We will dedicate this post to a very important part of physiotherapy and maybe a little known: cardiac rehabilitation. The vast majority of adults have ever attended the physiotherapist’s consultation due to muscle problems (contractures), skeletal (fractures), joint (sprains) but very few people have gone through a process of cardiovascular recovery.
The heart: protagonist of cardiac rehabilitation
First of all, let’s talk about the heart. It is the most important muscular organ of the circulatory system. The heart is located between the lungs in the center of the chest, oriented to the left of the sternum. It is covered with a membrane of two layers, called pericardium, that wraps the heart like a bag. The outer layer of the pericardium surrounds the roots of the major blood vessels of the heart ( coronary arteries ) and is connected to the diaphragm ( the muscle that helps to breathe) and another area of the body by ligaments. The inner layer of the pericardium is attached to the heart muscle. The heart is formed by four cavities. The upper chambers are called atria and the lower chambers are called ventricles. A muscular wall called the septum separates the left and right atria and the left and right ventricles. The left ventricle is the largest and strongest cavity of the heart. The walls of the left ventricle have a thickness of just over a centimeter, but they have enough force to expel the blood through the aortic valve into the whole body. The entrance of the blood to the heart and the passage of this from an atrium to a ventricle are made through heart valves. Once we know how the heart is structured.
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what are the main pathologies for which the heart must be rehabilitated:
- Infarction: Most infarcts occur when a clot in the coronary artery cuts off the supply of blood and oxygen to the heart.
- Angioplasty: Sometimes the coronary arteries become hardened or filled with atheroma (cholesterol) and do not allow the correct passage of blood. In these cases usually, perform bypass (shunt blood to another blood vessel) or placed the stent (wire mesh tube – shaped) that maintain the ideal diameter of the vessels.
- Valvulopathy: Repair or replacement of any of the valves of the heart.
- Heart or lung transplant.
- Angina pectoris: This is a strong, intense pain in the chest. It is usually caused by a problem in the coronary arteries. It can be stable, unstable and variable.
- Heart Failure: It is diagnosed when the heart is not able to pump blood, either to the lungs to oxygenate it or to the rest of the body.
Once you have suffered the acute pathological picture, it is important to start with recovery. The first phase is to get is that the patient is able to sit and achieve stand without becoming dizzy or tired. Once the standing position has been reached, the walk begins in the plane (without going up or down stairs), short walks on the hospital floor, always taking into account the patient’s condition and under supervision, usually a physiotherapist. After two or three weeks, the cardiologist will determine what type of rehabilitation the patient needs. This is the second phase and consists of supervised exercise. It is important for patients to be aware that the exercise guidelines they are about to learn should be followed for the rest of their life.
Supervised physical exercise
Always dependent on the medical criteria, the exercise program can start between the second and third week post-acute episode. The training protocol, in general, follows scheme: three days a week (Monday, Wednesday, and Friday) the patient goes to the gymnasium of the hospital to perform the controlled physical exercise, consisting of 1. Physiotherapy table (stretching of the main Muscle groups, joint movements, abs, upper body exercises including some with 1 and 2 kg weights) for 15-20 minutes. 2. Aerobic training, on exercise bicycle or treadmill, of duration and progressively increasing the intensity until reach 45-50 minutes to the few weeks.
Aerobic exercise can be controlled in two ways: through the Borg effort scale (scale at which the patient measures his fatigue, subjective) or through the heart rate of training (FCE). The performance of an exercise test (maximum or limited by symptoms) to know the FCE is necessary when planning the aerobic training on cycle ergometer or treadmill. As part of the exercise, a program to prevent risk factors (smoking, sedentary lifestyle, inadequate diet) that can lead to relapse is initiated in parallel with occupational therapists. This second phase may last several months, depending on the patient’s progress. Regular checks will be carried out to see what progress is made and if necessary and possible to make small changes in the training program. Once the patient is discharged from the hospital, begins the third phase, consisting of a physical exercise program unsupervised: the patient must complete the prescribed program according to their condition and recovery to be followed without medical supervision and For the rest of his life.
The patient has already rejoined his usual activities and his work, sometimes requiring the intervention of social workers in order to adapt and readapt to the job more in line with the patient’s reality, as well as His sociability with family and friends. Physical exercise in this phase will consist of a mixture of aerobic work of endurance and work in muscle stations. It should be done in sports centers (both public and private) where the staff is trained and qualified to treat this type of patient. It is important to note that each patient (and pathology) is unique and, therefore, their rehabilitation will be personal and will never be able to buy or equate to another patient.