- Cardiac rehabilitation in hospital
- Cardiac rehabilitation: first steps
- Cardiac rehabilitation: healing changes
- Rehabilitation after a heart attack: step by step
- Who is rehabilitation for?
- How to practice so that a heart attack won't happen again
In Poland, cardiac rehabilitation follows specific patterns. There is a different procedure for each event: heart attack, implantation, stents, bypass or pacemaker.
Whethercardiac rehabilitationsucceeds depends primarily on the patients. These, unfortunately, despite the disease, do not want to change the habits that contributed to the fact that their lives were seriously endangered. Such attitudes of patients include, on the one hand, the very high effectiveness of cardiological treatment, and, on the other hand, a great reluctance to physical activity, he althy eating and regular medication.
There are also other reasons why effective rehabilitation in cardiac patients is difficult. Most patients have additional conditions that manifest themselves as pain or shortness of breath. These patients usually lead a "armchair" lifestyle, which makes any physical effort difficult for them to accept.
Mental problems are a separate issue. Most of the patients suffer from more or less advanced depression, anxiety, which is also an obstacle in proper rehabilitation after a heart attack, implantation of by-passes, etc. Therefore, cardiac rehabilitation should be carried out in several ways. It is not only stimulating the patient to physical activity. It is also a necessity to cooperate with a psychologist and dietitian.
Cardiac rehabilitation in hospital
If the patient has to lie down, prevention of thromboembolic complications, contractures and pneumonia is imperative. For this purpose, the patient is encouraged to regularly perform isometric exercises, i.e. contracting and relaxing the muscles. In order to avoid contractures, the patient, together with the therapist, performs passive exercises (e.g. the therapist lifts and moves his arm to the side) or active-passive exercises, i.e. exercises that are performed alone, and the therapist supports him by guiding his arm in the right direction. People are also taught to get out of bed slowly to prevent orthostatic hypotension, which is a sudden drop in blood pressure. The patient must remember not to get up from the bed, but to turn over to the side first, lower his legs to the floor, sit on the bed and stand up after a few moments.
If cardiac surgery, such as angioplasty, was performed bythe brachial artery, the patient can get out of bed after 6 hours. When the femoral artery was used - only after 12 or 24 hours. For three days after the cardiac surgeon's intervention, the patient exercises 3 times a day, but only for 3-5 minutes. From the fourth day, he exercises twice a day - a little more intensively and for about 15 minutes. The first walk with the therapist takes about a minute. This time is gradually increasing. It is similar with exercises - it starts with one and ends with multiple repetitions.
Cardiac rehabilitation: first steps
In most cases, rehabilitation begins in the cardiology department. With the help of a therapist, the patient learns to get up, performs self-service activities (washing, brushing), walking down the corridor and up the stairs. Further improvement takes place in the cardiac rehabilitation department or outside the hospital: in sanatoriums or day departments. After performing the tests, the patient goes to a group that performs pre-planned exercises. Other exercises are performed by heart attack patients, other people with heart failure, and still other patients after implantation of by-belts or a pacemaker. When the patient is fit and the performance parameters improve, he starts the next stage of exercises. He exercises more and more intensively, but also according to a specific pattern. If a modification of the exercises is needed, the patient is transferred to another group.
Cardiac rehabilitation: healing changes
Interventional cardiology has made such enormous progress that in just a few days, eg after an uncomplicated heart attack, the patient "gets back on his feet", so he does not feel the seriousness of the situation in which he finds himself. And when the first fear is over, he quickly resumes his old habits - smoking, fatty food, abusing s alt and sugar. Meanwhile, the modification of existing habits is called secondary prevention of heart attacks. First you have to quit smoking, because nicotine damages the walls of blood vessels, accelerates the formation of atherosclerotic plaque, promotes the formation of blood clots. You also need to make changes to your diet. Excessive consumption of bread, red meat, animal fat, and full-fat dairy products is the pathway to atherosclerosis. After a heart attack, you should eat low-calorie foods, vegetables containing fiber, and fruits rich in vitamin C. Keep sugar and s alt to a minimum. Every day you need to drink 1.5-2 liters of unsweetened drinks (unless there is heart failure). A low-calorie diet combined with exercise will help you get rid of excess kilograms, lower the concentration of bad cholesterol (LDL) and increase the concentration of good (HDL). An extremely important element of secondary prophylaxis is strict adherencemedical recommendations. After a heart attack, you should regularly, regardless of your well-being, take prescribed medications, report for check-ups and, if any, treat other diseases, e.g. hypertension, diabetes, arrhythmia, etc.
Rehabilitation after a heart attack: step by step
After leaving the hospital, you shouldn't give up your activity. If the patient is weakened, doing the daily toilet by himself may be considered exercise. The next step is to prepare the meal. Then, walking for a few minutes around the apartment turns into a walk - at the beginning 15 minutes and gradually to 45. Extending the distance should be spread over 6 weeks after leaving the hospital. After each longer walk, you should rest for a dozen or so minutes. Rehabilitation includes minor cleaning works in the house, e.g. dusting off, watering flowers. The next step is to carry small loads up to 3 kg. When the patient regains strength and finds out that movement promotes their he alth and well-being, they can choose another form of activity - play volleyball or basketball.
Who is rehabilitation for?
People who have undergone uncomplicated heart attacks, cardiac surgeries, obstructive arteriosclerosis of the lower limbs, as well as by-passes, pacemakers and cardioverter implants, after "ballooning", i.e. percutaneous angioplasty of the coronary arteries, are eligible for cardiac rehabilitation. Rehabilitation is also necessary in people with hypertension, stable heart failure, after myocarditis, in cardiomyopathies, because exercise prolongs life. The patient should be as physically active as his he alth condition allows. Stillness, regardless of whether it is caused by a malaise or the fear of deteriorating he alth, is always deadly for those suffering from heart disease. That is why education is so important so that the patient knows when to start exercising and how to do it.
How to practice so that a heart attack won't happen again
- After a heart attack or cardiac surgery, we do not perform resistance exercises, i.e. we do not dig the garden or move a wardrobe.
- We avoid keeping our hands up for a long time (hanging curtains).
- We don't do any work or exercise that requires you to hold your breath.
- We start the exercises 1-2 hours after taking the medications.
- The first attempt at sexual intercourse can be made 2 weeks after the heart attack. But you mustn't
- help yourself with alcohol, drugs or pills. You should also avoid additional emotions, i.e., for example, not to engage in intercourse with a new partner.
- With low physical capacity, it is better to exercise several times a day for 3-4 minutes thando one 30-minute workout.
- We do endurance exercises, e.g. walking, every day. Strength exercises (with dumbbells) 2 times a week for 10-20 minutes. But here's an important note - individual strength training sessions must be separated from each other by a 48-hour break.
- Obese people should exercise 5-7 times a week. Effort should be moderate, but take at least an hour. If we focus on marches, we walk at a pace that allows us to be comfortable
- to talk. Nordic walking, cycling on mild terrain and swimming are also recommended.
- Who, apart from the heart, has kidney problems, should exercise more often, but briefly, so as not to overburden the body. Diabetics need to check their blood sugar regularly, and COPD patients - satma, or blood oxygen saturation. In osteoporosis, marches are recommended. People with degenerative changes should exercise in water to relieve the joints.
- After implanting a pacemaker or other heart-regulating device, avoid exercise by
- the first week after the procedure, so that the apparatus "settles" in the body and the wound heals. Also, do not raise your hands above your head or swim so that the device does not move. After 6 weeks, you can start rehabilitation classes and start playing volleyball, basketball or swimming.
- Exercise-induced arrhythmia is a contraindication to exercise.
- When we regain fitness (usually it takes 6 weeks with diligent rehabilitation), we should exercise over an hour 3 times a week. Such classes are safe for heart attack patients, as well as for people with implanted devices that regulate the work of the heart.
- Exercise should be stopped when chest pain, shortness of breath, dizziness, cold sweat, spots in front of the eyes or muscle aches appear.
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