CARDIAC REHABILITATION

Transcription

1 CARDIAC CENTRE: PHYSIOTHERAPY DEPARTMENT: GUIDELINES FOR PATIENTS CARDIAC REHABILITATION Please stick addressgraph here

2 Table f Cntents 1. Intrductin 2. What is Cardiac Rehabilitatin 3. Hw Will we Help Yu 4. The heart in brief 5. The heart and Crnary arteries 6. Heart Cnditins 7. Physical Activity 8. Supervised Exercise Classes 9. Cnclusin 10. Individual Patient Ntes Intrductin This bklet is fr peple wh have been in hspital and have had a prcedure r treatment fr their heart cnditin. It tells yu abut hw cardiac rehabilitatin can help yu get back t as full a life as pssible. The bklet will als be useful fr yur family, friends r carers. What is a Cardiac Rehabilitatin? Cardiac rehabilitatin is the prcess by which yu recver and get back t as full a life as pssible after a cardiac event such as a heart attack, r after having a treatment such as crnary bypass surgery. It als aims t help prmte yur health and keep yu well after yu g hme frm hspital. Cardiac rehabilitatin is smetimes called cardiac rehab. Wh is Cardiac Rehabilitatin fr? Cardiac rehabilitatin is an essential part f yur recver if: yu have had a heart attack yu have had a crnary angiplasty

3 yu have had crnary bypass surgery r anther type f heart surgery yu have had an implantable cardiverter defibrillatr (ICD) fitted, r yu have stable heart failure. Cardiac rehabilitatin can als be very imprtant fr peple wh have ther cnditins such as stable angina, cardimypathy r cngenital heart disease. Hw will we help yu The physitherapist r a cardiac care nurse will cme visit yu n the ward t prvide written infrmatin t yu, explain what has happened t yu, explain risk factrs t yu and prvide advice t yu pst yur prcedure. After yu are discharged hme, the physitherapist will cntact yu within a week, and arrange fr yu t attend the cardiac rehabilitatin prgramme- which cnsists f infrmatin sessins and a supervised exercise prgramme What are the aims f Cardiac Rehab? Imprve heart functin and general health, partly thrugh exercise Supprt yu in making lng-term changes in yur lifestyle Increase yur cnfidence Mdify the risk factrs fr heart disease Reduce the risk f heart events in the future Give yu a better quality f life Wh is invlved in Cardiac Rehab? We have a multidisciplinary team, led by a cardiac rehabilitatin c-rdinatr that includes the fllwing: Cnsultant Cardilgist Cardiac Registrar Clinical Nurse Specialists Dieticians Health Prmtin Nurse Pharmacist Physitherapists Psychtherapist Secretary Scial Wrker

4 The Heart in Brief Hw yur heart wrks: The heart circulates bld arund the bdy. The bld carries xygen and nutrients t the rest f the bdy thrugh the bld vessels, called arteries and veins. The heart is a muscular pump, which like all rgans, needs its wn bld supply. The main vessels supplying the heart muscle are called the crnary arteries; these supply the heart muscle with xygen Bld Pressure: This the pressure measured in the arteries, which rises and falls as the heart pumps ut bld. Systlic 140 r belw is the nrmal systlic reading Diastlic When the heart cntracts t pump bld ut, the pressure in the arteries ges up The Heart 85 r belw is a nrmal diastlic reading Heart Rate: When the heart relaxes, the pressure in the arteries ges dwn The heart pumps at different speeds accrding t the needs f ur bdy. There is a wide range f nrmal heart rate. Everyne s heart rate ges up r dwn, whether they are resting r exerting themselves. Heart rate and bld pressure are als affected by things such as ur emtins, medicatins, smking, and a variety f illnesses. Causes f heart disease: The reasn why the crnary arteries narrw is nt yet fully knwn. Research has shwn that there are several risk factrs which can cause heart disease, which may lead t the

5 develpment f angina and heart attacks. Risk factrs are habits and bdily characteristics which tend t increase yur risk f develping angina r a heart attack. Risk factrs include: Smking High Bld pressure Being verweight Diabetes Family Histry f heart disease Ethnicity Being inactive Age Yur sex Stress and Psychlgical Issues Hwever, sme peple still have heart disease even thugh they have nne f the abve risk factrs. Investigatins while in Hspital While yu are in hspital we will need t carry ut sme tests t investigate yur heart cnditin. These may include sme, r all f the fllwing. Electrcardigram (ECG) Recrds the rhythm and electrical activity in the heart. Exercise Tlerance Test/ Exercise Stress Test This is an ECG carried ut while yu walk n a treadmill. Yur Heart rate and bld pressure are recrded while yu exercise. This test helps t determine if yur symptms are cause by angina, a type f pain which is assciated with crnary heart disease. Echcardigram (Ech) This is an ultrasund f yur heart. This tells us hw the heart muscle has been affected by yur heart attach. Crnary angigram This test is used t find places where the crnary arteries are blcked r narrwed. A lcal anaesthetic is used t numb yur grin, and then a fine tube is passed up the artery at the tp f yur leg and int the heart. A special dye is injected int the artery. This is filmed using x-ray equipment. The picture is used

6 t help yur dctr t decide what, if anything needs t be dne t imprve the bld supply t yur heart muscle. bld vessels frm ther parts f the bdy, such as the leg, are als used. The Heart and Percutaneus Crnary Interventin (PCI) This treatment pens up the narrwed artery by squashing the atherma (fatty tissue), allwing the bld t flw mre easily. A special type f catheter (fine tube) which has a balln at the end is passed int the crnary artery thrugh the leg. The balln is then psitined in the narrw part f the artery and blwn up t squash the atherma. The balln is then deflated and mre dye is injected t check the results n an x-ray machine Often a small piece f stainless steel mesh (stent) is placed inside the artery t make sure it stays pen after the angiplasty. Crnary Artery Bypass Graft The purpse f this surgery is t bypass the narrwed/ damaged sectins f the crnary arteries. The heart surgen des this by grafting a sectin f bld vessel between the arta and a pint in the crnary artery beynd the narrwing. A bypass graft can be carried ut fr each f the main crnary arteries affected. Mst peple have 3 r 4 grafts. In mst cases the surgen uses the mammary artery frm yur chest wall but

7 Heart Cnditins Acute Crnary Syndrme This is a term which yu may hear the dctrs using when they discuss yur diagnsis. The dctr makes the diagnsis based n yur recent histry, clinical examinatin, the ECG and bld tests ver hurs. The bld test measures an enzyme called Trpnin - a chemical released by the heart when the heart muscle has been damaged. This measurement will be slightly raised even if nly a very small amunt f damage has ccurred. The dctr may then be able t talk t yu abut having had a heart attack. Heart Attack (Acute Mycardial Infarctin) A heart attack may als be called a mycardial infarctin, a crnary thrmbus, a crnary cclusin r acute crnary syndrme. A heart attack ccurs when an area f the heart muscle has been deprived f xygen fr a shrt perid f time by a bld clt r blckage in a crnary artery. This usually caused severe pain r discmfrt that may last fr up tp several hurs. It is therefre very imprtant that if yu have pain that is nt relieved by GTN spray r by rest that yu call 112/ 999 and get t a hspital as sn as pssible s yu can be treated. Other symptms that yu re having a heart attack can include nausea, vmiting, sweating, shrtness f breath, dizziness and ccasinal lss f cnsciusness. The area f the heart muscle that is deprived f xygen frms scar tissue ver the first 4-6 weeks. The aim f all the treatment yu receive in hspital is t help yur heart t recver. Physical Activity Regular physical activity had been shwn t have numerus benefits fr peple with heart disease. Fr example, it can: Help lwer yur bld pressure Imprve yur chlesterl levels Reduce yur risk f diabetes Help yu lse weight Reduce yur angina Reduce yur risk f having a strke Help yu return t wrk earlier after a heart attack Reduce the number f hspital visits that yu make r tablets yu have t take Als, if yu have had a heart attack, physical activity as part f a rehabilitatin prgramme can reduce yur risk f dying frm

8 anther heart attack by arund 25% (O Cnnr et al, 1989; Oldridge et al, 1988) Physical activity is a brad term that includes everything frm walking t dg r gardening, t structured frms f exercise such as swimming r playing a sprt. Many peple wh d regular physical activity reprt that it makes them feel better and mre energetic, prvides relief frm stress and anxiety, imprved their sleep, helps them t stay independent, as well as enhancing their md and level f self cnfidence. It can als be sciable and a lt f fun! Mst peple in yur psitin are understandably cncerned abut he much exercise and physical activity is right fr them. Hwever, the heart is a muscle, and like any ther muscles, it needs physical activity t stay healthy. Regular physical activity will imprve the bld flw t the heart muscle, and will help yur heart becme strnger and mre efficient It is imprtant that during any frm f physical activity, yu: STOP if yu experience any undue shrtness f breath Chest pain/ discmfrt Inapprpriate tiredness Nausea/ Headaches/ Dizziness Persistent Palpitatin Feeling Unwell If in dubt STOP and check with yur GP befre cntinuing Physical activity is very imprtant part f yur recvery, but the amunt and type f activity that we advise will differ tremendusly frm persn t persn, and it is imprtant that yu wrk within yur wn limits.

9 Immediately Pst Discharge Advice n Everyday Tasks During yur first week at hme, rest and enjy being there. Yu may find ut yu tire easily when yu first return hme. If yu feel tired, have a sleep during the day. As far as pssible stick t yur nrmal rutine, i.e. get up and get dressed- it is nt necessary t take t yur bed. Dn t let visitrs stay t lng in the early days. Frm the secnd week at hme, try increase the number f activities that yu d, ensuring that yu dn t get t tired. Walk up and dwn stairs as necessary. As a very general rule, light husehld chres may be resumed as sn as yu feel fit, but heavy manual wrk such as bed changing and vacuuming shuld be avided fr 6-8 weeks. Similarly, light gardening may be undertaken but heavy lifting and straining, digging, sawing, r mving shuld be avided fr 8-12 weeks. Initially yu shuld als try aviding lng perids f wrk with yur arms abve yur head, such as trimming a high hedge r painting the ceiling, because this will raise yur bld pressure and put extra strain n yur heart. When yu feel yu are able t d larger tasks such as mwing the lawn, r vacuuming fr the first time, split the task int manageable chunks- have a rest and sit dwn if yu are feeling t tired, and finish the task later r the next day if necessary. Als, try t space activities ut during the day. Try nt what yu are able t d nw with what yu used t d. D nt be afraid t ask fr help. Friends and family members will be mre willing t lend a hand. In time yu shuld be able get back t nrmal- if nt better! What srt f exercise is best? The types f activities that are mst beneficial fr the heart are called aerbic activities, Aerbic activities are repetitive, rhythmic frms f exercise such as walking, cycling, swimming, and dancing, which invlve large muscle grups (e.g. leg muscles). The ther main type f exercise is called resistance r strength training, e.g. press ups, and heavy lifting. Hwever, these activities are nt recmmended fr everyne, especially if yu have high bld pressure, because they increase yur bld pressure and put yur heart under mre stress. With this in mind, it is strngly recmmended that yu incrprate regular, cntinuus aerbic activity int yur day. This shuld be f a mderate intensity, i.e. exercise that makes yu feel slightly warm and slightly ut f breath. Walking is an ideal activity that can easily becme part f yur daily rutine. The fllwing

10 prgramme is designed t prvide yu with a frame wrk s yu can build up yur walking levels gradually. Cardiac Rehabilitatin Phase 2 Walking Prgramme The walking prgramme shwn belw is a rugh guide nly. Everybdy recvers at a different rate, be sensible- if yu are finding the distances hard, take things nice and slwly. If yu are finding them very easy yu may prgress thrugh the stages quite quickly. Prgress thrugh each stage in rder; d nt miss any stages regardless f hw well yu think yu are prgressing If yu feel cmfrtable, try t increase yur walk by 1 r 2 minutes, and mve n t the next stage when yu are ready. It is imprtant that yu increase the time and speed very gradually By the end f the prgramme yur aim shuld be t g walking at least 5 times a week, at a brisk pace fr at least 30 minutes. This is the amunt f activity that is recmmended t keep yur heart healthy. Imprtant pints t remember Once yu have established the walking prgramme, and prgressed t a mderate pace (Week 4 r abve) it is imprtant t: Warm-up: It is extremely imprtant that when yu g fr a walk, yu dn t start walking at yur full pace immediately, but build up gradually during the first few minutes f the walk. Ideally the warm up perid shuld be between 5 and 15 minutes lng. The warm up shuld be less effrt that the walk and shuld be adapted t yur stage f recvery e.g. walking n the spt, walking slwly. This will give yur bdy and heart time t adapt t the wrk that yu are asking it t d. This warm up perid has very imprtant safety implicatins, including reducing the risk f angina and disturbances in yur heart rhythm.

11 Cl Dwn: Similarly, yu shuld never speed up twards the end f yur walk and stp suddenly. It is imprtant that yu gradually slw yur pace during the last prtin (ideally 10 minutes) f yur walk. This cl dwn perid helps t reduce the risk f sudden heart prblems r a sudden drp in bld pressure, and shuld be taken very seriusly. Plan yur rute n firm, level grund if pssible, especially fr the first few weeks f yur prgramme. As yu gain cnfidence and fitness, increase the pace, and try t intrduce sme gradual hills int yur rute. Occasinally yu may have a day when yu are nt feeling as energetic as usual. Please d nt feel disheartened- this is nt a step backwards in terms f yur recvery. Reduce the amunt that yu d that day, r walk at a slwer speed. Everyne has gd days and bad days- remember t listen t yur bdy. Yu may find it useful t map ut a specific walking rute befre yu start. If pssible, find ut hw far it is and hw lng it takes yu t walk it, and then yu have a means f mnitring yur prgress. enjyment. Be careful that they d nt lead the pace, and g at a level suitable fr yu. D nt walk straight after a meal as this may bring n angina. Try t leave at least an hur after yu have eaten befre yu start exercising. Hw fast shuld I walk? Fr the first few weeks f the prgramme, yu shuld walk at a leisurely t mderate speed. As yu get fitter, yu shuld try t increase yur pace gradually, building up t a brisk pace. Talk Test One way f checking yur pace, is by ding the talk test while yu are walking. If yu can talk very easily, yu are nt walking briskly enugh. If yu can talk but feel warm and are breathing heavier than nrmal, yu are walking at abut right pace. If yu can t talk, yu are walking t briskly, s yu shuld slw dwn. T start with it may be a gds idea t take a friend r relative with yu when yu walk- this will help yur cnfidence and

12 Brg Scale Whilst exerting yurself yu will want t use the mdified Brg 0-10 scale belw t help yu t rate hw strenuus an exercise r activity feels as yu are ding it. The perceptin f exertin depends mainly n the strain and fatigue in yur muscles and n the feeling f breathlessness r aches in the chest. when yu g back t wrk why nt try ging fr a brisk walk during yur lunch break. Ideally yu shuld be ding at least 30 minutes f physical activity n 5 r mre days f the week. Dn t frget that yu can split up the 30 minutes- ding 2 lts f 15 minutes may be mre cnvenient fr yu. Remember that it is current physical activity that prtects yur heart- i.e. what yu are ding at the mment, nt what yu did last mnth, s yu must keep up the gd wrk! Sensible precautins In rder t maximise yur safety, it is imprtant t read and fllw these guidelines. Exercise nly when yu feel well. If yu are unwell with a virus, cld r tummy bug lease d nt attempt t undertake any exercise as this will slw yur rate f recvery. Wait at least 2 days after the symptms have disappeared. D nt exercise in extremes f temperature. By the time yu have cmpleted this prgramme physical activity shuld have becme a regular part f yur life. Fr example, If it is warm, slw yur pace. When exercising in the cld, dress warmly. Cld air/ r windy weather may prvke angina. Yu can help t prevent this by cvering yur muth with a scarf when yu are walking s that yu warm the air that yu are breathing in.

13 Yu must als cmpare hw yu feel n any given day with yur usual symptms and capabilities. If yu have develped any new symptms r yu have fund that yur usual symptms (i.e. mre breathlessness, mre frequent angina, swllen ankles) get wrse, yu must infrm yur GP as sn as pssible. Phase 3 Cardiac Rehabilitatin Supervised Exercise Classes As yu achieve yur gals with yur walking prgramme, yur cnsultant may recmmend fr yu t attend a series f supervised exercises and infrmatin classes during yur recvery after yur heart prcedure. Graded exercise is a vital part f yur rehabilitatin, and will help prgress yur activity levels frm a walking prgram back t yur baseline level. The Cardiac Rehabilitatin Prgramme in the Beacn Hspital aims t; Prvide ur patients with the highest quality cardiac rehabilitatin and secndary preventin service in partnership with the Cnsultant Cardilgists, multidisciplinary team members, patients and their families. Assist the patient in his/her recvery after a cardiac event, imprve self-cnfidence and enhance the wellbeing f the entire family unit. Prmte thrugh educatin and supprt the adaptatin by patients f a healthy heart lifestyle. We wrk as a multidisciplinary team t maximise the care prvided. Prmte learning and prvide a supprtive envirnment fr all participants, respecting each ther s needs, abilities and ptential. These sessins are prvided by the cardiac rehabilitatin team in the physitherapy department in the Beacn Hspital. They are specifically designed t help yu find ut hw much activity yu can safely d, and prvide yu with the cnfidence and infrmatin t becme mre active. The curses run fr a 6 week perid, 24 hurs ttal ver 6 weeks. It cnsists f ne hur s exercise twice a week, with ne educatin sessin befre r after the exercise class n ne day a week. There is a warm-up f ten/fifteen minutes prir t the circuit.

14 The aerbic phase lasts abut thirty minutes and cnsists f; reductin, smking cessatin, retraining with a view t returning t wrk. a treadmill biceps curls lunges press ups static bicycle upright rw stepping wall squats hamstring curls lateral raises This will be accmpanied by educatin cncerning the cardiac cnditin and the reasns why changes in lifestyle might be desirable. Cnclusin We hpe that yu have fund this bklet useful and that it has helped t relieve sme f yur fears and anxieties regarding yur heart prcedure. During yur hspital stay, yur medical team will be available t answer any ther queries yu may have. Individual Patient Ntes: T cnclude the exercise sessin, there is a ten/fifteenminute cl-dwn in rder t taper ff the exercise gradually. Graded exercise shuld be accmpanied at this stage by ther interventins tailred t meet yur individual requirements. The secnd hur f each sessin is fcused n this lifestyle educatin. Lifestyle changes shuld be encuraged and supprted where apprpriate, e.g. weight Cnsultant Name: Date f Surgery: Surgery Nte: Cntact Number fr Cardiac Rehabilitatin: (01) This Patient Educatin leaflet was develped by the Chartered Physitherapists in Beacn Hspital. Beacn Hspital.

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