High Risk Case StudyHigh Risk Case Study

Sudbury Regional Hospital Sudbury Regional Hospital Cardiac RehabilitationCardiac Rehabilitation

High Risk Case StudyHigh Risk Case Study

66 year old male66 year old male

MI 16 years ago and 2 months agoMI 16 years ago and 2 months ago

CABG 6 years ago CABG 6 years ago

Cardiac Arrest during recent AngiogramCardiac Arrest during recent Angiogram

High Risk Case StudyHigh Risk Case Study

Left Ventricle Ejection Fraction Grade 4 Left Ventricle Ejection Fraction Grade 4 ( less than 20%)( less than 20%)

Congestive Heart Failure( NYHA Class II)Congestive Heart Failure( NYHA Class II) TIATIA PVDPVD OsteoarthritisOsteoarthritis

CORONARY RISK FACTORSCORONARY RISK FACTORS

HypertensionHypertension DyslipidemiaDyslipidemia ObesityObesity StressStress DiabetesDiabetes InactivityInactivity Family HistoryFamily History

MEDICATIONSMEDICATIONS DigoxinDigoxin CoumadinCoumadin AldactoneAldactone Enteric Coated ASAEnteric Coated ASA NitrongNitrong AccuprilAccupril LasixLasix CarvedilolCarvedilol InsulinInsulin AtivanAtivan Slow KSlow K

Mr..H.

Nitrong SR 2.6mg

FUNCTIONAL CAPACITYFUNCTIONAL CAPACITY

3.5 - 4 Mets (metabolic equivalents)3.5 - 4 Mets (metabolic equivalents)

Moderate Dyspnea with ADLModerate Dyspnea with ADL

Walked 550 feet on 6 min. walk testWalked 550 feet on 6 min. walk test

RISK STRATIFICATION RISK STRATIFICATION SCORESCORE

Total Score from both Risk of Total Score from both Risk of Disease Progression and Acute Disease Progression and Acute

Event = Event = 84.384.3

HYPERTENSIONHYPERTENSION

MedicationMedication

Control weightControl weight

Reduce sodium - less than 3 gm/dayReduce sodium - less than 3 gm/day

DYSLIPIDEMIADYSLIPIDEMIA

MedicationMedication

Low fat dietLow fat diet

ExerciseExercise

OBESITYOBESITY Exercise to expend 200 cal/sessionExercise to expend 200 cal/session

BMI 20-25/ WHR <1BMI 20-25/ WHR <1

1500-1800 caloric intake daily1500-1800 caloric intake daily

Low fat, low sodium dietLow fat, low sodium diet

Referral to dieticianReferral to dietician

INACTIVITYINACTIVITY

Balance activity with restBalance activity with rest Combination wt./ non-wt.bearing Combination wt./ non-wt.bearing

exerciseexercise Must be stable (NYHA I-II)Must be stable (NYHA I-II) Exercise capacity of > 3 METSExercise capacity of > 3 METS 500 feet on 6 min. walk test500 feet on 6 min. walk test

F.I.T.T. PRINCIPALF.I.T.T. PRINCIPALFREQUENCYFREQUENCY

3-5 Times per week3-5 Times per week

Can try shorter bouts( 5-10min.) Can try shorter bouts( 5-10min.) of 2-3 sessions per dayof 2-3 sessions per day

F.I.T.T. PRINCIPALF.I.T.T. PRINCIPALINTENSITYINTENSITY

Based on treadmill test and/or 6 min. Based on treadmill test and/or 6 min. walk testwalk test

40-75% Vo2max40-75% Vo2max Karvonen’s formulaKarvonen’s formula RPE and Dyspnea scaleRPE and Dyspnea scale

F.I.T.T. PRINCIPALF.I.T.T. PRINCIPALTYPETYPE

Aerobic activities recommendedAerobic activities recommended

Resistance training -high rep, low wt.Resistance training -high rep, low wt.

F.I.T.T. PRINCIPALF.I.T.T. PRINCIPALTIMETIME

Brief initially: 2-5 min. per session, Brief initially: 2-5 min. per session, increasing this by total of 5 min. per weekincreasing this by total of 5 min. per week

Rest periods between intervalsRest periods between intervals

Progressively increase time to 20-30 min. Progressively increase time to 20-30 min. total as patient’s tolerance improvestotal as patient’s tolerance improves

STRESSSTRESS

Medication to reduce anxietyMedication to reduce anxiety Regular exerciseRegular exercise BDI46BDI46 Stress managementStress management Assess social and family supportAssess social and family support Quality of Life Assessment toolQuality of Life Assessment tool

DIABETESDIABETES

Regular exerciseRegular exercise

MedicationMedication

Diabetes EducatorDiabetes Educator