High Risk Case Study Sudbury Regional Hospital Cardiac Rehabilitation

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High Risk Case StudySudbury Regional Hospital
Cardiac Rehabilitation
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High Risk Case Study

• 66 year old male
• MI 16 years ago and 2 months ago
• CABG 6 years ago
• Cardiac Arrest during recent Angiogram

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High Risk Case Study

• Left Ventricle Ejection Fraction Grade 4 (
  less than 20)
• Congestive Heart Failure( NYHA Class II)
• TIA
• PVD
• Osteoarthritis

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CORONARY RISK FACTORS

• Hypertension
• Dyslipidemia
• Obesity
• Stress
• Diabetes
• Inactivity
• Family History

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MEDICATIONS

• Digoxin
• Coumadin
• Aldactone
• Enteric Coated ASA
• Nitrong
• Accupril
• Lasix
• Carvedilol
• Insulin
• Ativan
• Slow K

Mr..H. Nitrong SR 2.6mg
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FUNCTIONAL CAPACITY

• 3.5 - 4 Mets (metabolic equivalents)
• Moderate Dyspnea with ADL
• Walked 550 feet on 6 min. walk test

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RISK STRATIFICATION SCORE

• Total Score from both Risk of Disease Progression
  and Acute Event 84.3

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HYPERTENSION

• Medication
• Control weight
• Reduce sodium - less than 3 gm/day

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DYSLIPIDEMIA

• Medication
• Low fat diet
• Exercise

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OBESITY

• Exercise to expend 200 cal/session
• BMI 20-25/ WHR lt1
• 1500-1800 caloric intake daily
• Low fat, low sodium diet
• Referral to dietician

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INACTIVITY

• Balance activity with rest
• Combination wt./ non-wt.bearing exercise
• Must be stable (NYHA I-II)
• Exercise capacity of gt 3 METS
• 500 feet on 6 min. walk test

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F.I.T.T. PRINCIPALFREQUENCY

• 3-5 Times per week
• Can try shorter bouts( 5-10min.) of 2-3
  sessions per day

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F.I.T.T. PRINCIPALINTENSITY

• Based on treadmill test and/or 6 min. walk test
• 40-75 Vo2max
• Karvonens formula
• RPE and Dyspnea scale

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F.I.T.T. PRINCIPALTYPE

• Aerobic activities recommended
• Resistance training -high rep, low wt.

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F.I.T.T. PRINCIPALTIME

• Brief initially 2-5 min. per session, increasing
  this by total of 5 min. per week
• Rest periods between intervals
• Progressively increase time to 20-30 min. total
  as patients tolerance improves

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STRESS

• Medication to reduce anxiety
• Regular exercise
• BDI46
• Stress management
• Assess social and family support
• Quality of Life Assessment tool

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DIABETES

• Regular exercise
• Medication
• Diabetes Educator