patches are available to help prevent angina attacks before they occur.

Beta Blockers

Site and Radiation of Cardiac Pain

Action: They act by directly reducing the heart’s demand for oxygen. They achieve this by slowing down the rate of heart and reducing the force of contraction of the heart muscles. The oxygen supply, which would be limited by blockages, remains adequate for the slower muscle contraction and a comparative resting heart. These are used for long-term angina patients.

Calcium Channel Blockers

They are used for the long-term angina treatment.

Action: They reduce the oxygen demand by slowing down the heart’s activity. This helps the narrowed coronary vessels to relax and widen. Thus the oxygen supply to the heart increases and at the same time the heart’s demand for oxygen decreases.

Health tips for Everyone

Health tips

1.       Fish, Beef liver and Poultry are all good sources of B6 that helps to form hemoglobin (part of your red blood cells), thus prevent anemia.

2.       Many people feel that donating blood makes them week.  It is not true. It takes 1-2 days to replenish the fluid volume and 3 months for regeneration of red cells.

3.       The highest concentration of vitamin-A is found in sweet potatoes. Beef liver, spinach, fish, milk eggs and carrots are also good sources.

4.       Vitamin K in green and leafy vegetables is a crucial ingredient for blood clotting. Without in, your body would not be able to stop bleeding.

5.       Vitamin-B1, in nuts and fish, helps body to turn carbohydrates into energy. It is also an important nutrient for brain and nervous system to run properly.

6.       Zinc is important for immune function and is also important for your senses of taste and smell. Include zinc rich food like meat, shellfish and nuts in your diet.

7.       Numerous foods provide Vitamin-E. Nuts, seeds and vegetable oils are the best sources and significant amounts are available in green leafy vegetables and cereals.

8.       Yogurt is a great source of protein. The protein keeps you feeling full a little longer. It does have some liquid so it provides some hydration also.

a.       Eat heart-healthy diet. Include potassium and fiber and drink plenty of water. Stay at a healthy body weight. Thus you can control your blood pressure.

b.      Children between the ages of one and three need to have around 350mg of calcium a day. About 300ml of milk would provide this.

c.       Unsaturated fats can lower cholesterol and provides us essential fatty acids needed to stay healthy. Oily fish, nuts, olive oils are unsaturated fat.

d.      Fats and sugar are the sources of energy for the body, but when we eat too much of them we consume more energy than we burn and this means that we put on weight.

e.      Eggs are a good choice as part of a healthy, balanced diet. As well as being a source of protein, they also contain vitamins and minerals.

f.        Eating a healthy diet is a key step to feeling your best every day and supporting your immune system to avoid poor health in the future.

g.       People with low back pain should avoid sit-ups and crunches. Improper posture during these exercises can actually do a lot of harm.

h.      Smoking delays healing of peptic ulcers increases the risk of osteoporosis, cataracts, gallstones and male impotence. Quit Smoking today.

Diabetes Prevention and Control is in your hands.

1.       Regular exercise helps your body respond to insulin and known to be effective in managing blood glucose. Exercise lowers blood glucose and reduce medication amount.

2.       Women with diabetes during pregnancy are at increased risk of developing type-2 diabetes later in life. Regular screening is recommended.

3.       Eating, exercising and taking diabetes medicines at a fixed time everyday gives better control of blood sugar.

4.       Adding garlic to your daily food will help to lower blood sugar and decrease cholesterol levels.

Hardening of the Arteries

Hardening of the Arteries (Atherosclerosis)

Angina

Angina is a symptom of coronary artery disease. Progressive narrowing of the arteries, due to plaque formation supplies inadequate oxygen rich blood to the heart muscle, during exercise or stress. This condition is called “ischaemia”. When ischaemia of the heart muscle occurs, “angina” is the pain signal from the heart asking for rest.

Angina Pectoris

It means chest pain. This pain is often not confined to the chest. It is often a referred or radiating pain in the upper body, left arm, jaw or upper back. The pain can also show symptoms like heaviness in chest or indigestion.

An angianl attack normally lasts for less than five minutes. The effects of ischemia on the heart muscle are reversible and do not result in the death of cells. An angianl attack can be relieved by rest and medication.

Diagnosing Angina

Certain tests have to be conducted, besides the medical evaluation.

Medical Evaluation

Diagnosis of angina can be made on the basis of your medical history. The relation of your symptoms to your physical activity or emotional stress, identify the risk factors for atherosclerosis. Also certain laboratory tests, a resting electrocardiogram and chest X-ray are needed to help make the diagnosis of your disease.

Medical History

Your pattern of discomfort or pain along with a review of your medial history will help your doctor make a provisional diagnosis of angina.

      The priority will be given to the nature of your discomfort or pain. Its location what brings it on and what relives it.

      Your risk factors will be identified by your doctor.

      Your family history will be assessed – what kind of illnesses do you have in the family, etc.

Women and Heart Disease

Many woman experience short bouts of recurrent chest pain (angina), but routine tests like ECG pick up no abnormality.

Recent research based on a 10 year multicentre study in the United States has stated that women should be examined under “Women’s Ischemic Syndrome Evaluation” or Wise. Women’s pathophysiology is different from that of men.

Women have blood vessels of smaller diameter as compared to men. Blockage in minor vessels deprives the heart of oxygen, causing a condition called ischaemia. Over a time major blockages in the minor vessels and capillaries are not even picked up on an angiogram.

In the case of premenopausal women, due to the presence of estrogen hormone, stress ECG too can give a false test. For women suffering from chest pain and having a clear angiogram, the recommendation is of a stress echo or stress thallium.

Plaque Formation : heart

Plaque Formation

Plaque is a fatty substance in the blood which often builds up in and around the smooth arterial muscles. Clot forming platelets can accumulate on this. Due to the formation of the plaque, blockage of the vessels starts, restricting the blood flow.

The atherosclerosis plaque can block a part or whole of the “affected” artery and “atherosclerosis” is the result. The partial blockage of oxygen rich blood to the heart often results in chest pain. When the blockage is total, it can result in a heart attack.

Facts about the heart

Some Facts about the heart

v  The heart beats approximately 100,000 times each day.

v  About 7000 liters of blood flows through the heart.

v  Like other parts of the body, the heart receives its food through a system of arteries, known as coronaries.

v  The chances of a smoker suffering from a heart attack are three times more as compared to a non-smoker. On quitting, the risk is out to half in about a year’s time. After 10 years your odds nearly return to normal.

Coronary Arteries

Normal coronary arteries are similar to clear pipes and possess smooth linings. Therefore, the flow of blood through these arteries is smooth and free. Risk factors like high cholesterol, smoking, diabetes and high blood pressure can damage the lining of the arteries.

Heart attack

Heart attack occurs when there is a total blockage of a coronary artery. Heart attack, unlike angina lasts longer. It is a pain of more intensity and is not relieved by rest or medication. Heart attack causes damage to the heart muscle, which is permanent.

Medication often relieves the symptoms of angina. Different types of drugs are available, but they all have one purpose- to reduce the contraction and rate of the heart. All medications have possible side effects, which if needed can be discussed with your doctor.

Your Heart and its Arteries

The Heart

The heart lies in the center and more towards the left of the chest in an area called the mediastinum. As the heart is tilted slightly to the left you feel the beat of your heart on the left side at the apex. Here the beat is supposed to be the strongest.

The heart is about the size of a fist and weighs less than a pound. It is pinkish grey in color and is mainly made up of muscle called myocardium. It is hollow and divided into a left and a right side. Each side has two chambers, the one above is known as the atrium and the one below, ventricle.

                The heart pumps life-sustaining blood through the body. The right side of the heart supplies blood to the lungs, while the left, the stronger side, supplies blood to the rest of the body. Oxygen and glucose are supplied to the body. Carbon dioxide and waste gases collected in the blood are passed into the right atrium and via the right ventricle and pulmonary artery, are pumped out through the lungs. Blood from the lungs takes in oxygen which is breathed in by respiration. This blood goes to the left atrium and then to the left ventricle where it is pumped out from aorta to the rest of the body. 

How much do you know about Heart?

Your Heart: How Much Do you Know about it?

Answer the following questions to find out how much you know about your heart and its functioning.

1.       Where does the heart normally lie?

a.       On the right side of the chest

b.      More to the left

c.       In the centre of the chest

2.       Where do we experience the heart beat to be the strongest?

a.       In the centre of the heart

b.      A little on the left side

c.       A little on the right side of the chest

3.       The heart is supplied blood through arteries known as

a.       Capillaries

b.      Coronaries

c.        Carotids

4.       The chest is often examined by the doctors through an instrument called

a.       Sphygmomanometer

b.      Stethoscope

c.       Angioscope

5.       The procedure to study the blood vessels of the hart is –

a.       Arteriography

b.      Angiography

c.       Venography

The more times you answer (b), the more you are correct and seem to know about your heart.

Pain

Cardiac	Non-cardiac
Tightness	Sharp
Pressure	Knife-like
Weight	Stabbing
Constriction	Like a stitch
Ache	Like a needle
Dull	Pricking feeling
Squeezing feeling	Shooting
Soreness	Reproduced by pressure or position
Crushing	Can walk around with it
Like a band Breathless	Continuous