Diagnostic Groups Suitable for Rehabilitation

The categories of patients with coronary heart disease and its complications who may need rehabilitation services include the following:

- those who have been admitted to a hospital for unstable angina

- those with chronic ischemic heart disease who are starting an exercise program

- those who have undergone coronary bypass surgery and percutaneous transluminal coronary angioplasty.

The largest group will be patients who have sustained acute myocardial infarction, and this should be taken into consideration in planning personnel training and facilities for exercise programs.6-8

Risk assessment of patients entering exercise programs is essential, as is the identification of any factors that would contraindicate exercise. Individually prescribed exercises should take account of the degree and type of surveillance necessary for safety and for assessment of results. It is also important to assess patients' educational needs and to develop plans for secondary prevention. Any special needs (e.g. psychological or vocational) must also be considered.9-10

In many countries, rheumatic heart disease is a problem of childhood, adolescence, and young adulthood. The disease progresses rapidly and few of those affected survive into middle age without proper medical and surgical treatment. In both rheumatic heart disease and coronary heart disease, many of the common residual defects and hemodynamic derangements leave post-surgical patients with varying degrees of disability. This is further confounded by problems of chronic anticoagulation in patients with mechanical prosthetic valves.11-14

Patients who need rehabilitation generally belong to one of the following categories:

- those who have become inoperable or whose lesions are too complex for the available surgery

- postoperative patients in whom results and prognosis are good

- postoperative patients with significant residual defects

- those who need chronic anticoagulation and prophylaxis for rheumatic fever.

While patients with rheumatic heart disease and congenital heart disease may have to be cared for in the same rehabilitation facility as those with other cardiac problems, they may be very different in age from other cardiac patients and will need special care and assessment.15,16

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