Physical Activity program for heart Patient.

What is graduated physical activity program?

A graduated program of physical and self care activities can begin upon transfer from the coronary care unit. In the coronary care unit (CCU), assisted range of motion exercises can be initiated in the first 24 to 48 hours for most patients. Self care activities such as shaving, oral hygiene and sponge bathing can be undertaken in the intensive care unit. Upright posture should be encouraged as much as tolerated. Patents should walk with assistance at least twice daily. White some inpatient programs suggest walking specific distance each day; ambulation can be based upon the patient’s tolerances. Most patients will tolerance a minimum of 5 minutes of walking the first day. Walking time can be increased until patients are walking for 30 minutes twice daily. At that point, the walking sessions should include stair climbing to ensure that patients can perform that task at home. Patients able to walk unassisted for 30 minutes and climb stairs have sufficient strength and endurance for most activities of daily living.

rehabilitation after bypass surgery

Rehabilitation After Bypass Surgery 

It is usually believed that heart operation is very taxing. But patient usually recover completely after the bypass operation. The patient may find himself tiring easily for a while but he must not be frustrated. Physical strength will return slowly and steadily over the coming months. Although by-pass operation is usually done for the relief of chest pain or to improve overall well being, the patient may not be fully aware of these benefits until several months after the surgery. A sensible balance of rest and activity is the keynote to a good and speedy recovery. Patient must abide by few instructions after the by pass operation:

1.     It is recommended that the patient must avoid heavy exercise within one month of operation. If you an activity tiring, stop and rest.

2.     Graded exercise program like walking is beneficial. It is better to walk at a comfortable pace, daily increasing the length of time according to physical condition.

3.     It is better to avoid walking in very cold or hot weather and to climb uphill. Exercise in extreme of weather is discouraged.

4.     Formal exercise programmes e.g. wall climbing exercise, riding a stationary bicycle, sit-ups are usually recommended. Riding a stationary bicycle is favourable. Patient can increase the daily time of exercise slowly. Other exercises are equally beneficial.

5.     Heart rate increases when you climb stairs, so climb stairs slowly.

6.     Patient can drive car after 2 months of discharge from the hospital.

7.     Sexual activity can be started once the patient is discharged from the hospital. This is up to you and your sexual partner, when you wish to incorporate intercourse into your activities. If you hesitant or fearful about resuming sexual activity, it is helpful to discuss the feeling with your partner. The stress and fatigue of your operation may initially lessen your interest in sex but as with any activity your desire will return with your increased strength and feeling of well being. Initially it is advisable to place as little pressure on the sternal area as possible. Change of intercourse position may be beneficial. If you feel shortness of breath or chest pain during sexual activity it is better to stop there and to start again when symptoms disappear.

Non-Cardiac Chest pain- Incisional probles

Incisional problems

It is important to know that most of the patients experience non-cardiac chest pain related either to the incision on the breast bone or to ribs on either side of the midline  This type of pain is usually different from the heart pain experienced by the patient in the past. It is important to distinguish between the two. Incisional pain is usually aggravated by coughing, sneezing or sudden changes in body position. Nitroglycerine tablet or spray under tongue will not relieve the pain. This pain is usually relieved by analgesic tablets like paracetamol, indomethacin etc. The patient must be informed that the incisional pain will diminish in time but may recur when there is an adverse change in the weather or when the patient overdose physically. This pain related to cut mark will become less frequent and bothersome as time goes by.

The long cut marks on legs are usually made to harvest sections of veins for using them as by pass channels during operation. There may be local pain and some swelling in the areas of these incisions. Patient may feel some sense of numbness of the skin on either side of the incisions. Patient may have some swelling around the ankle joint for time being. This will disappear in time and should not cause concern. If the patient develops swelling with redness along with discharge of watery substance or pus from the leg or chest wounds, doctor to be consulted immediately?

Coffee and heart disease

Coffee consumption and heart disease

Epidemiological studies have not yet clarified whether coffee consumption is a risk factor for coronary artery disease. Framingham study assessed the survey data on coffee consumption in relation to age, blood pressure and total cholesterol with regard to impact on coronary heart disease. The analysis did not show any association between coffee consumption and the presence of atherosclerosis. Moreover, there was no demonstrable relationship between coffee intake and subsequent coronary events in patients with coronary heart disease. The effects of coffee intake on cholesterol were gender dependent: an inverse correlation with total cholesterol and with LDL in men and a positive correlation with each of these cholesterol values in women.