Methods of rehabilitation after myocardial infarction

From this article you will learn: what includes the rehabilitation measures after myocardial infarction. What tasks it performs, the time and place( hospital, sanatorium, house).Why are rehabilitation measures needed, and how do they affect the course of the disease.

  • Physical recovery
    • Physical recovery
    • Sexual activity
    • Psychological recovery
    • Secondary prevention
    • Conclusion

    Rehabilitation after a violation of blood flow in the heart muscle is a combination of activities carried out under the strict supervision of medical professionals, which are aimed at a qualitative and rapid recovery of physical fitness beforethe maximum possible for a particular patient level. They also need to reduce the risk of recurrent myocardial infarction and stabilize myocardial function.

    The main areas of rehabilitation:

    1. Physical recovery to return to independent maintenance and work.
    2. Psychological adaptation to their condition and disease.
    3. Secondary prevention of recurrence of the disease.

    The patient's recovery is carried out continuously, from the moment of hospitalization and throughout the whole subsequent life.

    None of the items is basic - only cumulative work in all three directions can guarantee the required result:

    • quickly return to the familiar, full life;
    • come to terms with the fact of the disease, learn how to live with it correctly;
    • significantly reduce the risk of repeated cases of blood flow disorders in the tissues of the myocardium.

    Without the rehabilitation, the success rate of treatment is lower by an average of 20-40%.

    Carrying out of measures for recovery is divided into the stages:

    Stage Its name and average dates Location
    1 Inpatient( 1-10 days) Department of intensive care or intensive care unit

    Department of Cardiology

    2 Rehabilitation and stationary( 11-28 days) Center for medical or cardiac rehabilitation

    Cardiac discharge in a sanatorium

    3 Out-patient( about 2 months) Policlinic

    Therapeutic and medical center

    House

    Rehabilitation programactivities is compiled individually, depending on:

    • the extent of myocardial damage;
    • general status;
    • presence and stage of compensation for other diseases in the patient;
    • response to ongoing treatment.

    Given this, the dates indicated in the table are only approximate, general and may vary considerably between patients.

    A rehabilitation physician works at all stages of recovery with the patient, who works closely with the treating therapist or cardiologist to fully assess the condition of the heart muscle, its functionality and ability to tolerate stress.

    Physical recovery

    Special schemes of curative gymnastics with a gradual expansion of the volume of loads, in accordance with the period from the violation of blood flow in the myocardium. All of them are divided into rehabilitation stages, but they can vary depending on the patient's well-being.

    In the process of performing any exercises, evaluate:

    Indicator Its changes
    General condition Moderate fatigue

    Severe fatigue that does not last for a long time

    Angina pectoris No

    Moderate, pass on their own

    Expressed, require drug correction

    AD Increase for upper - no more than 40 mm Hg.the lower one is not more than 12

    Or the decrease of the indices is not more than 10 units

    Heart beat frequency Increase by no more than 20 per minute

    Or decreasing by 10 units maximum

    Respiratory disturbance It is permissible to increase not more than 6 per minute
    Changes in the cardiogram Signs of blood flow disturbance( ST segment decline)

    Violation of the rhythm of contractions

    Pulse blockage

    For any pathological changes, it shows:

    1. Load reduction.
    2. Complete cancellation of training if the indicators worsened significantly.

    Usually, patient recovery is performed according to the program indicated in the table below. The terms of rehabilitation in the first stage can be reduced to one week if:

    • the patient is younger than 70 years;
    • the risk of complications from the vessels and the heart is low( estimated on a special scale, taking into account the extent of myocardial tissue damage and reaction to treatment);
    • there is no serious concomitant pathology( diabetes, cardiovascular disorders in the brain and heart, marked arteriosclerotic lesions of the arterial system, etc.);
    • there is no reduction in the fraction of the ejection of the left ventricle( a sign of the safety of its function is normal to decrease);
    • there were no violations of the rhythm of contractions of the heart( brady or tachyarrhythmia);
    • has the opportunity to continue rehabilitation activities in a specialized center.
    Stage Location Days Loading capacity
    1 Intensive therapy 1 Strict bed rest

    Turning in bed

    Raising the head of the bed for no more than 10 minutes 1-3 times a day

    2-3 Sitting in bed and / or armchairup to 20 minutes 1-3 times

    Sitting seated

    Starting exercise therapy under the supervision of the instructor no more than 5 min

    4-7 Get up and walk next to the bed 2-3 times a day

    exercise therapy( therapeutic exercise) up to 10 min per day

    Cardiology 8-10 Sidein the armchair and / or bed all day long

    Go to the toilet on the wheelchair

    Walk around the bed and in the ward - gradually increasing the number of minutes

    Perform exercise therapy 10-15 min

    With 10 Leave the room

    Increase the loadon the well-being, passing from 50 to 500 meters daily, with breaks for rest

    To practice therapeutic gymnastics up to 20-30 minutes twice a day

    2 Center for cardiac rehabilitation or sanatorium 14-28 Do cardio exercises( treadmill, bicyclergometry) with a gradual increase in intensity and time

    Do dosed walking in the open air

    Exercise exercises in therapeutic gymnastics for 40-60 min 2 times a day

    3 Home + sports and medical center C 29 Dosed outings in the open air up to 3,5 km 3 times a week, at the initial stage - with rest and at a slow pace

    Climbing stairs to 3-5 floors, also with breaks 1-2 times a week( does not replace walks!), Starting with a slow step to 1step for 3-4 with

    For20-30 minutes a day( at home or in a specialized center)

    Click on the picture to enlarge

    Criteria for transferring the patient from the first to the second stage of rehabilitation:

    • can pass 500 meters without stop and 1500 with interruptions;
    • independently ascends to one floor( two flights of stairs).

    Objectively evaluate these criteria can only be after stress tests:

    1. Daily monitoring of the electrocardiogram with mandatory "ladder".
    2. Treadmill - recording a cardiogram while working on a treadmill.
    3. Veloergometry is the study of an electrocardiogram on a background of riding a stationary bike.

    Rehabilitation after myocardial infarction at home includes everyday household chores. The possibility of their implementation depends on the degree of reduction of cardiac function( there are 4 classes that characterize the lack of blood flow).

    Activities and workloads Heart failure class
    First-second Third Fourth
    Walking speed up to 120 steps per minute Yes Yes No
    Walking speed up to 90 steps per minute Yes Yes Yes
    Raising stairs(floors) Up to the fifth Up to the third No
    Lifting and carrying of weights( in kg) 8-16 Up to 3 No
    Sexual relations Yes Yes No
    Firewood saw Yes No No
    Vacuuming Yes No No
    washing, washing windows or cars Yes No No
    Wiping dust Yes Yes No
    Washing dishes Yes Yes Yes
    Tailoring Yes Yes No
    Digging beds Yes No No
    Watering at the site with a hose Yes Yes No
    Watering on the site of the watering can Volume of the watering can to 10 l Volume of the watering can to 3 l No
    Planting of the tree seedlings Yes No No
    Planting of seedlings Yes Yes No
    Harvesting from bushes and trees Yes Yes No

    Sexual activity

    The loss of the opportunity to lead a normal sexual life is an important psychological aspect of the disease. Almost all patients are concerned about the return to active sex life, but embarrassment prevents the doctor from asking about it.

    Of course, after a heart attack, excessive and untimely sex life increases the possibility of deterioration, up to a repeated violation of blood flow to the heart muscle and the development of life-threatening conditions.

    If the first month after an episode of acute cardiac arrhythmias occurs without complications, and physical exercises do not cause stenocardial pain, sexual life can begin with 3-4 weeks.

    Objective criterion of the patient's readiness for sexual activity is absence of deterioration of the condition( subjectively and according to the ECG data) with the heart rate increasing to 130 per minute and increasing the pressure to 170 mm Hg. Art.on the background of stress tests.

    If the load causes only mild pain syndrome, but there are no characteristic signs of decreased blood flow in the myocardium or arrhythmia, then you can return to active sex life using nitroglycerin before the act itself.

    A significant reduction in cardiac function( grade 4 according to classification) is a contraindication for the resumption of sexual activity.

    Psychological recovery

    After the disturbed blood flow in the myocardium, there are signs of minor depression in 25-27% of patients, and large - in 15-25%.A high level of anxiety is detected in more than 50% of cases.

    Stress symptoms are present in 75% immediately after a heart attack, in 12% of cases they persist even after a year.

    Psychological disorders cause:

    • high risk of repeated violations of blood flow to the heart tissues;
    • decrease in success of medical and rehabilitation measures;
    • significant reduction in efficiency;
    • deterioration of the overall quality of life.

    Relieving the psychological discomfort associated with the awareness of your illness and the ability to preserve the habitual conditions of life is the second of the main areas of rehabilitation, greatly increasing the success of the other two.

    Stage Location Activities
    1 Resuscitation or intensive care Explanatory discussions:
    • about the disease;
    • its possible consequences;
    • treatment methods;
    • effectiveness of rehabilitation.
    Cardiologic hospital Repeated interviews with answers to emerging questions
    2 Sanatorium or cardiorehabilitation center Individual training with a psychotherapist for assessing the psychological state( on the scale of anxiety and depression)

    Group trainings and educational programs

    Psychological video and audio training

    Drugs fromgroup of antidepressants( sertraline, escitalopram) in case of detection of clinical depression and violation of adaptation processes

    3 Ambulatory Communicating with the district therapist and cardiologist about the degree of heart disorders, the effectiveness of treatment and rehabilitation, the further plans for therapy

    Classes with a therapist within the group or individually

    Medication support - according to

    Secondary prevention

    Secondary prevention is a set of measures aimed atto reduce the possibility of repeated episodes of blood flow disorders and the risk of life-threatening complications of the disease.

    Smoking

    It is necessary to completely abandon the use of any kinds of nicotine products( cigarettes, cigars, hookah).Tobacco smoking increases the risk of recurrence of a heart attack by 2-4 times, and death from it occurs in 40-50% of patients.

    It is unacceptable to use any number of cigarettes per day - even a single smoking keeps the risk of complications.

    To achieve the effect, the use of:

    1. is recommended. Psychological training and group training.
    2. Use of nicotine replacement therapy( spray, patch, chewing gum).
    3. Use of medicines to suppress dependence( Zeban, Champix).

    Substitution and drug therapy may be prescribed only by the attending physician, in the absence of contraindications.

    Arterial hypertension

    For persons who have experienced an episode of impaired blood flow to the tissues of the heart muscle, normalization of pressure is an important element of the treatment. If the high figures of the indicator remain, the probability of a recurrent infarction reaches 60-70%.

    In the treatment of hypertension, standard groups of drugs and their combinations are used. Regardless of the correction scheme, the target pressure should be 139-130 at 89-85 mm Hg. Art.

    Diabetes of the second type

    The presence of a concomitant pathology such as diabetes in a patient with a heart attack increases the possibility of complications up to 20-30%, depending on the duration of the disease and the maintained level of glucose in the plasma.

    The recommended range of glycosylated hemoglobin in biochemical blood analysis: 6.5-7%.Absolutely impermissible is its significant reduction( hypoglycemia).

    For correction, it is preferable to use drugs without the property of reducing blood sugar:

    • inhibitors of sodium glucose cotransporter: Empaglyflozin, Dapaglyflozin, Kanagliflozin;
    • inhibitors of dipeptidyl peptidase: Sitagliptin, Vildagliptin;
    • biguanides: Metformin.

    Disturbance of fats metabolism, or dyslipidemia

    The laboratory manifestations of impaired fat metabolism are the indices determined in venous blood:

    • cholesterol more than 4 mmol / l;
    • low density lipids more than 2 mmol / l.

    Such high figures are the main enemy of the vascular system, causing atherosclerotic changes in its arterial part and leading to a decrease, and then to a violation of blood supply in all organs, including the myocardium.

    To reduce the indices to normal values ​​it is recommended:

    1. Observe the Mediterranean diet, the main criteria of which are: vegetables and fruits daily up to 500 g, consumption of fatty fish( salmon, herring, trout) two or more times a week, daily consumption of 1 cup dryof wine.
    2. To consume animal fats in an amount not exceeding 7% of the daily amount of calories.
    3. Limit the intake of cholesterol with food 200 mg per day.
    4. The amount of salt per day should not exceed 4 g.
    5. Actively use medicamentous support for statins: Atorvastatin, Rosuvastatin.

    Pain syndrome

    In addition to the suffered episode of cardiac arrhythmias, other pains other than vascular and cardiac diseases may be of concern to the patient:

    • head,
    • muscular,
    • bone.

    Any pain syndrome requires a drug correction. For patients after acute infarction, the use of standard non-steroidal analgesics( Ketoprofen, Nimesulide, etc.) can cause blood clots in the vascular bed.

    In such cases are recommended for use: Tramadol, Paracetamol and Naproxen.

    Conclusion

    Carrying out all types of rehabilitation activities at each stage of recovery after myocardial infarction:

    • significantly improves treatment success;
    • almost doubles the possibility of complications;
    • prevents the worsening of the course of heart disease.

    Dosed physical exercises should not end after two months after a heart attack - they need to continue for life, but not excessive. The option of walking in the fresh air is optimal, while you can refuse from the stair flights and the exercise bike.

    All items of secondary prevention are general recommendations not only for the rehabilitation period. Their observance allows you to extend your life by more than 8 years.