More about Myocardial infarction
Myocardial infarction involves the death of an area of heart muscle wall because one or more coronary arteries were obstructed by plaques. As a result, the heart will be weak, having less available muscle to pump blood. Problems arise during activities that require more effort, because the body needs more oxygen the heart can no longer provide it. It appears so-called “exertion dyspnoea” – shortness of breath, which means that the body needs oxygen for realization of that activity. That’s why patients whose heart no longer has the ability to provide oxygen needs are very limited in terms of effort. Inactivity leads to a further decrease in exercise capacity. Muscles and cardiovascular system lose strength and the situation worsens. It can get out of this vicious circle so patients who have suffered a myocardial infarction can have a normal life again? If so, what can be done?
When caution is harmful
Attitude toward rest and exercise has changed considerably in the last hundred years in terms of cardiac patients. If in 1930 was prescribed bed rest for two months following a heart attack in 1956 walking began to be recommended after two weeks. It’s not the happiest situation, but it’s still progress. The ’60s come with early studies on cardio-circulatory changes during training exercise with the first attempts to use exercise as a therapeutic modality. In the ’80s, already appeared studies showing significant benefits on decreasing risk factors and impact in terms of lower mortality and relapse rate for patients caught in an exercise program. In the 90s, the studies provide additional interesting facts attesting slow evolution of coronary artery disease, reducing stress and improving quality of life due to physical exertion. Although there are tens and hundreds of studies showing the effectiveness of the effort in decreasing mortality, relapse rate, improving the quality of life, how many times do physicians (including cardiologists!) not prohibit patients exercise? Here is an attitude that needs to be changed, which is not in agreement with the advances in medical science. It is true, rehabilitation to effort must necessarily be done in specialized centers and adapted to each patient after a detailed balance. Following these tests is established the level of effort that a patient is capable and heart and the body does not suffer from lack of oxygen.
There are solutions
Most times, atherosclerosis being guilty of myocardial infarction occurs due to an unhealthy lifestyle. A diet high in calories and fat, smoking, presence of obesity, hypertension, diabetes, sedentary lifestyle, stress are risk factors known to be associated very closely with myocardial infarction. To prevent or decrease the rate of relapse and adverse consequences, treatment should begin with some changes related to lifestyle. Control stress, decrease LDL cholesterol and increase HDL cholesterol by switching to a diet rich in vegetables and low in animal fat, quitting smoking, controlling diabetes and blood pressure are of vital importance if you want to continue to enjoy a quality life.
Currently are known many of the positive effects of exercise rehabilitation program on patients with heart disease. Among these, we mention:
– Decrease in heart rate and blood pressure;
– More efficient use of oxygen in muscles;
– Increasing the blood supply to the heart;
– Improving exercise capacity by 20-30%;
– Decreased biomarkers of inflammation (fibrinogen, C-reactive protein);
– Lowering LDL-cholesterol and triglycerides, and platelet Adhesion;
– 25% decrease in cardiovascular mortality and sudden death risk by 20%;
– Regression of atheromatous lesions;
– The formation of new blood vessels;
– Reducing stress and depression.
Rehabilitation after myocardial infarction involves the three phases.
The first phase corresponds to the acute stage and begins immediately after admission. Means preventing the loss of muscle mass through light exercises for each muscle group, preventing ventilatory problems by practicing abdomino-diaphragmatic breathing, prevention of venous thrombosis by venous drainage massage and exercises for leg muscles, walking in the room and the corridor, reducing anxiety by informing patients about the benefits of the recovery program.
The second phase, the proper rehabilitation, begins after the third or fourth week after the heart attack, after cardiac injury healing, after a cardiology balance. It involves making a simple electrocardiogram or for 24 hours (Holter), a simple cardiac ultrasound or stress, effort test, measurement of expiratory gases during exercise. These tests will give us valuable information about severity of heart damage, heart behavior during exercise, parameters to be respected in the process of rehabilitation.
Objectives of rehabilitation at effort are aimed to increase muscles strength, recovery of heart cells that are in a state of “hibernation” because of ischemia, the formation of new blood vessels, combat risk factors.
For rehabilitation to be effective, you need a minimum of 20 training sessions with a frequency of at least 2-3 times a week. One day training session involves a relaxation, a heating gym session (30-45 minutes), a light resistance exercise (30-45 minutes) and a proper workout using bicycle or treadmill (30-45 minutes). Exercises have an intensity which increases progressively, always maintaining a constant heart rate calculated as the target during testing effort.
A workout also requires 5-10 minutes of heating, 20-30 minutes of constant effort and 5 minutes of recovery.
During this phase, effort tests and measuring of expired gases are repeated to measure progress. A monitoring of the electrical activity of the heart, blood pressure and heart rate are required.
It is very important during this time to educate patients about the benefits of modifying risk factors, about knowledge of their disease, the benefits of exercise training, the targets can be achieved.
The third phase involves continuing training exercise in a safe place, after the second phase, when the patient returns at home. Heart rate considered as target should not be exceeded. A minimum of 30 minutes at least 3 times per week of physical activity are required, like swimming, cycling, walking, running. A normal life is possible for those who have suffered a myocardial infarction.