Stress Myocardial Perfusion Imaging
Exercise perfusion imaging appears to be superior to exercise ECG alone in detecting CAD, in identifying multivessel disease, in localizing diseased vessels, and in determining the extent of ischemic and infarcted myocardium. Perfusion imaging is also useful for detecting myocardial viability in patients with left ventricular dysfunction, either regional or global, with or without Q waves, and provides important information with regard to risk stratification and therapeutic strategies.6 Stress...
The Role and Responsibilities of the Nurse
A central issue to explore is the role and responsibility of nurses in heart failure programs. Among all tasks, nurses have formal competence for some, delegated responsibility for others, while some extended tasks need additional training and education. There are huge differences both within and between countries regarding the education and competencies of registered nurses. There are legal differences as to what nurses are allowed to do within their license. The whole team needs to agree on...
Stage 2 Contemplation
Only in the second stage, the contemplation phase, will the patient be open to information about the short-term and long-term effects of quitting smoking. Short-term advantages are being in better shape and feeling more energetic, having a better skin, better taste and smell, a better voice, and whiter teeth. Long-term effects are a better prognosis, adding years to life, less chance of, or improvement of, lung diseases and heart and vascular diseases, less chance of lung cancer and other forms...
Myths and Misconceptions
Myth 1 Sex and sexuality are the same. Truth The term sex is often used to refer to the sex act, whereas sexuality reflects both the psychosocial and physical aspects of intimacy. Engaging in sex can be fun, passionate, and has been called a restorative forcethat can be both healing and energizing.7 Myth 2 Older adults with cardiac disease are less interested in information on resuming sex. Truth Older adults have many of the same questions and sexual concerns as younger individuals. Studies...
The Role of Cardiac Rehabilitation Physical Training
The physical capacity of patients early post-MI is diminished due to physical deconditioning, a possible loss of cardiac reserve and the effect of drug treatment. Exercise training influences VO2max, blood lipid levels, platelet aggregation, and fibrinolysis, and protects against malignant arrhythmia. Exercise-related dyspnea, fatigue, and angina may be alleviated. Table 38-1. Return to work after myocardial infarction Author, publication year, reference number and country Outcome of morbidity...
Classification of Sports
Exercise is usually classified into dynamic isotonic and static isometric and the intensity as low, moderate, or high. Running is typical dynamic exercise and leads to increased cardiac output, oxygen consumption, and systolic blood pressure, whereas diastolic blood pressure may fall due to decreased peripheral resistance. Static exercise leads to pressure overload with little influence on oxygen consumption and cardiac output. Traditionally, dynamic exercise is preferred in cardiac patients,...
Exercise Testing Before and after Revascularization
Patients who are planned to undergo revascular-ization, and especially those who are asympto matic,should have documented ischemic or viable myocardium.5 This most commonly requires a more sensitive test than exercise ECG, particularly in the setting of one-vessel disease and when the culprit vessel supplies the posterior wall. However, documentation of pre-procedure exercise capacity may be of value. With regard to the early phase after revascularization, the goal of an exercise test is to...
Chapter 35 Adherence to Health Recommendations
Adherence is the single most important modifiable factor that compromises therapeutic outcome across a wide spectrum of diseases. The most efficacious treatment is made ineffective if the patient fails to adhere to it. Non-adherence produces unnecessary medical and psychosocial consequences of CHD, reduces quality of life, and wastes valuable healthcare resources. Adherence to health-related recommendations is thus a major challenge for prevention and rehabilitation in cardiovascular disorders....
Nutritional Counseling for Patients with MetS
MetS has been identified as a target for dietary therapies to reduce CVD risk other than LDL cholesterol lowering by the NCEP ATP III.13-15 Clear evidence from metabolic studies, epidemiological studies, and clinical trials supports the consumption of unsaturated fats from natural liquid vegetable oils and nuts at the expense of saturated and trans fats rather than simply lowering total fat in the treatment of various components of the MetS e.g. dyslipidemia, insulin resistance, and Table 25-4....
Contemporary Cardiac Rehabilitation Programs in South Africa
South Africa is divided into nine provinces. Formal cardiac rehabilitation programs exist in most of these provinces associated with academic universities or private hospitals. Although there have been initiatives to arrange rehabilitation services at governmental hospitals, these services have been fragmented and severely limited due to staff and financial shortages. Some provincial government hospitals' physiotherapy units provide some phase I rehabilitation following cardiac surgery. Most...
Who Is the Patient Psychological Factors Readiness to Change
Health professionals' knowledge of the different phases of a patient's acceptance of chronic disease is fundamental. It is often a long period of time from the initial phases of psychological shock, denial, opposition or anger, to coping strategies and progressive acceptance. It would be unrealistic to propose major nutritional behavior modifications for a patient in the denial phase, which may be felt as a partial loss of their identity or familial culture, or even aggression. Readiness to...
Competitive Sports in Cardiac Diseases
Cardiovascular disease may induce an increased risk of sudden death or deterioration of disease on competitive athletic activity therefore recommendations are important to provide careful directions for physicians and consultant cardiologists. By competitive athletes is meant individuals of young or adult age who are engaged in regular exercise training and participation in official sports competitions. The recommendations are particularly important in elite athletes due to the intense pressure...
Historical Perspective 1
Regular physical exercise and a high exercise capacity have been hallmarks of health and vitality for millennia and were associated with a distinct survival advantage in a hostile environment. In the modern civilized environment it is usually not the external enemy who is to be defeated. One of the enemies of survival is lack of physical activity and the resulting decreased physical fitness both emerge once again as enemies of survival, this time in an all too friendly and comfortable...
Myocarditis and Pericarditis
Myocarditis accounts for about 10 of SD in young athletes and should be assessed by standard clinical examination included viral serology particularly enteroviruses , ECG, and echocardiography including tissue Doppler . In active myocarditis, athletic competitions are not recommended. Six months after onset competitions may be resumed provided there are no symptoms, normal LV function, and no arrhythmias assessed by ECG, echocardiography, exercise ECG, and Holter monitoring. A new...
Atrioventricular AV Block
Individuals with AV block grade I and second-degree AV block type Wenckebach Mobitz type I can participate in all sports if there are no symptoms, no structural heart disease, and no progression of AV block during exercise. Those with Mobitz type II or third-degree AV block can participate in low-moderate dynamic, and low-moderate static sports in the absence of symptoms, cardiac disease, ventricular arrhythmias during exercise, and if the resting heart rate is gt 40 beats min.
Cardiomyopathy
The most common cardiomyopathies are the dilated and hypertrophic varieties, while the restrictive variety, though rarer in many countries, is common in Africa and South America. All ages and both sexes are affected. The disease may be very mild and chronic, or severe enough to result in death in a short period of time. There is increasing evidence that some form of exercise is of benefit to patients with dilated cardiomy-opathy. Careful exercise training may result in sufficient peripheral...
Nonsustained Ventricular Tachycardia NSVT Slow Ventricular Tachycardia
Athletes can participate in all sports, except those with increased risk see Table 22-1 ,in the absence of cardiac disease, arrhythmogenic condition, family history of sudden death, symptoms syncope , relation with exercise, and multiple episodes of NSVT or VT over 24 hours and or with short RR interval. Athletes with symptomatic fascicular tachycardia or RVOT who undergo catheter ablation can participate in competitive sports 3 months after successful ablation if asymptomatic and without...
and Rehabilitation
Helmut Gohlke, FACC, FESC Klinische Kardiologie II Herz-Zentrum Bad Krozingen Germany Cardiology , PhD Institute of Health Sciences Department of Earth Sciences Vrije University and Department of Cardiology Vrije University Medical Center Amsterdam The Netherlands Assistance Publique-H pitaux de Paris Peter Mathes, MD, FACC, FESC Department of Cardiology Technical University of Munich Munich Rehabilitation Center M nchen Germany Catherine Monp re, MD Cardiac Rehabilitation Center Bois Gilbert...
Current Status and Future Directions
Through its CR policy and guidelines6 the NHF promotes the routine referral of all patients with cardiovascular disease to an appropriate CR program. Patients are encouraged to attend as soon as possible after discharge. Currently, there are almost 300 structured post-discharge CR programs throughout Australia, mainly in urban areas. Programs vary in length from a minimum of one session a week for 6 weeks through to more comprehensive programs. Despite the abundant evidence supporting the...
Valvular Heart Disease Mitral Valve Disease
Mitral valve disease is the most common problem among patients with rheumatic heart disease. In dominant mitral stenosis, closed valvular mitral commissurotomy reduces the symptoms, improves function, and provides cost-effective rehabilitation. Patients in classes III and IV with mitral valve disease are candidates for surgery and subsequent exercise training programs. Such patients usually have a long history of disability and severely limited activity. Exercise after Heart Valve Replacement...
Contributors
Attikon University Hospital Athens, Greece Department of Cardiology Karolinska University Hospital Solna Stockholm, Sweden Dan Atar, MD, FESC, FACC FAHA Department of Cardiology Aker University Hospital Oslo, Norway Cardiac Rehabilitation Clinic University of Medicine and Pharmacy Victor Babes Timisoara Timisoara, Romania Guy de Backer, MD, PhD Department of Public Health Ghent University Ghent, Belgium Service de Cardiologie Hopital Beaujon Clichy, France Cardiovascular Rehabilitation Unit...