EXERCISE FOR MYOCARDIAL INFRACTION DURING COVID-19 LOCKDOWN

Exercise for Myocardial infarction during covid-19 Lockdown

      Medical History

   Mr x is a 46 year old who had an unremarkable medical history. He is sedentary and has been for most of his adult life. He works with ministry of budget and planning. He has smoked three packs of cigarettes a day for 22 years and his body mass index is 28.6.His total cholesterol is 276mg. dl-l, LDL is 146mg. dl-l and HDL is 26mg. dl-l. He does not know his typical blood pressure value.

        Diagnosis

     Mr x presented to the emergency department with substernal and left arm discomfort and diaphoresis. Mr x was immediately given morphine on arrival at the hospital. His blood pressure was 185/117mmHg. An ECG   

Demonstrated ST-segment elevation and tall T waves in leads VI through V6 and ll, III, and avf. Blood was drawn and analyzed for creatine phosphokinase and lactate dehydrogenase. These values were both elevated above resting values.

From this information, the diagnosis of acute myocardial infarction was made. The plan was to evaluate for thrombolytic  versus primary angioplasty therapy. Mr x underwent percutaneous coronary intervention (PCI) with stent placement of his right coronary artery and left coronary artery 2 hours after arrival at the hospital.

The circumflex artery also had an 80% blockage that was anatomically difficult and thus was not revascularized. A subsequent in hospital dobutamine echocardiography examination revealed a lateral wall motion abnormality at the highest dose of dobutamine.

 

 Exercise Test Results

  After stabilization and release from the hospital, Mr X was referred for cardiac rehabilitation. The patient began phase ll at two weeks post -MI and was subsequently scheduled for an exercise test to evaluate his functional status, prognosis, and ischemic status and to develop an exercise prescription. He walked on a treadmill using a modified Bruce protocol. His ECG was interpreted as anterior and inferior MIs with repolarization abnormality. The following are the results :

   Protocol:Bruce

    Time:10.40

     Resting heart rate :86

Resting blood pressure :146/97mmHg

Peak heart rate :138

Peak blood pressure :224/110mmHg

Vo2 peak:22.6ml.min.kg

Symptoms :angina at peak exercise shortness of breath, right calf cramping

ECG:ST-segment depression

Development of exercise prescription

    Mr x wishes to progress to jogging but he is a candidate for coronary artery bypass surgery but wishes to medically manage his condition.

 

 

Exercise Training Recommendations

     Aerobic and resistance training may be best initiated in a monitored setting (e. g cardiac rehabilitation), consider comorbid conditions such as hypertension, diabetes, chronic obstructive pulmonary disease and peripheral arterial disease when developing and implementing an exercise programme.

     Type :Aerobic

     Modes:walking,cycling,swimming,etc

 Intensity :40-86‰ of HRR

Frequency and duration :4-7times per week, 30-60 min per session

Special consideration: exercise physiogist will determine instability if necessary.

Type :Resistance

Mode :universal type machine /dumbbells

Intensity :40-60%of direct or indirect 1RM

Frequency and duration :2-3 times per week, 1 or 2 sets per lift working through the major muscle groups 20-30mins.

Special consideration :exercise physiologist will determine that but avoid valsalva maneouver. Goals are to increase skeletal muscle strength and endurance.

      A myocardial infarction (MI) is the formation of infarct tissue within the layers of the heart. An MI occurs when there is a substantial decrease or complete disruption of blood flow through a coronary artery so that the downstream tissue is deprived of oxygen for an extended period of time. The infarct region is composed of necrotic tissue.

Typically, an MI is caused by thrombus formation in a coronary artery that has a degree of established coronary artery disease or atherosclerosis.

The term acute MI refers to the sudden occurrence of ischemia leading to myocardial damage and subsequent infarction.

  Signs and symptoms

    Pain is the most common complaint in the patient experiencing an MI. Patients often described their pain as a squeezing or burning sensation or a heavy or crushing discomfort. This Symptom is the result of severe myocardial ischemia and is termed angina pectoris.
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