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
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