When to Return for Usual Activity After ACS The Benefit of Cardiac Rehabilitation

Cardiac rehabilitation (CR) can be managed as global long-term care and comprehensive risk reduction of cardiac patients based on preventive care through a professional multi-disciplinary integrated process approach.11 Multidisciplinary CR elements include: patient evaluations, physical activity counselling, exercise training, diet/nutritional counseling, psychosocial management, lipid management, smoking avoidance, management of weight, and regulation of blood pressure. Exercise training if begun at the post-ACS acute phase, would achieve its greatest beneficial effect on the process of LV remodeling in the dysfunctional LV and cardiopulmonary rehabilitation in patients after acute coronary syndrome. Cardiac rehabilitation (CR) can be managed as global long-term care and comprehensive risk reduction of cardiac patients based on preventive care through a professional multi-disciplinary integrated process approac

Comparison of Predicted Significant Coronary Lesion by Duke Treadmill Score among Coronary Heart Disease Risk Factors in Patients with Positive Ischemic Response Treadmill Test

Background: According to Framingham Study, independent risk factors for coronary heart disease (CHD) are diabetes, hypertension, smoking, dyslipidemia, family history of CHD and obesity. Previous study reported cut-off value of Duke Treadmill Score (DTS) < -0.5 represents a significant coronary lesion with positive predictive value 88.4%. Objective: To compare the incidence of predicted significant coronary lesions by DTS among various risk factors for coronary heart disease. Methods: A cross sectional study was done on 292 patients age 18 to 74 years old who had positive exercise testing for CAD screening during period of June 1st 2016 until May 30th 2017. DTS was calculated from treadmill test as: exercise time - (5 x ST deviation in mm) - (4 x exercise angina). A coronary lesion was predicted significant with DTS cut off value < -0.5. Results: Subjects mean age was 57 years old, male were 60.4%. The risk factors for CHD were found sequentially from the most frequent were hypertension 51.9%, smoking 35.3%, diabetes mellitus 23.1%, dyslipidemia 11.9%, obesity 4.2% and family history of CHD 6.3%. It was found that diabetes was significantly different from its effect on DTS value with p value = 0.021, while hypertension, obesity, dyslipidemia and family history CHD had no significant effect. Logistic regression found consistently that diabetes was significant (p=0.019). Conclusion: Predicted significant coronary lesions by DTS developed more frequent in diabetes compared to, hypertension, smoking, dyslipidemia, obesity and family history of coronary heart disease

Cardiac Rehabilitation to Prevent Rehospitalization in Myocardial Infarction Patients

Introduction. There is mounting evidence that cardiac rehabilitation (CR) based on physical activity has a positive influence on the degree of disability and level of quality of life, in addition to playing an important and beneficial role in modifying morbidity and mortality. Discussion. Patients who have experienced an acute myocardial infarction, are candidates for cardiac rehabilitation as an essential component of their care. Clinical evaluation, optimization of pharmacotherapy, physical training, psychological rehabilitation, evaluation and reduction of coronary disease risk factors, lifestyle modification, and patient education are the components that should be included in comprehensive cardiac rehabilitation. Immediately following the acute phase of a myocardial infarction, the designated team (consisting of a physician, physiotherapist, nurse, psychologist, dietician, and social worker) should begin comprehensive cardiac rehabilitation. This rehabilitation should contain individualized programs that are designed to optimize the patient's physical, psychological, social, and emotional status. It is recommended that the modern model of comprehensive cardiac rehabilitation be started as soon as possible, continued for the required amount of time, properly staged, and individualized depending on the clinical status of the patients. Conclusion. Cardiac rehabilitation after myocardial infarction is an exercise method that could improve the post myocardial infarct patient’s living quality, includes increasing cardiac ejection fraction, exercise tolerance, and physical status. Therefore, it can decrease rate of rehospitalization in patient post myocardial infarct

Ventricular tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy: How to Manage?

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a condition characterized by fibrofatty replacement of the RV myocardium due to genetic abnormality. Structural changes may be absent or minor in the early stages of the disease and be localized in a specific region of the RV. Clinically it appears as RV electrical instability. To reduce the risk of arrhythmic events or sudden cardiac death, device therapy and pharmacotherapy may be recommended. In this paper, we describe a case of a female with ARVC and a brief discussion based on a literature review. The patient presented with chest discomfort accompanied by palpitation. An electrocardiogram (ECG) showed ventricular tachycardia of RV apex origin, and convert to symmetric inverted T-waves and probable epsilon waves in the right precordial leads, mimicking a pseudo-right bundle branch block (RBBB) pattern following electrical cardioversion. The parasternal short-axis view of echocardiography shows severe right ventricular dilatation. Subsequent workup using CMR was planned but the patient refused. We diagnosed this patient with ventricular tachycardia on a background of suspicious arrhythmogenic right ventricular cardiomyopathy. We were able to provide accurate diagnosis and treatment, avoiding potentially fatal consequences. As a result, it is critical to recognize potential ARVC ECG findings and to know when to pursue further research and implement therapies

Best Recommended Exercise for patients with Hypertension

Hypertension is known as a fatal yet preventable risk factor for cardiovascular disease and is responsible for majority of cardiovascular mortality. Hypertension is closely associated with sedentary lifestyle. Physical activity and/or exercise are shown to retard development of hypertension. Exercise, combined with other measures of lifestyle behaviour and pharmacologic treatments, is recommended as&nbsp;an effective lifestyle behaviour for adults to prevent and treat hypertension. The current exercise prescription for the treatment of hypertension is:&nbsp;cardiovascular mode, for 20-60 minutes, 3-5 days per week, at 40-70% of maximum oxygen uptake (VO2(max)).. Both aerobic and resistance exercise, should be performed simultaneously by hypertensive patients. Aerobic activity could include &nbsp;walking, jogging, cycling, rowing swimming. While dynamic resistance training could include &nbsp;free weights, resistance machines, and resistance bands. Functional exercises should be comprised of &nbsp;step-ups, bodyweight exercises, and balance training. After an exercise session, BP decreases, and this decline continues for up to 24 h; which is called post-exercise hypotension. Overall 5 mmHg decrease in BP with regular exercise may be encouraged. With a decrease of 5 mmHg in systolic BP, mortality due to coronary artery&nbsp; disease decreases by 9%, mortality due to cerebrovascular accident&nbsp; decreases by 14% and all-cause mortality decreases by 7%. Regular exercise should therefore be recommended for all individuals including normotensives, pre-hypertensives, and hypertensives

Increasing Age, Diabetes Mellitus and Beta Blocker Influence Heart Rate Recovery Values in Patients Undergoing Exercise Treadmill Test

Background: Heart disease is the number one cause of death globally. This disease is initiation affected by autonomic dysfunction which will cause disruption of the sympathetic-parasympathetic system. Heart Rate Recovery (HRR) is used to determineautonomic dysfunction.Objective: To determine the relationship of risk factors and cardiovascular treatment to HRR values of 1 minute and 2 minutes.Methods: Cross sectional study to measure HRR 1 and 2 minute undergoing exercise treadmill test for the screening of coronary heart disease in Saiful Anwar hospital in May 2016 until September 2017. Univariate analysis was performed to determine the frequency and proportion of HRR values classified into normal groups (HRR 1 minute > 12x / minute or HRR 2 minutes > 22x / minute) and abnormal groups (HRR 2 minutes ≤ 12x / minute or HRR 2 minutes ≤ 22x / minute).We also performed bivariate analysis using comparative test (Generalized Linear Model) and correlation test (Pearson, Spearman and Eta) and multivariate linear regression analysis.Results: This study found that age, hypertension and beta blocker were significantly associated with HRR abnormalities (p<0.05). HRR 1 and HRR 2 were significantly associated with diabetes mellitus (DM) (p=0.004 and p=0.039) and beta blocker (p=0.042 and p=0.039). Then looking at the relationship of multivariate correlations found a significant correlation between age (β=-0.133, p=0.000) and DM (β=-2.617, p=0.032) at 1 minute HRR and significant correlation with age (β=-0.165, p=0.004) and beta blockers (β=-2,947, p=0.017).Conclusion: increasing of age, diabetes mellitus and beta blockers correlate with decreasing of HRR. The most influential risk factors for HRR values of 1 minute were increasing age and DM, while for HRR values of 2 minutes were increasing age and beta blockers

The Consequences of a Heart Condition: Acute Stroke and Limb Ischemia Secondary to Massive Intracardiac Thrombus in a Young Female with Dilated Cardiomyopathy

Background :Dilated cardiomyopathy (DCM) is associated with the increased occurrence of left ventricular (LV) thrombosis caused by cardiac dysfunction. This condition is associated with significant mortality and morbidity because of its significance as a potential source of systemic emboli. We are reporting a case of Acute Stroke and Limb Ischemia in a Young Female Patient with DCM.Case Illustration :A 20-year-old female was referred to our hospital due to pain in her right lower extremities and weakness in her right limb. She had been diagnosed with peripartum cardiomyopathy five years earlier. A general physical examination found her right lower limbs to be cold and pulseless. A neurological examination revealed hemiparesis involving the right side of her body. The chest radiograph showed cardiomegaly. Electrocardiography indicated sinus rhythm with LVH. The transthoracic echocardiograms revealed significant LV systolic failure with a massive thrombus at LV. The Duplex ultrasound showed a thrombus at the right dorsal pedis artery, and a head CT scan revealed an acute infarct. The patient was started on heparin and bridged with warfarin 5mg orally daily, and she was uneventfully discharged after one week.Conclusion :DCM had been associated with thrombosis, stroke, and an increased risk of thromboembolism. Previous studies had documented decreased thromboembolic events due to administering anticoagulants

Acute Myocardial Infarction in a 25-Years-Old Male: Understanding the Risk and Comprehensive Management

Acute coronary syndrome (ACS) in young adults is a rare entity, yet it occurs. We present a case of a man 25 years old with no history of certain diseases, suddenly come up with ST elevation myocardial infarct. Young patients have different risk factors, clinical features and prognosis as compared to elderly patients. The diagnosis of ACS is also often overlooked in this subset of population. Furthermore, it constitutes an important problem because of the devastating effect of this disease on the more active lifestyle of young adults. This case report was an attempt to look for the risk factors most prevalent in young patients and its management prior and during the hospital stay

Peripartum Cardiomyopathy (PPCM): How to Diagnose and Deal with?

Peripartum cardiomyopathy (PPCM) is a diagnosis of exclusion, where patients present with heart failure (HF) secondary to left ventricular (LV) systolic dysfunction without any other cause of HF identified in the last month of pregnancy or within first five months after delivery, abortion, or miscarriage. PPCM is a life-threatening condition which frequently under diagnosed and inadequately treated, whereas the morbidity and mortality rate ranges between 7% and 50%. Early diagnosis is important to decrease morbidity and mortality. Therefore, it is necessary to report the case related to this condition.A 34-year-old woman was referred to RSSA with worsening shortness of breath (SOB). She has given birth about 2.5 months prior to admission. History taking and supporting findings form this case were supported to diagnosis of PPCM. She was treated with diuretic, aldosterone antagonist, ACE-I, beta blocker, anticoagulant, and bromocriptine. The symptoms were improved in the following days. She was discharged with better condition and educated to comply with medication

Phase I Cardiac Rehabilitation Intervention In Patients Undergoing Coronary Artery Bypass Grafting

Patients undergoing coronary artery bypass grafting (CABG) have a risk of postoperative complications that result in prolonged hospitalization and even death. Interventions in the form of phase I cardiac rehabilitation are needed to help speed up the postoperative recovery process and prevent complications after CABG. Although a lot of research has been carried out, it is necessary to conduct further studies of research articles regarding interventions that can be carried out in cardiac rehabilitation programs that are safe and easy to perform in postoperative CABG patients. The purpose of this literature review was to examine safe and effective interventions in phase I cardiac rehabilitation in patients undergoing CABG. The implementation of phase I cardiac rehabilitation in patients undergoing CABG started from the preoperative phase and continued postoperatively until the patient was discharged. Phase I cardiac rehabilitation interventions, both pre and postoperative, consist of education and counselling, physical exercise, breathing exercises, effective coughing exercises, inspiratory muscle training, and chest physiotherapy. The results of this literature review can be used as a basis for determining standard operating procedures for the implementation of phase I cardiac rehabilitation for hospitals that provide CABG services