Revascularization of the Heart and Exercise Prescription.

Revascularization of the Heart and Exercise Prescription.                        

Medical History                

Mr X is a 67 years old who previously had an unremarkable medical history. He is sedentary and has been for most of his adult life. He was admitted within the last month for unstable angina.               

Procedures :progress cardiac catheterization and off-pump two -vessels CABS.                                    

Following PTCA  and stent placement at the first admission, he had early recurrence of angina and an anterior -septal infarction. Having declined restudy, he had a trial on medical management. His clinical course was complicated by progressively limiting postinfarct angina.

Hospital Course                  

Cardiac catheterization demonstrated that the left anterior descending coronary artery had developed critical restenosis    proximal to the stent. There was a long 60% stenosis attributable to dissection distal to the stent.

Bypass surgery was advised. Two -vessel off-pump bypass was performed. His postoperative course was uneventful. He was discharged to home convalescence on postoperative day 3.

Diagnosis

Principle diagnosis : Post-infarct angina.

Secondary diagnosis:       

Coronary artery disease, surgical procedures anteroseptal infarct, PTCA. to the left anterior descending artery, diabetes mellitus, chronic obstructive pulmonary disease.                

Medications. Lopressor, Ecotrin, Albuterol inhaler, and Micronase with entrance into cardiac rehabilitation in 10 days.

 

Exercise Prescription

Outpatient Cardiac Rehabilitation:

Following CABS, the patient returned to cardiac rehabilitation 4 weeks post-surgery.

The patient had an uncomplicated postsurgical course and had experienced no further symptoms since discharge.

The patient was restarted in the programme as follows.                               

Resting heart rate          :72.        

Resting blood pressure   :143/84.

Initial Exercise Programme

Treadmill walking:                

2.0mph/0% grade for 10 min Combined arm/leg ergometry                                      = 100 W for 10min

Upper body ergometry                   =  30 to 50 W for 5 min.             Stepper                                          =  6  MET for 5 min.  

Hydraulic resistance Machine     = 2 set of 3 exercises for 10 repetitions.

Patient completed 6 weeks in the programme following surgery at the following workloads. Initially, 6 weeks were completed post -PTCA/stent therapy before surgery.

Treadmill walking                        =   2.5 mph /3% grade for 10 min.                                 

Combined arm/leg ergometry = 100 to 125W for 10min.                               

Upper body ergometry                  =  100 W for 5 min.                      

Rower                         =  50 to 75 W for 10min.                               

Hydraulic resistance machine              =     2 sets of 3 exercises for 10 repetitions.       

Exercise heart rate:

90 to 96 beats.min.  Exercise rating of perceived exertion :12

Remainder of programme was uneventful. Patient completed a total of 12 weeks from his initial start and returned to his home walking programmes and activities of daily living.

Question for this week.           

Do you agree when a person has coronary artery disease, many clinical procedures may be elected to restore blood flow throughout the myocardium.


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