Benefits of Cardiac Rehabilitation

The most substantial evidence-based benefits of cardiac rehabilitation include an improvement in exercise tolerance, improvement in symptoms, improvement in blood lipid levels, reduction in cigarette smoking, improvement in psychosocial well-being and reduction of stress, and reduction in mortality. These are addressed in turn. Appropriately prescribed and conducted exercise training is an integral component of cardiac rehabilitation, particularly for patients with decreased exercise tolerance....

Rehabilitation of Elderly Patients

As populations age in both developed and developing countries, more elderly patients with cardiac disease will be enrolled in rehabilitation programs. Coronary heart disease is the most common problem. Elderly coronary patients are medically complex because of the frequent complications of coronary disease and concomitant problems of diabetes, cerebral and peripheral vascular disease, hypertension, and chronic obstructive pulmonary disease. The exercise capacity of elderly cardiac patients...

Pharmacotherapy for Smoking Cessation

Quitting smoking is one of the primary lifestyle changes that reduce the risk of cardiovascular disease in primary and secondary prevention. However, the addictive nature of nicotine makes smoking cessation difficult to initiate, and withdrawal symptoms, including cravings for cigarettes, make continued abstinence difficult to maintain. Studies show that the majority of serious quit attempts will fail within 1 year.67 This is understandable in the light of evidence showing that cigarette...

The Cardiovascular Prevention and Rehabilitation CVPR Program Hospital

The EUROACTION CVPR program is a nurse-led comprehensive, multidisciplinary, hospital-based 16-week program for coronary patients and their families. The aim of the program is to help coronary patients and their partners, and first degree relatives of patients with premature coronary disease, to achieve the European lifestyle, risk factor, and therapeutic goals as defined in the 1998 Joint European Societies' guidelines (Table 58-1).11 The partners of coronary patients, together with first...

Exercise Testing in Special Groups

Cardiovascular disease is one of the leading causes of death in women, exceeding mortality due to breast cancer by a factor of 11. However, the probability of CAD in women is most commonly in the low to intermediate probability range, especially in premenopausal women, and the investigation of CAD in women presents difficulties that are not experienced in the identification of the disease in men. These difficulties reflect gender differences in exercise physiology, coronary physiology, and...

Nicotine Pharmacodynamics

It is not only due to the pharmacokinetic properties of nicotine administered by smoking, mentioned earlier, that nicotine is as addicting as it is, its pharmacodynamics play an important role as well. Nicotine interacts with the nicotinic cholinergic receptors in both the central and peripheral nervous system. The effect of nicotine can be stimulating but in a high dose it can be dampening too, due to complex electrochemical processes. Stimulation of the nicotinic cholinergic receptor causes...

Diet and the Risk of Heart Failure Following AMI

The incidence of chronic heart failure (CHF), the common end-result of most cardiac diseases, is increasing steadily in many countries despite (and probably because of) considerable improvements in the acute and chronic treatment of CHD, which is nowadays the main cause of CHF in most countries.25 In recent years, most research effort about CHF has been focused on drug treatment, and there has been little attention paid to non-pharmacological management. Some unidentified factors may indeed...

Exercise Testing in Patients with Mitral Stenosis MS

Increasing numbers of asymptomatic patients with severe MS are being diagnosed with echo-Doppler. Due to the long duration of their disease these patients have slowly adjusted to their restrictions and frequently do not report symptoms or nonspecific symptoms like fatigue. This is particularly the case in elderly patients. In these patients exercise testing is of clinical value. Induction of dyspnea during exercise, excessive heart rate responses to a relatively low level of exercise, and...

The Dilemma of Traditional Identification of High Risk Patients

Two large cohort studies revealed that 80 to 90 of the patients with CHD had at least one of four traditional risk factors (cigarette smoking, hyper-lipidemia, arterial hypertension, or diabetes).54,55 In the clinical practice of prevention, however, we have the opposite problem of course we treat arterial hypertension and diabetes anyway, but which asymptomatic patient without demonstrable myocardial ischemia with which risk factors is at high risk for developing a cardiovascular event The...

Returning to Work after Myocardial Infarction

One of the main goals of a cardiac rehabilitation (CR) program is to support the patient in returning to work strong economic and quality of life arguments exist. It has been stated that patients after an acute myocardial infarction (MI) without complications such as left ventricular dysfunction or exercise-induced myocardial ischemia may safely resume their previous work for light office work 2 weeks of sickness absence are recommended, for average manual work 3 weeks, and for strenuous...

The Swiss Heart Foundation

A cardiac event or a cardiovascular disease requires life-long aftercare. This insight led to the establishment of the first training groups for heart patients (heart groups) in Switzerland in the early 1980s, which was driven by the private initiative of committed physicians and heart patients. Four years ago, the Swiss Heart Foundation started to take care of the heart groups with the aim of promoting the establishment of a nationwide network. Today, 85 heart groups for long-term...

Pharmacotherapy for Weight Management and Prevention of Diabetes

Weight reduction for the prevention of cardiovascular disease is an imperative in the current environment of epidemic obesity and metabolic syndrome. However, the failure rate is 70-95 within 1-2 years of weight loss. Weight loss is followed by a number of adaptations including decreased thyroid and immune function and changes in signaling in the central nervous system that result in weight regain. Thus, the treatment of obesity, which is the common denominator underlying the variable symptoms...

Antiplatelet Drugs

Primary prevention with antiplatelet agents is focused almost solely on acetylsalicylic acid (ASA).7 The effect of ASA has been scrutinized in six large primary prevention trials (Table 53-3).8-13 Although some of these trials investigated high-risk patients with one or more risk factors, the yearly cardiovascular event rate was rather low in all of these studies. The reduction in the odds ratio for adverse cardiovascular events in favor of ASA was in the range of 0-29 , which translates into...

Exercise Testing in Asymptomatic Individuals Without Known CAD

The use of exercise testing for diagnosis of CAD in asymptomatic individuals is a controversial topic. The rationale of screening is the early detection of a disease that is the leading cause of death worldwide in the hope that treatment may prolong life or improve its quality and reduce the costs of treating acute events. Unfortunately, the accuracy of exercise testing in asymptomatic individuals has never been defined and probably never will be, because it is unethical to perform coronary...

The Finnish Heart Association

In Finland, secondary prevention and cardiac rehabilitation are part of public healthcare by legislation. The Social Insurance Institution of Finland also offers rehabilitation to patients who are at work. During the last decade, however, the budget cuts and personnel shortages in the public sector have reduced the availability of cardiac rehabilitation and secondary prevention. Finland participated in the EUROASPIRE study,3 which proved that the present patient guidance system has been...

Exercise Training Combined with Blood Glucose Control

The importance of early diagnosis and subsequent therapy of diabetes has been highlighted by the United Kingdom Prospective Diabetes Study (UKPDS). The results showed that it is necessary to keep HbA1c levels < 6.0mmol L in order to reduce the incidence of cardiovascular events.14 These data were confirmed by a study of Hu et al. in 84,941 nurses where it could be demonstrated in a subgroup with a low-risk profile (body mass index < 25, healthy diet, > 30 minutes of physical exercise per...

Hypertension

Hypertension is defined as systolic blood pressure (BP) 140mmHg or above and or diastolic BP 90mmHg or above, or patients on antihypertensive treatment. The prevalence is approximately 15 , 30 , and 55 in males aged 18-39 years, 40-59 years, and above 60 years. Corresponding numbers in females are 5 , 30 , and 65 . However, 25 of patients with hypertension by conventional measurements have a normal blood pressure on 24-hour monitoring.7 According to a meta-analysis by Fagard and Amery,8...

Dietary Influence on Blood Pressure Regulation

Medical nutrition therapy for the management of hypertension has focused on weight reduction and reducing sodium intake.20 In both normoten-sive and hypertensive individuals, a reduction in sodium intake lowers blood pressure. In hypertensive patients, the goal should be to reduce sodium intake to 2400mg (100mmol) or sodium chloride (salt) to 6000mg day. Other nutritional variables that have been considered include alcohol, potassium, calcium, and magnesium intake. An association between high...

Recurrence12 Alcohol and SCD

The question of the effect of alcohol on heart and vessel diseases has been the subject of intense controversy in recent years. The consensus is now that moderate alcohol drinking is associated with reduced cardiovascular mortality, although the exact mechanism(s) by which alcohol is protective are still unclear. In experimental models, an ethanol preconditioning phenomenon13 has been reported, suggesting that low dose ethanol drinking protects the myocardium against damages provoked by...

Treatment of Hypertension

Hypertension is a major risk factor for PAD, but data are not available to clarify whether treatment will alter the progression of the disease or the risk of claudication. Beta-adrenergic-antagonist drugs have been thought to have unfavorable effects on symptoms in patients with PAD. This concern arose from several early case reports of worsening claudication and decreases in blood flow in the legs in patients taking these drugs. A meta- analysis and a critical review of different studies,...

Rehabilitation in Cardiac Transplantation

Patients awaiting transplantation are often decon-ditioned and exhibit severe cardiac impairment, breathlessness on exertion, and cardiac cachexia they are also at increased risk of sudden cardiac death. The goal of exercise is to prevent further deconditioning and, in some patients, to improve skeletal muscle status. Standard exercise testing or cardiopulmonary exercise testing is valuable in formulating recommendations for physical activity.39 Education and counseling can introduce the...

Alternative Modes of Delivery of Cardiac Rehabilitation Services

Alternative approaches to the delivery of cardiac rehabilitation services, other than traditional supervised group interventions, were considered effective and safe for stable cardiac patients.1 Transtelephonic and other means of monitoring and surveillance were advocated to extend cardiac rehabilitation services beyond the setting of supervised, structured, and group-based rehabilitation. The American Heart Association 2005 Scientific Statement7 further offered models that included home-based...

Future Developments in Preventive Cardiology The Euroaction Project

Although there is substantial scientific evidence that professional lifestyle intervention on smoking, diet and physical activity, together with control of blood pressure, cholesterol and glycemia, and selective use of cardioprotective drug therapies can reduce cardiovascular morbidity and mortality, the translation of that evidence into everyday clinical practice remains a challenge. The joint European Societies guidelines on prevention of cardiovascular disease (CVD) define priorities for...

Prevention Guidelines Management of the Coronary Patient

Guidelines on prevention of coronary heart disease (CHD) in clinical practice have been issued by Joint Task Forces of European and other Societies1-3 and the latest update was released in 2003 by the Third Joint Task Force.3 The objectives of these guidelines are the prevention of disability and early death from cardiovascular disease (CVD) through lifestyle changes, management of risk factors and when needed the prophylactic use of certain drugs. The guidelines represent a state of the art...

Developments in Rehabilitation Care

Enormous changes in the rehabilitative approach to the care of patients with cardiovascular disease have occurred since the WHO Expert Committee on the Rehabilitation of Patients with Cardiovascular Disease was organized by WHO in 1963. At that time, rehabilitation was concerned predominantly with individuals recovering from acute, essentially uncomplicated, myocardial infarction the rehabilitative interventions recommended for such patients were considered to encompass the sum of activities...

Antihypertensive Drugs

Blood pressure lowering therapy should be considered in individuals with repeated measures of systolic blood pressure > 140mmHg and or diastolic blood pressure > 90mmHg. Guidelines recommend that the overall cardiovascular risk should be considered.1 Treatment directed at lowering blood pressure should include lifestyle change encompassing smoking cessation, moderation of alcohol consumption, weight reduction, physical exercise, reduction of high salt intake and other dietary changes. When...

Physical Exercise

Physical Benefits Exercise Cardiac

The incidence of diabetes mellitus correlates inversely with the degree of physical activity.4 Regular aerobic exercise of 30 min day at a moderate intensity can cut the risk for impaired glucose tolerance by half and the diabetes risk by up to three-quarters.5-7 Although there is no direct proof that endothe-lial dysfunction leads to atherosclerosis, it has been shown that endothelial dysfunction is associated with increased cardiovascular mortality.8 Endothelial dysfunction is found when the...

Effects of Exercise Training in Heart Transplant Recipients

Exercise intensity is best measured by rate of perceived exertion RPE . Using the original Borg scale, RPE should be 12 to 14, which corresponds to the ventilatory threshold and a heart rate of usually between 60 and 80 of maximum. For testing protocols small increments of 10 W per minute are recommended to allow for the slow adaptation of heart rate in HTRs. Aerobic exercise may be started in the second or third week after transplant but should be discontinued during corticosteroid bolus...

The Causes of Exercise Intolerance in Cardiovascular Diseases

Exercise intolerance is a key feature of most cardiovascular diseases. Its value for describing the stage of the disease is so important that standardized classification systems of exercise limitation i.e. the New York Heart Association Classification were developed more than half a century ago. While the symptoms of reduced maximal exercise capacity may be similar, the underlying mechanisms causing exercise limitations are fundamentally different between major disease entities In stenotic...

Grown up Congenital Heart Disease GUCH

Patients with congenital heart disease CHD reaching adulthood are a growing population.4 Most of them require lifelong care. The hemo-dynamic situation of the patient with CHD varies considerably. This makes it impossible Table 22-1. Classification of sports Table 22-1. Classification of sports Running mid long Swimming Squash Tennis single Team handball Symbols Danger of bodily collision, y Increased risk if syncope occurs. Source Adapted and modified after Mitchell et al.' to give...

References

The Social Readjustment Rating Scale. J Psychosom Res 1967 11 213-218. 2. Beck A. Cognitive Therapy of Depression. New York Guilford Press 1977. 3. Rees K, Bennett P, Vedhara K, West R, Davey Smith G, Ibrahim S. Stress Management for Coronary Heart Disease. The Cochrane Library, Issue 2. Chichester John Wiley amp Sons 2004. 4. Van Dixhoorn J, White A. Relaxation therapy for rehabilitation and prevention in ischaemic heart disease a systematic review and meta-analysis. Eur...

Effects of Lifestyle Change on MetS Components

The underlying conditions that promote the development of MetS are overweight and obesity, physical inactivity, and an atherogenic diet.16,17 Therefore, lifestyle modification is first-line therapy to prevent and treat MetS.14,15 The most important therapeutic intervention effective in subjects with MetS should focus on modest weight reduction and regular leisure-time physical activities. The Finnish Diabetes Prevention Study11 and the Diabetes Prevention Program DPP in the United States12...

Nicotine Replacement Therapy

Before starting the nicotine replacement therapy the user has to quit smoking. Nicotine replacement therapy provides an alternative form of nicotine to relieve symptoms of withdrawal in a smoker who is abstaining from tobacco use.8 The pharmacokinetic properties of available products differ, but none deliver nicotine as fast as does inhaling nicotine. The patch provides a relatively stable, fixed dose of nicotine over a period of 16 or 24 hours. The other products have a more rapid onset and a...

Contents

xiii Section I Introduction Edited by Peter Mathes 1. From Exercise Training to Comprehensive Cardiac Rehabilitation 3 2. The Evidence Base for Cardiac Rehabilitation 9 3. Indications for Cardiac Rehabilitation 19 4. Prevention Guidelines Management of the Coronary Patient 26 L. Vanhees, M. Martens, S. Beloka, A. Stevens, A. Avram, and Dan Gaita 6. Cardiac Rehabilitation United States 34 8. Cardiac Rehabilitation Australia 41 Michael V. Jelinek and Stephen J. Bunker 9. Cardiac Rehabilitation...

Preventing Reinfarction

The largest study involving the use of stress management in post-MI patients7 targeted type A men i.e. those who scored highly on measures such as time urgency, competitiveness, hostility, and easily aroused anger a form of self-stress who had experienced a recent MI. Over a 4-year intervention, participants in the type A management program were at half the risk for further infarction than those in a similarly long, but traditionally focused, rehabilitation program, with total infarction rates...

Summary and Conclusion

Because of nicotine, smoking is quickly and strongly addictive. This will result in a chronic change in the brain, causing a strong craving and a high chance of relapse after quitting. Greater understanding of the neurophysi-ological background of addiction, that is, the disruption of the neuroreceptors, has increased the possibilities of treatment with medication. Cardiac rehabilitation plays an important role in supporting the patient to quit smoking. Fur...

Exercise Training in Coronary Artery Disease

Training Coronary Artery Disease

Effects of Exercise on the Vascular Endothelium in Atherosclerotic Disease Despite the clear prognostic benefits of exercise training in reducing cardiovascular events, the underlying mechanisms have long remained obscure. Basically, regional myocardial hypoper-fusion in CAD results from a combination of four pathogenetic components A vascular stenosis, B coronary vasomotion, C microrheology and hemostasis, and D mobilization of EPCs. All four components may be affected by exercise training in...

Physiologic Fitness and Health

In the last two decades, a striking amount of data have been published demonstrating the importance of fitness level in predicting risk for adverse health outcomes.2,3,13,14 A consistent observation in these studies is that after adjustment for age and other risk factors, exercise capacity has been shown to be a stronger marker of risk for cardiovascular morbidity or all-cause mortality than established risk factors such as hypertension, smoking, obesity, hyperlipidemia, diabetes, and obesity....

Definition of MetS and Health Implications

MetS also called deadly quartet, syndrome X, insulin resistance syndrome, plurimetabolic syndrome, dysmetabolic syndrome, cardiometabolic syndrome comprises a cluster of abnormalities that occur as a result of perturbations in multiple metabolic pathways, leading to insulin resistance and hyperinsulinemia, hyperglycemia, athero-genic dyslipidemia, hypertension, fibrinolytic abnormalities, etc.3 Numerous other disturbances have been progressively added to the syndrome, including a prothrombotic...

Myths and Misconceptions

Myth 1 Sex and sexuality are the same. Truth The term sex is often used to refer to the sex act, whereas sexuality reflects both the psychosocial and physical aspects of intimacy. Engaging in sex can be fun, passionate, and has been called a restorative forcethat can be both healing and energizing.7 Myth 2 Older adults with cardiac disease are less interested in information on resuming sex. Truth Older adults have many of the same questions and sexual concerns as younger individuals. Studies...

Nutritional Counseling for Patients with MetS

MetS has been identified as a target for dietary therapies to reduce CVD risk other than LDL cholesterol lowering by the NCEP ATP III.13-15 Clear evidence from metabolic studies, epidemiological studies, and clinical trials supports the consumption of unsaturated fats from natural liquid vegetable oils and nuts at the expense of saturated and trans fats rather than simply lowering total fat in the treatment of various components of the MetS e.g. dyslipidemia, insulin resistance, and Table 25-4....

Who Is the Patient Psychological Factors Readiness to Change

Health professionals' knowledge of the different phases of a patient's acceptance of chronic disease is fundamental. It is often a long period of time from the initial phases of psychological shock, denial, opposition or anger, to coping strategies and progressive acceptance. It would be unrealistic to propose major nutritional behavior modifications for a patient in the denial phase, which may be felt as a partial loss of their identity or familial culture, or even aggression. Readiness to...

Valvular Heart Disease Mitral Valve Disease

Mitral valve disease is the most common problem among patients with rheumatic heart disease. In dominant mitral stenosis, closed valvular mitral commissurotomy reduces the symptoms, improves function, and provides cost-effective rehabilitation. Patients in classes III and IV with mitral valve disease are candidates for surgery and subsequent exercise training programs. Such patients usually have a long history of disability and severely limited activity. Exercise after Heart Valve Replacement...

Contributors

Attikon University Hospital Athens, Greece Department of Cardiology Karolinska University Hospital Solna Stockholm, Sweden Dan Atar, MD, FESC, FACC FAHA Department of Cardiology Aker University Hospital Oslo, Norway Cardiac Rehabilitation Clinic University of Medicine and Pharmacy Victor Babes Timisoara Timisoara, Romania Guy de Backer, MD, PhD Department of Public Health Ghent University Ghent, Belgium Service de Cardiologie Hopital Beaujon Clichy, France Cardiovascular Rehabilitation Unit...