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Cardiac Rehabilitation

Cardiac Rehabilitation. Alison Anderson Specialist Nurse Gail Bohin Psychologist. Making Sense of Symptoms. What do these symptoms mean?. What has caused this?. What does the future hold?. What has happened to me?. How long will it take to get better?.

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Cardiac Rehabilitation

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  1. Cardiac Rehabilitation Alison Anderson Specialist Nurse Gail Bohin Psychologist

  2. Making Sense of Symptoms What do these symptoms mean? What has caused this? What does the future hold? What has happened to me? How long will it take to get better?

  3. Thoughts, feelings, behaviour & recovery • Cardiac misconceptions • Hypervigilance for symptoms • Fear & avoidance of exertion/activity • Mood disturbance • Low motivation for lifestyle changes • Denial

  4. The Psychological Recovery • Can often feel harder than the physical one • Post MI we can see a predictable pattern of peaks & troughs of anxiety, CABG and PCI require more research • A patient’s psychological response to their cardiac event will have a huge impact upon their physical recovery, rehabilitation potential, quality of life and survival

  5. When Can I……………?

  6. Goal Setting and Pacing Goal ------------- Baseline----------

  7. Warm Up and Cool Down

  8. “I am on the go all day at work, why do I need to exercise?”

  9. Multi-disciplinary Management of Angina Symptoms • Medication / investigations • Education – Risk factor and symptom management • Psychology - Awareness of vicious circles, reducing anxiety, stress triggers, relaxation techniques • Exercise - Pacing, exercising appropriately to increase functional capacity and lower angina threshold

  10. “Angina is damaging my heart”  fatigue, angina at lower workload Increasingly restricted life Increasing: anxiety depression symptoms Seeking further treatment Patient reduces activity to avoid angina Physical de-conditioning lowers angina threshold

  11. Work Influencing factors: • Type of job • Attitude to job • Capacity / support of employers to phase return • Environmental conditions • Travelling • Cardiac condition – awaiting tests / treatment • Other medical conditions

  12. Sex After A Cardiac Event 54% of people do not resume their previous level of sexual activity following a cardiac event. Partners can also be anxious about resuming sex due to fears of over exertion.

  13. Sex After a Cardiac event You can have sex when: • You can walk 300 yards on the level comfortably or • You can climb two flights of stairs without getting chest pain or becoming breathless • 2-3 weeks post MI (BHF)

  14. Driving DVLA guidelines Group 1 MI/ CABG 4 weeks Angioplasty 1 week Valve No restrictions!

  15. Driving and Acute Coronary Syndromes (ACS) For Group 1 ACS defined as All: • Persistant or recurrent cardiac pain • Cardiac troponin release positive • Electrocardiographic changes (NSTEMI & successful angioplasty – 1 week)

  16. Driving (Group 2) LGV / PCV Angina 6 weeks MI 6 weeks ACS 6 weeks Angioplasty 6 weeks CABG 3 months

  17. Holidays • Insurance • Altitude • Temperatures • Flying

  18. Summary A multi disciplinary team approach is needed to address the complex issues that patients have about their recovery.

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