CARDIAC REHABILITATION Follow-up Options & Dismissal Instructions Myocardial Infarction & Angioplasty

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1 CARDIAC REHABILITATION Follow-up Options & Dismissal Instructions Myocardial Infarction & Angioplasty For patients with: Myocardial infarction with catheterization Myocardial infarction with medical management Angioplasty with or without stent placement As you re discharged from the hospital, you may have questions about your continuing recovery. Here are some answers to those questions and a description of your options. If you have more questions, please call us. We re looking forward to seeing you outside of your hospital room and working with you to continue your recovery. CALL YOUR HEALTH CARE CONTACT You ll receive your contact name and phone number before you leave the hospital. If you don t or have misplaced the information, call us at Your contact person: If you have an emergency, call 911 or your physician. Our hours are Monday through Friday, 7 a.m. to 3 p.m. If your contact is unable to take your call, please leave a message, and your contact will call you back as soon as possible. CARDIAC SUPPORT GROUP You know that trying to live a normal life with heart disease is tough. Sometimes you just need to talk to people who understand. People who will listen because they experience the same frustrations. Our active Cardiac Support Group includes a diverse mix of people who meet monthly to listen to a speaker, share information and just talk. We meet at 7 p.m. the third Tuesday of each month at The University of Kansas Hospital White Heart Learning and Resource Center Center for Advanced Heart Care 2 nd floor Conference Room. There s no fee for this service. For more information, call Cardiac Rehab Follow-up and Dismissal Myocardial Infarction & Angioplasty 1

2 DISMISSAL INSTRUCTION FOR HEART ATTACK PATIENTS Healing begins quickly after a heart attack. Scar tissue replaces the damaged heart cells in about six to eight weeks. When healing is complete, you will be able to resume most of your regular activities. Discuss your activities with your cardiologist at your appointment. Exercise / Activity Follow the written program provided by your cardiac rehab nurse. Limit strenuous activity and avoid heavy lifting (anything over 10 to 15 pounds) until your appointment with your cardiologist (four to six weeks). No driving for two weeks, unless otherwise instructed by your physician. You may use stairs. Go slowly, take one step at a time, and avoid repeated use for four to six weeks. You may resume sexual activity in approximately four to six weeks; consult with your doctor at your next appointment. Don t do any isometric activities. These are activities that require a sudden burst of energy or pressure against resistance. Examples: opening tight-fitting jar lids, pushing to open heavy doors, moving heavy furniture, shoveling, digging, vacuuming, etc. These activities will raise your blood pressure, making your heart work harder. You should avoid activities that are extremely tiring or cause discomfort during this recovery period at least four to six weeks. Anticoagulation and Preventative Antibiotic Therapy Healing of the stent site takes place within about four weeks. You will be taking anticoagulant medications (aspirin) and anti-platelet medications (Plavix) to help prevent blood clots from forming on your stent as the vessel heals. If you need dental work or any other medical procedures done during this time, contact your physician first; you may need antibiotic therapy. It s extremely important to follow your medication regimen exactly! Do not stop aspirin or Plavix unless directed by a cardiologist! When to Call the Physician Call the cardiologist if you experience any of these symptoms: - Severe weakness - Fainting or near fainting - Dizziness - Shortness of breath (especially at rest) - Angina (chest pain, neck or jaw pain, arm or back pain) - Palpitations (heart beating fast or heart skipping beats) - Weight gain of two to three pounds for two to three days in a row. Please weigh daily. - If you re experiencing symptoms, call your cardiologist at Physician Follow-up Visit If you have not made a follow-up appointment with your cardiologist while you re in the hospital, call to make an appointment. Cardiac Rehab Follow-up and Dismissal Myocardial Infarction & Angioplasty 2

3 DISMISSAL INSTRUCTION FOR ANGIOPLASTY/STENT PATIENTS Exercise / Activity No heavy lifting (anything over 10 to15 lbs.) and limit strenuous activity for one week. Avoid activities that put strain on your cath site for one week. You may drive now, unless your doctor has instructed otherwise. You may use stairs. Go slowly, take one step at a time and avoid repeated use for a few days. You may resume sexual activity in approximately one week. Catheterization (Cath) Site Check your cath site daily. If you have unusual pain, swelling or bleeding in the cath site, apply pressure to the cath site and call your cardiologist immediately at Do not take a tub bath or submerse yourself in water for one week. You may shower and wash the site gently with soap and water. Rinse well. Report any signs of infection (increased redness, fever, tenderness, swelling or puslike drainage) to your physician. Anticoagulation and Preventative Antibiotic Therapy Healing of the stent site takes place within about four weeks. You will be taking anticoagulant medications (aspirin) and anti-platelet medications (Plavix) to help prevent blood clots from forming on your stent as the vessel heals. If you need dental work or any other medical procedures done during this time, contact your physician first; you may need antibiotic therapy. It s extremely important to follow your medication regimen exactly! Do not stop aspirin or Plavix unless directed by a cardiologist! When to Call the Physician Call the cardiologist if you experience any of these symptoms: - Severe weakness - Fainting or near fainting - Dizziness - Shortness of breath (especially at rest) - Angina (chest pain, neck or jaw pain, arm or back pain) - Palpitations (heart beating fast or heart skipping beats) - Weight gain of two to three lbs. for two to three days in a row. Please weigh daily. If you re experiencing symptoms, call your cardiologist at Physician Follow-up Visit If you have not made a follow-up appointment with your cardiologist while you re in the hospital, call to make an appointment. Cardiac Rehab Follow-up and Dismissal Myocardial Infarction & Angioplasty 3

4 HOME WALKING PROGRAM You should be exercising at around 3 on the Perceived Exertion Scale. Remember, Listen to your body. If you can t carry on a conversation while you re exercising, you need to slow down or stop for a moment. WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 WEEK 6 WEEK 7 WEEK 8 Start with walking three to five minutes, two to four times a day. Walk five to10 minutes, two to three times a day. If you re tolerating this well, add one minute each day. Walk 10 to 20 minutes one to three times a day. Walk 15 to 25 minutes one to two times a day. Walk 20 to 30 minutes one or two times a day. Walk 25 to 35 minutes one time a day. Walk 30 to 45 minutes one time a day. Walk 45 minutes one time a day. Once you reach your personal maximal level, continue to exercise in this manner at least five days a week. Be sure to allow a few days a week for rest. PERCEIVED EXERTION SCALE Perceived Exertion: The mental and physical judgment of the effort it takes to exercise or perform daily activities. 0 No effort 1 Extremely light 2 Very light 3 Light 4 Fairly light 5 6 Somewhat hard 7 Hard 8 Very hard 9 Extremely hard 10 Maximum effort Slow or stop exercise if your exercise effort is greater than 5 6 or somewhat hard. After you re recovered or rested, resume exercise at a lower exercise effort. It s ok to feel: - A mild stretching or pulling sensation in the working muscles and joints - An increased but comfortable rate of breathing that gradually returns to normal after exercise - Mild perspiration - Mild fatigue after exercising But if you must rest, then you ve pushed too hard. You want to feel a pleasant sense of exertion. COMMENTS: Cardiac Rehab Follow-up and Dismissal Myocardial Infarction & Angioplasty 4

5 HOME ACTIVITY PROGRAM RECOMMENDATIONS Here are some guidelines for increasing your activity. Keep in mind that each person is different, so your progress may be faster or slower than someone else s. These tips are designed to keep you active before, during and after Outpatient Cardiac Rehab. They re not an alternative to the formal program. If you are unable or unwilling to participate in an outpatient cardiac rehab program, please talk with your cardiologist before beginning any formal activity. Guidelines It s normal to feel tired when you return home from the hospital. This will improve as you follow your activity program. Alternate rest with activity during the day. Rest 45 minutes to one hour twice a day for the first three weeks at home. Begin exercise the day following discharge. Wait at least one hour or more after eating before exercising. Walk on level surfaces. Avoid large hills and inclines. Avoid walking against strong winds or in soft sand or snow. Exercise outdoors only in moderate temperatures. - Not when the temperature is warmer than 80 degrees - Not when the humidity is greater than 70% - Not when the temperature is colder than 40 degrees If you re on a medication that prevents your heart rate from increasing in response to exercise, use the Perceived Exertion Scale on page 4 or walk at a pace that you can carry on a conversation. You may use stairs. Take one step at a time. Stop and rest as needed. Reasons to Stop Exercise and Call the Physician Change in coordination Nausea or vomiting Skipping heartbeats Shortness of breath (not relieved with rest) Dizziness / lightheadedness / feeling faint Palpitations Leg pain / swelling and/or tenderness in leg Fatigue (lasting longer than 24 hours after exercise) Angina (discomfort, heaviness, pressure, etc. in your arms, chest, back, neck, shoulder blades or jaw) Remember, Listen to your body. Rest when you re tired. If your fatigue is relieved, continue at a slower pace. If fatigue persists, rest and stop your exercise session. Notify your physician. Cardiac Rehab Follow-up and Dismissal Myocardial Infarction & Angioplasty 5

6 PHASE II OUTPATIENT CARDIAC REHAB Outpatient Cardiac Rehab (OPCR) or Phase II builds on the exercise and education that you receive in Inpatient Cardiac Rehab or Phase I. The program provides a supportive environment to assist in your cardiac recovery. Phase II consists of EKG-monitored exercise sessions usually three times a week for six to 12 weeks. These exercise sessions are one way to evaluate your recovery progress. The monitoring also provides your physician with information to make adjustments in your medical treatment. The program is flexible, allowing you to follow an exercise plan tailored to your own capabilities and requirements. We ll Call You to Begin Our staff will discuss OPCR with you while you re in the hospital. After discharge, we ll call you to make arrangements. We also will contact your physician for authorization to begin OPCR. The program includes three sessions a week, so convenient access is important. We ll identify an OPCR location that is near your home or work. Many Insurance Companies Cover the Cost Many insurance companies cover most or all of the costs of OPCR. We ll contact your insurer to ask about your coverage before you join the program. We ll discuss this information with you before you begin. OPCR Benefits Increased understanding of heart disease Reduction or control of cardiac risk factors Improved cardiovascular fitness / increased overall activity tolerance Early identification of developing medical problems Improved confidence and psychological outlook Help with adjusting to living with heart disease Best of Luck in Your Recovery! Revised October 2012 Cardiac Rehab Follow-up and Dismissal Myocardial Infarction & Angioplasty 6

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