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.