cardiac rehabilitation

Coronary Artery Disease

The cause of coronary artery disease (CAD) has not yet been fully established but several risk factors have been identified:

Cigarette Smoking
Please Note! There are no safe cigarettes
High blood pressure
The higher the blood pressure the greater the risk for CAD. It is therefore very dangerous to stop treatment once the blood pressure has been controlled by medication
High blood cholesterol
The most common blood fat is cholesterol. The body manufactures it own but a lot are taken in by food. You can also inherit high blood cholesterol for your parents
Overweight
Each kilogram of extra weight carried by a person means that the heart has to pump blood through extra 3 kilometres of blood vessel. An overweight person often has high blood pressure and blood fat disorders.
Lack of exercise
Exercise has many benefits on the heart.
Stress
Stress may aggravate angina in patients’ with CAD, which may lead to a heart attack
Diabetes
People with diabetes are inclined to develop CAD more easily and it is therefore essential that their diabetes be controlled as soon as possible

The goals of Cardiac Rehabilitation

Cardiac rehabilitation is divided into 3 phases:

Phase 1

During this phase the patient is in the hospital and receives physiotherapy in a group or on an individual basis. Most have already experienced phase 1 rehab and have been issued a walking programme to continue with while you were in hospital.

Phase 2

This is conducted on an outpatient basis after discharge from hospital and the goals are:

Increase exercise capacity and endurance in a safe and progressive manner.
To help patients continue with their exercise programme and progress to an independent exercise programme.
Continue with patient education on risk factors and life-style changes.
Relieve on anxiety and depression. It has been proven that patients after a bypass or heart attack go through a period of denial, anger and depression and thus cardiac rehab is a process that directs and supports physical, emotional and physiological recovery.
Patient education on signs and symptoms and contra-indications to exercise.

Phase 3

This is an ongoing exercise programme that the patient is able to continue independently at home.

Phase 2 helps and prepare the patient for this stage.

Exercise

Exercise as part of a comprehensive rehabilitation programme has many benefits. This is the good news; the bad news is that these benefits are only as long as you continue to exercise.

When starting an exercise programme you need to start slowly and simply, your body requires time to adapt after your bypass.

Exercise has the following benefits:

It increases the breathing rate and therefore improves oxygenation in the body.
It strengthens the hearts’ ability to pump, maintains and improves coronary artery flow and encourages the development of new vascular pathways.
Weight loss is improved
High-density lipoproteins are increased (lipoproteins carry cholesterol from blood to the tissue and are good for the body)
Insulin, which converts glucose (sugar) into glycogen, is improved. Exercise is one way in controlling sugar imbalances in diabetic patients.
It releases “happy hormones” which reduce stress levels and therefore improves self-esteem
It decreases the desire to smoke
Stickiness of platelets is reduced thus; the incidence of blood clot formation in the arteries is also reduced
It promotes collagen formation so the ligaments and bones become stronger
It reduces sudden cardiac death by 25% (according to research)

Contra-indications to Exercise

Certain contra-indications to exercise should be noted, as this may be dangerous to patients. The following are a list to serve as a guideline:

1. Chest pain
2. Heart failure
3. Irregular heart beats (cardiac arrhythmia)
4. Unstable blood pressure
5. Unstable pulse speed
6. Heart rate > 120 beats/ min (tachycardia)
7. Heart rate < 50 beats/ min (bradycardia)
8. Fatigue
9. recent angiogram or angioplasty
10. Flu symptoms

Concerning your pulse speed:

It may not increase by more than 20 beats/ min from rest pulse during any stage of exercising. It will increase initially because you might be scared and overcautious. If this happens, deep breathing exercises will help a lot.

When to stop exercising immediately

Sudden drop in pulse speed
Irregular heart beats
Shortness of breath
Chest pains
If you are cold and clammy
Fatigue
Irritable or angry
Sudden continuous rise in pulse speed

Please note! The above serves as a guideline and you should stop exercising if you feel unsure about your health or condition and seek professional advice.

General guidelines regarding your medication

You and your spouse/ next of kin should have knowledge of your medication (dosage and how many times/ day you need to take medication)
Should you consult another doctor/ dentist/ specialist/ pharmacist inform him/ her of your present condition and medication
Do not change your medication without doctor’s consultation
You will probably need to take medication for the rest of your life, do not stop taking your medication when feeling better
All medication must be taken with water and after meals (unless stated otherwise)
All medication must be taken regularly and on time (do not take extra pills if you forget to take medication)
Medication have side effects, read insert before taking any medication
If you do experience side effects, consult your doctor/ pharmacist
Make sure you have enough medication, do not run out
If You are on dispirin, aspirin or anti-coagulation therapy
- Panado, Dolorol or Paracetamol should be taken for a headache
- No additional medication should be taken without approval (doctor, pharmacist, etc)
- Be very careful when taking medication for arthritis, gout and influenza (it may strengthen the action of “Aspirin”)
- Patients on anti-coagulation therapy must keep the intake of alcohol to a minimum
- Be aware of signs and symptoms of nosebleed, blood in urine and stools