CARDIAC REHABILITATION PROGRAM

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1 CARDIAC REHABILITATION PROGRAM Preparation for the Cardiac Rehabilitation Program After your heart problem is stable, your physician or cardiologist will refer you to the Cardiac Rehabilitation program. You may begin your outpatient exercise and education program as early as 2 weeks after leaving the hospital. Before you begin the exercise program, your physician will order a stress test. The Cardiac Rehab staff develops your accurate, individualized exercise prescription from this stress test. After your stress test, you will visit the cardiac rehab exercise area. During this visit, an orientation appointment and exercise program start date and time will be scheduled. Our cardiac rehab program offers a variety of class times throughout the day so that you may pick the time that best suits your schedule. During the Cardiac Rehabilitation Program Your class date and times have been reserved for you. If you are unable to attend a session due to emergency or illness, contact the Cardiac Care Center. Wear loose comfortable clothing and comfortable walking shoes. Take all your medicine as directed. Eat a light meal 1-2 hours before coming to class. Large meals place a greater demand on the heart. Avoid smoking and caffeinated coffee for at least 1 hour before class. Smoking and Caffeine cause an increased heart rate and blood pressure, which increases the demand on the heart. Report all medication changes to the cardiac nurse/therapist. A home walking program will be encouraged for the days you do not come into cardiac rehab. Do not be persuaded to do more exercise than prescribed. Your home exercise level should always be lower than your exercise level at the Cardiac Care Center.

2 Report Symptoms During cardiac rehab, be sure to report if you have any of the following during exercise sessions or when away from the center: chest, arm or jaw discomfort (angina symptoms) shortness of breath fatigue dizziness or lightheadedness After the Cardiac Rehabilitation Program A Stress Test may be scheduled within one week following your graduation from cardiac rehab. Your Home Exercise Program will be determined based on this stress test. You will receive your individualized home exercise program in the mail within one week following your post-rehab stress test. Continue to make the exercise and lifestyle changes you learned in Cardiac Rehab an ongoing part of your routine. Ask your family and friends to help you stay motivated. You, your family and your friends are encouraged to continue to attend the monthly Heart to Heart Club meetings. It may help you and your family to enroll in other lifestyle change classes - like quitting smoking, reducing stress, weight management and nutrition classes. These types of classes are offered through the Heart to Heart program at the Mind-Body Wellness Center. Stress testing is done to determine how the heart responds during various work levels. This test is used to evaluate heart symptoms, response to heart medication or following a heart procedure like open-heart surgery or balloon angioplasty. This test is also done to determine your safe exercise level for those starting an exercise program like Cardiac Rehabilitation. The test records your heartbeat while you walk on a treadmill or receive a medication to stimulate your heart to work. A physician is present at all times during the testing procedure. 2

3 TYPES of STRESS TESTS Regular Treadmill Stress Test While walking on a treadmill, the patient is monitored by an ECG (electrocardiogram). This test is helpful in finding out what your exercise capability is and if you have any heart-related problems with exercise. Problems with exercise include changes on the ECG (ECG's show the electrical pathway of your heartbeat), chest or angina discomfort, shortness of breath or abnormal blood pressure response to exercise. Preparation for the Regular Treadmill Stress Test You do not have to hold any medications unless otherwise instructed by the ordering physician. The Cardiac Registered Nurse will contact you the business day prior to your scheduled appointment. The nurse will discuss your medications and any specific preparation for the test with you. Do not have any caffeine for at least two hours prior to your test. Coffee, tea, soft drinks and chocolate may contain caffeine. Do not smoke for at least 3-4 hours prior to your test. You may eat a light breakfast - such as toast and juice. Wear flat, comfortable walking shoes. Wear a baggy or button front short-sleeved shirt. Women are encouraged to wear a button front shirt During the Regular Treadmill Stress Test Small sticky pads are placed on your upper body to monitor your heartbeat. A blood pressure cuff is placed on your arm. A Cardiac Registered Nurse will explain the Stress Test Procedure. You will need to exercise for several minutes. The exercise is very easy at first and slowly gets harder. You should exercise for as long as possible or until you are asked to stop. The more you are able to exercise the more information your physician will get from the test. Your blood pressure and heartbeat will be monitored throughout the test. Report Any Symptoms During the test, be sure to tell the staff if you have any of the following: Chest, Arm or Jaw Discomfort. Shortness of Breath Fatigue Dizziness or Lightheadedness 3

4 Leg Cramps or Soreness After the Regular Treadmill Stress Test You may resume your normal activity unless otherwise directed by the testing physician. Take your regular medications as directed unless otherwise directed by the testing physician. Within two to three business days, the test results will be sent to the physician that ordered the test. Contact the ordering physician's office to discuss the results of your test. Keep any scheduled follow-up appointments. Nuclear Exercise Stress Test A Nuclear Stress Test is a Regular Treadmill Stress Test done with the addition of a low dose radioactive material during maximum exercise. The radioactive material will be inserted through a small IV line in your arm. The heart muscle absorbs the radioactive material during exercise. It is not a dye. Tell the staff if you are pregnant or think you may be pregnant. While walking on a treadmill, the patient is monitored by an ECG (electrocardiogram). This test is helpful in finding out what your exercise capability is and if you have any heart-related problems with exercise. Problems with exercise include changes on the ECG (ECG's show the electrical pathway of your heartbeat), chest or angina discomfort, shortness of breath or abnormal blood pressure response to exercise. The Nuclear Exercise Stress Test is a way to see if enough blood is getting to all the areas of the heart muscle. Nuclear Imaging You will initially report to the Nuclear Medicine Department. When you arrive, you will have an IV inserted into your arm. You will then be given a low-dose radioactive material through the IV line. You will then wait approximately 30 minutes for the radioactive material to circulate and be absorbed by your heart muscle. You will then be asked to lie very still on a table for approximately 20 minutes. The nuclear camera will take pictures of the blood flowing through your heart muscle. Afterwards, you will be escorted to the Cardiac Care Department for the exercise portion of your test. Preparation for the Nuclear Exercise Stress Test 4

5 The Cardiac Registered Nurse will contact you the business day prior to your scheduled appointment. The nurse will discuss your medications and any specific preparation for the test with you. This is a 1-day test. Exercise test in the Cardiac Care Department and Nuclear pictures in the Radiology Department. Expect to be at the hospital for 3 1/2 to 4 hours. Do not eat or drink for 2 hours before your test. Wear flat, comfortable walking shoes. Wear a baggy or button front short-sleeved shirt. Women are encouraged to wear a button front shirt. During the Nuclear Exercise Stress Test Small sticky pads are placed on your upper body to monitor your heartbeat. A blood pressure cuff is placed on your arm. A Cardiac Registered Nurse will explain the Stress Test Procedure. The Nurse will flush the IV in your arm to verify placement. The exercise is very easy at first and slowly gets harder. You should exercise for as long as possible or until you are asked to stop. The more you are able to exercise the more information your physician will get from the test. your blood pressure and heartbeat will be monitored throughout the test. A small amount of low dose radioactive material will be given to you through the IV line during maximum exercise. Your IV line will then be removed. Report Any Symptoms During the test, be sure to tell the staff if you have any of the following: Chest, Arm or Jaw Discomfort Shortness of Breath Fatigue Dizziness or Lightheadedness Leg Cramps or Soreness After the Nuclear Exercise Stress Test You will be escorted back to Nuclear Medicine for one more set of nuclear pictures that take approximately 20 minutes. You may resume your normal activity unless otherwise directed by the testing physician. Take your regular medications as directed unless otherwise directed by the testing physician. 5

6 Within two to three business days, the test results will be sent to the physician who ordered the test. Contact the ordering physician's office to discuss the results of your test. Keep any scheduled follow-up appointments. Chemical Stress Tests (Lexiscan or Dobutamine Stress Test) A Nuclear Chemical Stress Test is a Nuclear Exercise Stress Test done without exercise. This test is ordered for patients that are unable to walk effectively on the treadmill. You will be given a medication (Lexiscan or Dobutamine) through a small IV line inserted in your arm. The medication speeds up your heartbeat - like you are exercising. It is normal to feel your heart pound for a few minutes. Once you reach the target heartbeat, the radioactive material will also be inserted through this small IV line in your arm. The heart muscle absorbs the radioactive material. It is not a dye. Tell the staff if you are pregnant or think you may be pregnant. You will be monitored by an ECG (electrocardiogram) while the medication is running. This test is helpful in finding out if you have any heart problems when your heart is working harder. Problems with increased heart work include changes on the ECG (ECG's show the electrical pathway of your heartbeat), chest or angina discomfort, shortness of breath or abnormal blood pressure response to increased heart work. The Nuclear Chemical Stress Test is a way to see if enough blood is getting to all the areas of the heart muscle. Nuclear Imaging You will initially report to the Nuclear Medicine Department. When you arrive, you will have an IV inserted into your arm. You will then be given a low-dose radioactive material through the IV line. You will then wait approximately 30 minutes for the radioactive material to circulate and be absorbed by your heart muscle. You will then be asked to lie very still on a table for approximately 20 minutes. The nuclear camera will take pictures of the blood flowing through your heart muscle. Afterwards, you will be escorted to the Cardiac Care Department for the exercise portion of your test. Preparation for the Nuclear Chemical Stress Test You do not have to hold any medications unless otherwise instructed by the ordering physician. The Cardiac Registered Nurse will contact you the business day prior to your scheduled appointment. The nurse will discuss your medications and any specific preparation for the test with you. If you are having a Lexiscan Stress Test: 6

7 o Tell the Nurse if you have Asthma. o Do not take Theophylline for 3 days before test. o Do not take Persantine for 24 hours before test. This is a 1-day test. o Day 1: Medication part in the Cardiac Care Center & Nuclear pictures in Radiology Department. Expect to be at the hospital 3 1/2 to 4 hours. No caffeine 12 hours prior to the test. Coffee, tea, soft drinks and chocolate may contain caffeine. Do not eat or drink for 2 hours before your test. Wear a baggy or button front short-sleeved shirt. Women are encouraged to wear a button front shirt. During the Nuclear Chemical Stress Test Small sticky pads are placed on your upper body to monitor your heartbeat. An automatic blood pressure cuff is placed on your arm. A Cardiac Registered Nurse will explain the procedure. The Nurse will flush the IV in your arm to verify placement. The medication is given over a short period of time through the IV line. Your heart will feel like it is working harder. The effects of the medication go away very quickly after the medicine is stopped. Your blood pressure and heartbeat will be monitored throughout the test. A small amount of low dose radioactive material will be given to you through the IV line while the medicine is being given. Your IV line will then be removed. Report Any Symptoms During the test, be sure to tell the staff if you have any of the following: Chest, Arm or Jaw Discomfort Shortness of Breath Fatigue Dizziness or Lightheadedness Heart Racing Nausea After the Nuclear Chemical Stress Test You will be escorted back to Nuclear Medicine for one more set of nuclear pictures that take approximately 20 minutes. You may resume your normal activity unless otherwise directed by the testing physician. Take your regular medications as directed unless otherwise directed by the testing physician. 7

8 Within two to three business days, the test results will be sent to the physician that ordered the test. Contact the ordering physician's office to discuss the results of your test. Keep any scheduled follow-up appointments. Stress Echocardiography or Stress Echo A Stress Echo is a Regular Treadmill Stress Test done with the addition of harmless sound wave pictures done before the test at rest and immediately after maximum exercise. The sound wave pictures are done while you lie on your left side on a stretcher. The sound wave pictures show the structure and movement of your heart. The physician can see any changes in the way your heart muscle works when exercising. Sound wave pictures are done at rest before the test. While walking on a treadmill, the patient is monitored by an ECG (electrocardiogram). This test is helpful in finding out what your exercise capability is and if you have any heart-related problems with exercise. Problems with exercise include changes on the ECG (ECG's show the electrical pathway of your heartbeat), chest or angina discomfort, shortness of breath, abnormal blood pressure response to exercise or a change in the pumping power of your heart with exercise. Preparation for the Stress Echo Do not take your heart medications for 24 hours before your test unless your physician instructs you differently. The Cardiac Registered Nurse will contact you the business day prior to your scheduled appointment. The nurse will discuss your medications and any specific preparation for the test with you. Do not have any caffeine for at least 2 hours prior to your test. Coffee, tea, soft drinks and chocolate may contain caffeine. Do not smoke for at least 2 hours prior to your test. You may eat a light breakfast- such as toast and juice. Wear flat, comfortable walking shoes. Wear a shirt that you can remove easily. You will be asked to remove your clothing from the waist up. A hospital gown will be provided for women. Allow at least 1 to 2 hours from your arrival to the time you leave the hospital. During the Stress Echo Small sticky pads are placed on. your upper body to monitor your heartbeat. A blood pressure cuff is placed on your arm. 8

9 While you lie on your left side, a Cardiovascular Technician will place a transducer (a small device that produces sound waves) and gel on your chest to record images on videotape of your heart's pumping action at rest. A Cardiac Registered Nurse will explain the Stress Test Procedure. You will need to exercise for several minutes. The exercise is very easy at first and slowly gets harder. You should exercise for as long as possible or until you are asked to stop. The more you are able to exercise the more information your physician will get from the test. Your blood pressure and heartbeat will be monitored throughout the test. Once you reach your maximum heart rate, you will be asked to move immediately to the stretcher and lie on your left side. The Cardiovascular Technician will take another set of sound wave pictures while your heart is pumping harder from the exercise. Report Any Symptoms During the test, be sure to tell the staff if you have any of the following: Chest, Arm or Jaw Discomfort Shortness of Breath Fatigue Dizziness or Lightheadedness Leg Cramps or Soreness After the Stress Echo You may resume your normal activity unless otherwise directed by the testing physician. Take your regular medications as directed unless otherwise directed by the testing physician. Within two to three business days, the test results will be sent to the physician that ordered the test. Contact the ordering physician's office to discuss the results of your test. Keep any scheduled follow-up appointments. 9

10 Dobutamine Echocardiography or Dobutamine Stress Echo A Dobutamine Stress Echo is a Stress Echo done with the addition of medication (Dobutamine) to make your heart beat faster. This test is ordered for patients that cannot walk effectively on a treadmill. It is normal to feel your heart pound for a few minutes. While you lie on your left side on a stretcher, sound wave pictures are done before, during and after the medication is given. The sound wave pictures show the structure and movement of your heart. The physician can see any changes in the way your heart muscle works when beating faster. Sound wave pictures are done at rest before the test. You will be monitored by an ECG (electrocardiogram) while the medication is running. This test is helpful in finding out if you have any heart problems when your heart is working harder. Problems with increased heart work include changes on the ECG (ECG's show the electrical pathway of your heartbeat), chest or angina discomfort, shortness of breath, abnormal blood pressure response or a change in the pumping power of your heart with exercise. Preparation for the Dobutamine Stress Echo Do not take your heart medications for 24 hours before your test unless your physician instructs you differently. The Cardiac Registered Nurse will contact you the business day prior to your scheduled appointment. The nurse will discuss your medications and any specific preparation for the test with you. Do not have any caffeine for at least 2 hours before the test. Coffee, tea, soft drinks and chocolate may contain caffeine. Do not smoke for at least 2 hours before the test. Do not eat or drink for at least 4 hours before the test. Wear flat, comfortable walking shoes. Wear a shirt that you can remove easily. You will be asked to remove your clothing from the waist up. A hospital gown will be provided for women. Allow at least 1 to 2 hours from your arrival to the time you leave the hospital. 10

11 During the Dobutamine Stress Echo Small sticky pads are placed on. your upper body to monitor your heartbeat. An automatic blood pressure cuff is placed on your arm. While you lie on your left side, a Cardiovascular Technician will place a transducer (a small device that produces sound waves) and gel on your chest to record images on videotape of your heart's pumping action at rest. A Cardiac Registered Nurse will explain the procedure. The Nurse will place a small IV line in your arm. The medication is given over a short period of time through the IV line. Your heart will feel like it is working harder. The effects of the medication go away very quickly after the medicine is stopped. Your blood pressure and heartbeat will be monitored throughout the test. The Cardiovascular Technician will take sound wave pictures while your heart is pumping harder from the medication. Report Any Symptoms During the test, be sure to tell the staff if you have any of the following: Chest, Arm or Jaw Discomfort Shortness of Breath Fatigue Dizziness or Lightheadedness Heart Racing Nausea After the Dobutamine Stress Echo You may resume your normal activity unless otherwise directed by the testing physician. Take your regular medications as directed unless otherwise directed by the testing physician. Within two to three business days, the test results will be sent to the physician that ordered the test. Contact the ordering physician's office to discuss the results of your test. Keep any scheduled follow-up appointments. 11

12 Pulmonary Treadmill Stress Test Pulmonary Treadmill Stress Test is a Regular Treadmill Stress Test with the addition of a pulse oximeter (a device used to measure the level of oxygen in your blood). While walking on a treadmill, the patient is monitored by an ECG (electrocardiogram). This test is helpful in finding out what your exercise capability is and if you have any heart or lung related problems with exercise. Problems with exercise include changes on the ECG (ECG's show the electrical pathway of your heartbeat), chest or angina discomfort, shortness of breath, abnormal blood pressure or decrease in oxygen level in response to exercise. Preparation for the Pulmonary Treadmill Stress Test Do not take your heart medications for 24 hours before your test unless your physician instructs you differently. The Cardiac Registered Nurse will contact you the business day prior to your scheduled appointment. The nurse will discuss your medications and any specific preparation for the test with you. Do not have any caffeine for at least 2 hours prior to your test. Coffee, tea, soft drinks and chocolate may contain caffeine. Do not smoke for at least 3-4 hours prior to your test. You may eat a light breakfast - such as toast and juice. Wear flat comfortable walking shoes. Wear a baggy or button front short-sleeved shirt. Women are encouraged to wear a button front shirt. During the Pulmonary Treadmill Stress Test Small sticky pads are placed on your upper body to monitor your heartbeat. A blood pressure cuff is placed on your arm. A painless device to measure your oxygen level in your blood will be placed on your finger. A Cardiac Registered Nurse will explain the Stress Test Procedure. You will need to exercise for several minutes. The exercise is very easy at first and slowly gets harder. You should exercise for as long as possible or until you are asked to stop. The more you are able to exercise the more information your physician will get from the test. Your blood pressure, heartbeat and oxygen level will be monitored throughout the test. 12

13 Report Any Symptoms During the Test, be sure to tell the staff if you have any of the following: Chest, Arm or Jaw Discomfort Shortness of Breath Fatigue Dizziness or Lightheadedness Leg Cramps or Soreness After the Pulmonary Treadmill Stress Test You may resume your normal activity unless otherwise directed by the testing physician. Take your regular medications as directed unless otherwise directed by the testing physician. Within two to three business days, the test results will be sent to the physician that ordered the test. Contact the ordering physician's office to discuss the results of your test. Keep any scheduled follow-up appointments. 13

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