Cardiac rehabilitation following myocardial infarction. A practical approach

Abstract

The concept of cardiac rehabilitation following myocardial infarction is not a new one but is now at last gaining acceptance as an essential part of the service to the coronary patient. Its aim is to restore the effectiveness of post-infarct patients by ensuring that they are well adjusted, well educated and fit and thereby best able to cope with the long term consequences of their ischaemic heart disease. The first essential factor for good rehabilitation is patient education. Studies have shown high levels of distress and anxiety after infarction and to a large extent this is related to lack of information. Where patients have been given adequate information concerning their condition and treatment there is a high level of patient satisfaction and greater compliance. It must be appreciated that stress and anxiety impair the patient's ability to assimilate information and therefore repeated reinforcement is necessary. During the in-hospital period, the staff who are caring for the patient are constantly changing and while there is a role for all to educate the patient, the use of a cardiac liaison sister provides a continuity throughout the early recovery period to ensure that the education process is adequate. The use of written material and both audio and video tapes is also helpful. It is also important for the liaison sister to extend her role to the patient's immediate family, who also require information, and finally the liaison sister can provide a link into the post discharge phase, to answer the many questions that arise at this time, and to provide encouragement to the patient who is attempting to modify his lifestyle by stopping smoking, changing his diet and taking regular exercise. The use of exercise training is the second vital ingredient for adequate rehabilitation. This begins in earnest after the 6-week assessment, which can provide information on which to base an exercise prescription. The majority of patients enrolled within exercise programmes are medically stable and relatively symptom-free. There is increasing evidence that those with extensive myocardial damage, left ventricular dysfunction or failure, and ongoing myocardial ischaemia may also benefit. Traditional training programmes have been hospital based and have used mainly aerobic exercise. However, home based programmes should not be discounted where they may be more economical, more convenient, and improve patient compliance. Similarly, circuit training with weights has been shown to improve aerobic endurance and muscle strength and to have additional benefits in improved treadmill time compared with traditional aerobic programmes.(ABSTRACT TRUNCATED AT 400 WORDS)