Cardiac rehabilitation of patients

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According to statistics cardiac diseases are one of the most widespread causes of death in the Republic of Azerbaijan. The most noticeable problems in the control of cardiac diseases are:

  • Late and incorrect diagnostics;
  • Ineffective surgery or conservative treatment;
  • Absence of dynamic observation over the risk factors for cardiac diseases during the post-hospitalization period.

All these problems abruptly increase the risk of repeated heart attacks, worsen the course of the disease, increase the death rate of patients who could have return back to their productive active life. These problems can be avoided by means of programs for rehabilitation after infarction, stenting, heart surgeries, in case of CAD, hypertensive disease, angina pectoris, cardiomyopathy, myocarditis and other cardiac diseases. These programs include:

  • Advice from highly qualified physicians of the Center.
  • Comprehensive diagnostics and examination of the cardiovascular system.
  • Effective program of physical and social rehabilitation of cardiac patients.
  • Support in formation of healthy lifestyle, correct nutrition, minimum medication support under continuous medical control of the risk factors for cardiac diseases.

Cardiac rehabilitation is applicable for patients of different age and many forms of cardiac diseases. In particular, cardiac rehabilitation is an effective choice if you suffered or still suffer from one of the following diseases:

  • Myocardial infarction;
  • Some congenital heart diseases;
  • Cardiac failure;
  • Coronary artery bypass graft surgery;
  • Angina pectoris;
  • Angioplasty or stenting;
  • Myocarditis;
  • Heart transplantation;
  • Cardiomyopathy;
  • Heart valve replacement surgery..

Rehabilitation in case of cardiac diseases is often divided into phases that include exercises controlled by the physician, development of the most optimum diet, emotional support and methodical lifestyle teaching. Rehabilitation in case of cardiac diseases is a program that is based on individual peculiarities of patients, consists of exercises, events and training, and is aimed at recovering health after one or another heart disease or after a cardiac surgery.
The objectives of cardiac rehabilitation are to restore previous capabilities of the body, restore the lost force, and first of all prevent the risk for relapse of cardiac complications in future. At our institute an individual remedial treatment plan will be selected for each patient. Therapy is performed under control of highly qualified specialists. Up-to-date and effective procedures are used. During the implementation of the program the state of the patient is permanently monitored which makes it possible to trace all changes in health, safe it and assure the maximum efficiency of rehabilitation.

mitri.az Cardiac rehabilitation program after myocardial infarction, stenting, in case of stable effort angina, chronic cardiac failure.
  1. Everyday cardiologist examination (except for weekends).
  2. Specialist advice: nutrition specialist, psychotherapist, physiotherapist.
  3. Complete set of instrumental cardiovascular examination methods:
  • ECG — at least once a week and when indicated;
  • Echo-CG (heart USI), echo-CG with load if required;
  • Loading tests with respiratory metabolism monitoring (bicycle ergometry, treadmill test, 6 minute walk test – one type of testing two times during the program at the discretion of the physician);
  • 24 hour Holter ECG monitoring;
  • 24 hour blood pressure monitoring;
  • Pleura USI (if required);
  • Monitoring pulse oxymetry.
  1. A wide range of clinical analyses:
  • Complete blood count;
  • Chemistry panel;
  • Urine analysis.
  1. Effective methods of physiotherapeutic impact:
  • Swimming in the rehabilitation pool (in the absence of contraindications) under supervisor control;
  • Individual remedial physical training (when indicated);
  • Exercises with cardio-vascular machines under supervisor control including an anti-gravity treadmill;
  • Galvanic baths (in the absence of contraindications);
  • Massage course (in the absence of contraindications).
Studies, advisory services, procedures made within the program when indicated:
  • Specialist advice: endocrinologist, pulmonologist, neurologist;
  • Instrumental methods of examination: USI of the major arteries of the head, arteries and veins of the lower extremities, soft tissues, roentgenography of lungs, spirometry, determination of body composition;
  • Clinical analyses: blood test for TTH, urinary protein determination, blood glucose determination;
  • Procedures: low flow oxygen therapy (ongoing or during physical training).
Additional services (not included into the program price), with indications and contraindications determined by the physician:
  • Hyperbaric oxygenation;
  • Inhalations in case of bronchial pathology;
  • Interval vacuum therapy;
  • Advice from ophthalmologist, gynecologist, urologist, traumatologist, gastroenterologist;
  • A wide range of USI using expert class equipment;
  • Physiotherapeutic methods for treating accompanying diseases;
  • Set of dental services;
  • Acupuncture ;
  • Manual therapy.
mitri.az A cardiac rehabilitation program after coronary artery bypass graft surgeries, cardiac valve surgeries includes:
  1. Everyday cardiologist examination (except for weekends).
  2. Specialist advice: nutrition specialist, psychotherapist, physiotherapist.
  3. Complete set of instrumental cardiovascular examination methods:
  • ECG — at least once a week and when indicated;
  • Echo-CG (heart USI), echo-CG with load if required
  • Loading tests with respiratory metabolism monitoring (bicycle ergometry, treadmill test, 6 minute walk test – one type of testing two times during the program at the discretion of the physician);
  • 24 hour Holter ECG monitoring;
  • 24 hour blood pressure monitoring;
  • Pleura USI (if required);
  • Monitoring pulse oxymetry.
  1. A wide range of clinical analyses::
  • Complete blood count;
  • Chemistry panel;
  • Urine analysis.
  1. Surgical support, wound dressing if required.
  2. Effective methods of physiotherapeutic impact:
  • Exercises with underwater machines under supervisor control;
  • Individual remedial physical training (when indicated)
  • Exercises with cardiovascular machines under supervisor control including an anti-gravity treadmill
  • Collar zone massage course (in the absence of contraindications).
Studies, advisory services, procedures made within the program when indicated:
  • Specialist advice: endocrinologist, pulmonologist, neurologist;
  • Instrumental methods of examination: USI of the major arteries of the head, arteries and veins of the lower extremities, soft tissues, roentgenography of lungs, spirometry, determination of body composition;
  • Clinical analyses: blood test for TTH, urinary protein determination, blood glucose determination ;
  • Procedures: low flow oxygen therapy (ongoing or during physical training), shortwave ultraviolet irradiation on the post-surgical wound areas.
Additional services (not included into the program price), with indications and contraindications determined by the physician:
  • Hyperbaric oxygenation:
  • Inhalations in case of bronchial pathology;
  • Interval vacuum therapy;
  • Advice from ophthalmologist, gynecologist, urologist, traumatologist, gastroenterologist;
  • A wide range of USI using expert class equipment;
  • Physiotherapeutic methods for treating accompanying diseases;
  • Set of dental services;
  • Acupuncture;
  • Manual therapy.
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Coronary artery bypass graft (CABG) is a complex surgery that requires to be followed by special rehabilitation procedures. They are to prevent complications, fix the achieved remedial effect, return the patient to the full life. Patients after CABG can undergo an effective cardiac rehabilitation program that will be implemented by competent specialists. Unfortunately, methods of restoration of patients after CABG other than drug therapy are hardly used in our country. In this case patients need cardiac rehabilitation, a special complex of restorative procedures carried out by specialists in a specialized institution. Our institute provides restorative programs for patients after coronary artery bypass graft. Patients with 2-14 weeks after the end of hospital treatment can be admitted to the rehabilitation program. Why is a cardiac rehabilitation course after CABG necessary? The surgery is performed on an open heart to restore the impaired blood flow in the myocardium. It is rather traumatic, and taking into account that the surgery is made for patients with already weakened health (with an ischemic cardiac disease), recovery after it happens with difficulty sometimes. After CABG complications can occur. The most frequent delayed complication is graft occlusion (blockage). According to statistics, 20% of grafts become blocked in a year after the surgery, all the rest become blocked in 7-10 years. In other words, the “lifetime” of such a complex surgery for the physician and the patient as CABG is only 10 years! Fortunately, these terms can be significantly increased if after the surgery the patient undergoes comprehensive cardiac rehabilitation. Cardiac rehabilitation after CABG at our institute? Patients after coronary vessel stenting can be admitted for the rehabilitation program. Rehabilitation is indicated for those who were hospitalized for a short period of time as well as for those who still had symptoms of the disease after the surgery. An operated heart has considerable capabilities, the most important thing is to reveal them in a correct way. For patients after CABG we use a special program combining different techniques. A patient management plan is developed individually that improves the efficiency of rehabilitation. It considers all key points including the type of surgery (autoarterial, autovenous grafting), age of the patient, presence of accompanying diseases, etc. The state of the patient is permanently monitored, there are all resources to render emergency medical services at the health resort. Tasks of rehabilitation after CABG: • Prevention of complications, liquidation of surgery consequences. • Restoration of the heart functional reserve, mobilization of compensating mechanisms, adaptation of the heart to the modified blood supply. • Fixation of treatment effects. • Deceleration of the coronary heart disease. • Preparation of the patient for the everyday life, domestic loads. • Psychological, social, labour rehabilitation. • Methodical lifestyle training to maintain the results achieved by CABG for a long time. The successful implementation of the program demonstrates the fact that even after a serious heart surgery a person can lead an active life with reasonable limits instead of becoming disabled. How rehabilitation after CABG is performed at our institute: Cardiac rehabilitation after CABG lasts on the average 2 to 4 weeks and is performed by the help of physicians of different specialties and experienced nursing staff. Rehabilitation includes the services of cardiologist, psychotherapist, functional diagnostician, physiotherapist, laboratory doctor, nutritionist, rehabilitation physician. If required, other physicians can be involved to the diagnostics and treatment. Cardiac rehabilitation after CABG is performed in the following way: During the first 2-3 days of the program the state of the patient is determined. Examination is made, information about the disease is collected, laboratory tests, ECG, loading tests to determine the initial level of tolerable weight bearing, a set of special breathing exercises as well as other research are performed. The presence and functional class of postsurgical angina pectoris (if available) as well as accompanying diseases are determined. Individually, the risk for occurrence or reoccurrence of acute coronary events is determined. Physical capabilities of the patient, his/her psychoemotional status are evaluated; presence of and risks for postsurgical complications are defined. As a result of examination a case conference is carried out where an individual program is developed adapted for a specific patient. Physical capabilities of the patient and the drugs he/she takes as well as presence of and risk for complications are assessed. Psychological rehabilitation is also performed. The patient is trained how to behave and live correctly. The case conference determines an optimum scheme for physical rehabilitation. Then, a set of restorative measures is implemented including the use of drugs, a set of special breathing exercises, physical load under supervisor control (sets of remedial physical training, training walk, cardiovascular machines), physiotherapy (magnetotherapy, massage etc.). Tolerance for exercises and reaction to them are carefully traced, which makes it possible to plan an optimum load mode for each patient. The patient is advised by a psychotherapist. This helps the person set his/her mind on successful recovery, form the right attitude to the disease and treatment. Risk factors are controlled: hypertension, high glucose and cholesterol, excess weight etc. Affecting the risk factors allows avoiding complications, accelerate the recovery and improve the prognosis. The patient finishes the program with all required recommendations for further stages of treatment and examination, remains in contact with the physicians of the institute. Contraindications to rehabilitation after CABG: Cardiac rehabilitation is contraindicated for unstable patients. Pains in the region of the heart, signs of serious blood circulation failures, dangerous cardiac rhythm disorders, high blood pressure, the treatment of these and other serious states must be finished in hospital.
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Cardiac rehabilitation after a myocardial infarction is a program that helps achieve maximum recovery of health and return to the normal lifestyle. The disease is still considered as pessimistic and incurable. Nevertheless, up-to-date treatment standards make it possible to effectively cure the infarction, while rehabilitation helps patients avoid disability and recover their health. Investigations show that cardiac rehabilitation increases the survival rate after a myocardial infarction by 25%. We offer programs for after-treatment and adaptation to physical loads after a myocardial infarction. It will help you:
  • Lead an active normal lifestyle;
  • Return to work as fully as possible;
  • Control the state of your health;
  • Enjoy your life again.
Patients with 2-14 weeks after hospitalization can be admitted to the program.
Cardiac rehabilitation after a myocardial infarction is:
  • High quality diagnostics to evaluate your state and reserves in detail to select the best remedial treatment mode;
  • Individual meetings with the specialists of the institute in a comfortable mode;
  • Opportunity to render emergency first aid in case of health disturbances;
  • Personal cardiologist that will coordinate the therapeutic process;
  • Advice from other specialists, if required;
  • Teaching how to live with a coronary cardiac disease.
During the implementation of the program the state of the patient is permanently monitored which makes it possible to trace all changes in health, safe it and assure maximum efficiency of the rehabilitation.
Why is a cardiac rehabilitation course after a myocardial infarction necessary?
Rehabilitation of patients with cardiac diseases is performed in three stages systematically in hospital, health resort and polyclinic. However it is known that after hospital release patients go directly to the polyclinic stage. Therefore, it may seem that rehabilitation is not compulsory. It is necessary to treat and secondarily prevent atherosclerosis, modify risk factors and change the lifestyle to avoid repetitive ischemia.
However, there are a few undeniable facts:
  • If a patient feels better after an infarction, it does not mean that his/her objective state has improved.
  • Within half a year after the disease a person still has increased thrombin activity that predisposes to formation of clots in coronary vessels and threatens with a recurrent infarction
  • The damaged cholesterol plaque in the vessel heals minimum in several weeks, a clot that caused the disease and negatively affects blood supply to the myocardium also remains in the vessel for a long period of time
  • Most part of recurrent infarctions and complications develops during the first months after hospitalization.
These facts indicate that hospitalization is not enough for stable recovery. A person needs special remedial therapy to liquidate the pathological process that caused the myocardial infarction, to finally stabilize his/her state and avoid unfavorable outcomes of the disease.
Principles of rehabilitation after a myocardial infarction:
Rehabilitation is performed by the help of a whole team of physicians: cardiologist, nutritionist, physiotherapist, remedial physical training physician, neurologist, psychotherapist, laboratory doctor, functional diagnostician. If required, other physicians can be involved: endocrinologist, therapist, pulmonologist, etc.
The rehabilitation treatment after a myocardial infarction is performed in the following way.
Physicians evaluate the initial physical and psychological state of the patients; all required laboratory tests and instrumental investigations are performed; medical documents available from the hospital are learnt, consultations with individual specialists are carried out. Based on the state of the patient, presence of accompanying diseases, severity of the myocardial infarction, age and other features an individual patient management plan is developed. The program is implemented. First of all it includes drug therapy (its scheme can be revised if required), remedial physical training under physician control, physiotherapeutic procedures. Simultaneously the patient communicates with the psychotherapist to remove anxiety, depressive emotions, psychological discomfort. An adequate attitude of the patient to the disease is formed. Risk factors are controlled: smoking and alcohol withdrawal, reduction of body weight in case of obesity. The patient is taught, becomes more informed about the disease and its treatment. The state of the patient is permanently monitored which makes it possible to trace all changes in health. Before release general examination is repeated. The patient is released with considerable improvement and recommendations for the further polyclinic stage of rehabilitation. The program lasts for minimum 4-6 weeks.
When is rehabilitation after a myocardial infarction not performed?
Cardiac rehabilitation should be postponed if the patient has:
  • Severe rhythm disturbances (frequent and group ventricular extra systoles, seizures of ventricular tachycardia, type I and type II sinuatrial and atrioventricular blocks)
  • Level II-III blood flow deficiency,
  • Recurrent thromboembolic complications,
  • Thrombophlebitis in an active stage,
  • Unstable angina,
  • Aorta dissection,
  • Severe arterial hypertension resistant to drug treatment.
Decompensated accompanying diseases as well as other disorders that are life-threatening and require active drug treatment. Contraindications to rehabilitation treatment are a severe blood circulation deficiency (level III congestive heart failure, functional class III-IV congestive heart failure), decompensated heart deficiency. Besides, rehabilitation is not indicated for patients with serious and life-threatening states that require hospital treatment.

Stenting is performed to restore an impaired blood flow in the myocardium. During this procedure a wire mesh tube is inserted into the narrowed coronary artery. It deploys under the influence of the temperature of the body, this mechanically expands the vessel and improves the blood flow. Stenting is considered to be a minimally invasive surgery, however in the place where the stent is located the vessel wall remains inflamed for several weeks. Moreover, a possibility remains that a coronary syndrome will appear..
Unfortunately, methods of restoration of patients after stenting other than drug therapy are hardly used in our country. In this case patients need cardiac rehabilitation, a special complex of restorative procedures carried out by specialists in a specialized institution. Our institute provides restorative programs for patients with cardiac angina.
Why is a cardiac rehabilitation course after stenting necessary?
It is considered that after stenting a patient can return to his/her normal and even more active lifestyle very soon. However, it is not always so in reality. The changed conditions of blood supply to the myocardium require the adaptation of the organism that will take time and need special procedures to be performed. After stenting the problem with in-stent restenosis is always urgent. It appears due to the malignant course of atherosclerosis, maintenance of the previous lifestyle and bad habits, lack of risk factor correction and incorrect drug treatment or interruption of drug treatment without permission. The duration of the effect achieved after stenting is quite urgent. The fact is that in approximately 15-20% of cases after stenting the vessels narrow again after a while. To prevent this slightly reversible process and provide the best results of stenting it is necessary to undergo comprehensive remedial treatment soon after the surgery.
Who can be admitted to a post-stenting cardiac rehabilitation course at our institute?
Patients after coronary vessel stenting can be admitted to the rehabilitation program. Rehabilitation is indicated for patients after invasive surgery. We have a special post-stenting rehabilitation program that is individually adapted for each patient taking into account his/her state and peculiarities. The program is implemented by skilled physicians who use the experience of foreign cardiologists when selecting and performing treatment procedures. Great attention is given to correction of all accompanying diseases the patient has (chronic obstructive pulmonary disease, diabetes mellitus, obliterating atherosclerosis, obesity, sleep disturbances etc.) and his/her psychological state. The best results can be achieved when rehabilitation is based on the principles of a comprehensive approach, consistency and continuity. Our patients receive these in full. The institute has rich capabilities for diagnostics and therapy of cardiovascular diseases, many techniques we use are unique. Tasks of rehabilitation after stenting:
  • To restore the functional capabilities of the heart and organism as much as possible.
  • To prevent postsurgical complications, especially the recurrent narrowing of the vessel with a stent.
  • To improve the prognosis.
  • To slow down the progression of the coronary cardiac disease, to improve the prognosis of the disease.
  • To suppress the activity of the pathological process that caused the disease.
  • To prevent the progression of the disease, the development of complications (in particular the myocardial infarction).
  • To decrease and optimize the drug therapy the patient receives.
  • To achieve the control over the symptoms of the disease, to reduce their severity as much as possible.
  • To improve the physical capabilities of the patient, his/her ability to self care.
  • To assure the return of the patient to the normal and active lifestyle, professional life (as much as possible).
  • To assure a psychologically comfortable state of the patient.
  • To correct the accompanying diseases.
  • To normalize clinical and laboratory performance.
  • To correct the lifestyle and behavior that will maintain the results achieved by the rehabilitation.
  • To increase the physical capabilities of the patient, minimize limitations in the life and activity.
How rehabilitation after stenting is performed at our institute:
Cardiac rehabilitation after stenting lasts from 4-6 weeks to 3-6 months and is performed by the help of physicians of different specialties and experienced nursing staff. Rehabilitation includes the services of cardiologist, neurologist, psychotherapist, functional diagnostician, physiotherapist, laboratory doctor, nutritionist, rehabilitation physician. If required, other physicians can be involved to the diagnostics and treatment.
Cardiac rehabilitation after stenting is performed in the following way:
During the first 2-3 days of the program the state of the patient is determined. Examination is made, information about the disease is collected; laboratory tests, ECG, loading tests to determine the initial level of tolerable weight bearing as well as other research are performed. The functional class of angina pectoris as well as accompanying diseases is determined. Individually, the risk for occurrence of an acute coronary event is determined. Physical capabilities of the patient, his/her psychoemotional status are evaluated; presence of and risks for postsurgical complications are defined.
As a result of examination a case conference is carried out where an individual program is developed adapted for a specific patient. Within this program the patient undergoes drug therapy, physiotherapy, remedial physical training. Psychological rehabilitation is also performed. The patient is trained how to behave and live correctly. The implementation of the program begins; it lasts from 4-6 weeks to 3-6 months and includes drug therapy, physiotherapy, remedial physical training. These helps improve blood supply to the heart, metabolic processes in the myocardium, increase tolerance for physical loads, positively influence the general state of the patient. The institute has an opportunity to render emergency first aid. Simultaneously risk factors are controlled to normalize weight, refuse bad habits, control blood pressure, level of glucose and cholesterol etc. The patient also communicates with the psychotherapist. The state of the patient is permanently monitored which makes it possible to trace all changes in health. Specialist help the patient reduce weight (in case of obesity) and refuse bad habits (if any). Treatment is performed to normalize the blood pressure, achieve normal values of glucose and cholesterol in blood etc.
Before release general examination is repeated. The physicians that treated the patient make detailed recommendations concerning the lifestyle: physical, sexual activity, nutrition, medication taking etc. The patient finishes rehabilitation with all required recommendations for further treatment, keeps contacts with the physicians of the institute. In what cases is rehabilitation not performed after stenting? : If a person after stenting has serious health disorders or life-threatening complications (unstable angina, symptoms of current infarction, severe rhythm disturbances, aorta dissection, decompensated diabetes mellitus, malignant arterial hypertension, some defects of the muscular-skeletal apparatus, etc.), he/she is not recommended to undergo rehabilitation until his/her state stabilizes.
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Chronic heart failure (CHF) occurs as a complication of cardiovascular diseases when the heart is unable to perform its functions in the proper way. In case of CHF blood congests in the systemic and/or pulmonary circulation. This causes symptoms (shortness of breath, swelling, excess fluid in body cavities, excessive tiredness etc.), which considerably worsen the general state and quality of the patient’s life. To improve their state patients with CHF are recommended to undergo cardiac rehabilitation. Patients with levels I, IIa and IIb and functional class I and II congestive heart failure can be admitted for rehabilitation. Patients with accompanying diseases except for life-threatening situations requiring hospitalization can also be admitted for the program. At our institute an individual remedial treatment plan will be selected for each patient. Therapy is performed under control of highly qualified specialists. Up-to-date and effective procedures are used. During the implementation of the program the state of the patient is permanently monitored which makes it possible to trace all changes in health, safe it and assure the maximum efficiency of rehabilitation. Why is a rehabilitation course in case of CHF necessary? When not treated congestive heart failures progress; due to impairment of circulation the work of internal organs is disturbed; numerous vicious cycles are formed. As a result, symptoms become more serious and nonreversible. In many cases heart failures cause disability and are potentially life-threatening. According to the results of the Framingham Heart Study, five-year survival rate in the case of this disease amounts to 58% in women and only 38% in men. These figures are quite high. Tasks of rehabilitation in case of chronic heart failure: • To improve the functionality of the heart and internal organs, to decrease and liquidate existing symptoms • To slow down the advance of the disease • To optimize the drug therapy, to decrease the quantity and doses of drugs the patient takes • To minimize the risk of cardiovascular failures, disease decompensation • To correct the accompanying diseases • To increase the physical capabilities of the patient and his/her level of activity To teach the patient how to live and behave, form recommendations that will help maintain a satisfactory state of health as long as possible after rehabilitation. How rehabilitation in case of congestive heart failure is performed Rehabilitation is performed by the help of physicians of different specialties and experienced nursing staff. Rehabilitation includes the services of cardiologist, neurologist, psychotherapist, functional diagnostician, physiotherapist, laboratory doctor, nutritionist, rehabilitation physician. Cardiac rehabilitation in case of congestive heart failure is performed in the following way: During the first days of rehabilitation the patient is examined, the state of his/her health is evaluated by physicians. A set of diagnostic procedures is performed; the level and functional class of the heart failure as well as other present diseases are determined. The acute coronary disorder risk group the patient belongs to is determined. Based on the received information physicians develop an individual patient management plan. The program is implemented: drug therapy is corrected; the physiotherapeutic program is carried out; depending on physical capabilities remedial physical training is performed. The objective is to improve the work of muscles and optimize the work of the heart, to decrease the existing symptoms and claims of the patients. Specialists of the institute permanently monitor the state of the patients. To improve the prognosis of the disease risk factors are controlled, specialists help the patient refuse smoking, lose weight. Fluid is restricted. A psychotherapist communicates with the patient to encourage him/her for treatment and to improve his/her psychological state, teaches him/her how to live and behave. After the rehabilitation program detailed recommendations are given and explained to the patient concerning his/her further treatment and life. Cases when rehabilitation is not performed with congestive heart failure: Contraindications for remedial treatment are severe blood circulation failure (level III chronic heart failure, functional class III-IV congestive heart failure), decompensated heart failure. Besides that, rehabilitation is not indicated for patients with serious and life-threatening states that require hospitalization.
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Cardiac angina is a form of the ischemic heart disease (IHD). In case of stable cardiac angina the blood supply to the myocardium becomes impaired that results in intermittent short-term breast pain attacks. Besides that, unstable cardiac angina exists; it is a state with more serious symptoms when the blood flow in the heart becomes considerably impaired and unstable. This is a form of an acute IHD that can trigger an infarction. Unfortunately, methods of stable and unstable cardiac angina treatment other than drug therapy in a hospital, polyclinic or private practice are hardly used in our country. However in both the cases patients need cardiac rehabilitation, a special complex of restorative procedures carried out by specialists in a specialized institution. Our institute provides restorative programs for patients with cardiac angina. Why is a cardiac rehabilitation course in case of cardiac angina necessary? In fact, unstable cardiac angina is a failed infarction. Therefore, this disease has the same risks as the myocardial infarction. This confirms that any form of cardiac angina requires rehabilitation treatment. Stable cardiac angina is also a rather serious disease. Yearly death rate among patients with stable cardiac angina is 2%, and in another 2-3% of such patients infarction develops. In case of diagnosed cardiac angina the rate of death due to IHD is twice as much as in people without this disease. Men with cardiac angina live on the average 8 years less than people with a healthy heart. Who can be admitted to cardiac rehabilitation in case of cardiac angina at our institute? Patients who suffered an unstable cardiac angina episode 3 or more months ago as well as patients with functional class I-II stable cardiac angina can be admitted to remedial treatment at the institute. We use an individual approach: patient management programs are developed by specialist based on the severity of the state of the patient, history of his/her disease (occurrence of infarctions), accompanying pathologies and other peculiarities. This helps create an optimum remedial program that will make it possible to achieve the best results in a short period of time. The institute has rich capabilities for diagnostics and therapy of cardiovascular diseases, many techniques we use are unique. Tasks of rehabilitation in case of cardiac angina: • After an unstable cardiac angina event: • To suppress the activity of the pathological process that caused the disease. • In case of any form of cardiac angina: • To prevent the progression of the disease, development of complications (myocardial infarction in particular); • To control and decrease the symptoms of the disease; • To improve the physical capabilities of the patient, his/her ability to self care; • To assure the return of the patient to the normal and active lifestyle, professional life (as much as possible); • To improve the prognosis; • To correct accompanying diseases; • To teach the patient how to live and behave taking into account his/her disease. How rehabilitation in case of cardiac angina is performed at our institute: Rehabilitation is performed by the help of physicians of different specialties and experienced nursing staff. Rehabilitation includes the services of cardiologist, neurologist, psychotherapist, functional diagnostician, physiotherapist, laboratory doctor, nutritionist, rehabilitation physician. Cardiac rehabilitation in case of cardiac angina is performed in the following way: During the first 2-3 days of the program the state of the patient is determined. Examination is made, information about the disease is collected; laboratory tests, ECG, loading tests to determine the initial level of tolerable weight bearing as well as other research are performed. The functional class of cardiac angina is determined. Individually, the risk for occurrence of acute coronary events is determined. As a result of examination a case conference is carried out where an individual program is developed adapted for a specific patient. The implementation of the program begins; it lasts from minimum4-6 weeks to 3-6 months and includes drug therapy, physiotherapy, remedial physical training. These helps improve metabolic processes in the myocardium, increase tolerance for physical loads, positively influence the general state of the patient. Simultaneously risk factors are controlled to normalize weight, refuse bad habits, control blood pressure, level of glucose and cholesterol etc. The patient also communicates with the psychotherapist. The state of the patient is permanently monitored which makes it possible to trace all changes in health. Before release general examination is repeated. The physicians that treated the patient make detailed recommendations concerning the lifestyle: physical, sexual activity, nutrition, medication taking etc. The patient keeps contacts with the physicians of the institute. Contraindications for rehabilitation in case of cardiac angina: In case of functional class III—IV cardiac angina rehabilitation treatment is prohibited. If a person has serious health disorders or life-threatening complications (malignant arterial hypertension, circulation failure, aorta dissection, decompensated diabetes mellitus, severe rhythm disturbances, some defects of the muscular-skeletal apparatus, etc.) that require hospitalization, he/she is not recommended to undergo rehabilitation.
It should be stated that cardiac rehabilitation cannot be used for all patients with heart diseases. Only rehabilitation physicians can decide whether this program is suitable for you. Sometimes, traumas such as muscle and ligament stretching or even bone fractures can occur with patients during cardiac rehabilitation which happens in case of pathologies with the muscles, ligament system or bone tissue. Therefore, rehabilitation physicians thoroughly control the whole process of cardiac rehabilitation to avoid these complications.
Cardiac rehabilitation shall start when you are still in hospital and continue after release. The first stages of the majority of our cardiac rehabilitation programs last from three to six months. During this time a cardiologist, nutritionist, physiotherapist as well as psychologist will work with you.
Medical examination and evaluation of the general state Initial examination makes it possible for the physicians to assess your general state, physical force, limitations and other states influencing the cardiac rehabilitation to be selected. Physicians evaluate your risk factors for heart diseases, infarction and blood hypertension. Based on the received information physicians develop an individual cardiac rehabilitation that will be safe and effective exactly for you. Physical activity Cardiac rehabilitation aims at improving your cardiovascular system by walking (terrain cure), bicycling, swimming and other types of physical activity. Strength exercises are also used (for example, weight lifting) to improve the muscle strength. Do not worry if you have never done any exercises before. The team of rehabilitation physicians will select a set of exercises safe and comfortable for you. Generally, these exercises should be done three to five times a week. You will be taught how to do these exercises, how to warm up and stretch muscles before the main set of exercises. Teaching the right lifestyle Diet is one of the most important moments in cardiac rehabilitation. You will be taught how to eat and select healthy food that best suites you avoiding excess fat, salt and cholesterol. You will be assisted to quit bad habits that are in contradiction with the healthy life style of a person who suffered from a heart disease, for example, smoking. You will be taught how to cope with pain and tiredness. Psychological support A heart disease is a serious problem that makes you feel frustrated. It can lead to depression, annoyance. You can’t work or do routine things. Therefore, psychological support is very important. If you suffer from depression don’t ignore this step of rehabilitation, otherwise recovery from the disease will become very difficult. Control of depression can be made with the help of both medication therapy and continuous exercises that allow you forget about the disease. In spite of the fact that it is difficult to start cardiac rehabilitation when you don’t feel good, in future your state will considerably improve. Cardiac rehabilitation will help you overcome anxiety, depression and give you strength and energy.
After cardiac rehabilitation you will have to continue to maintain the healthy lifestyle, this concerns the diet, bad habits, and exercises. By that time you will know all about these.
Rehabilitation in case of heart diseases is a long-term program. If you have ever suffered from a heart disease no matter whether it has been a surgery or not, the rehabilitation process must continue for life. But it’s not as bad as it may seem. Isn’t it good to lead a healthy lifestyle? This has an undeniable advantage – this sustains life! The results of rehabilitation can be observed from the very beginning. You will not suffer from shortness of breath, you will learn to distribute the load in such a way that this will even contribute to your cardiovascular system. You will learn to cope with stress and depression; it means that you will be able to encourage other persons like you. To sum up, cardiac rehabilitation is an integral part of heart disease treatment.
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