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High Risk Case Study Sudbury Regional Hospital Cardiac Rehabilitation

High Risk Case Study Sudbury Regional Hospital Cardiac Rehabilitation. High Risk Case Study. 66 year old male MI 16 years ago and 2 months ago CABG 6 years ago Cardiac Arrest during recent Angiogram. High Risk Case Study. Left Ventricle Ejection Fraction Grade 4 ( less than 20%)

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High Risk Case Study Sudbury Regional Hospital Cardiac Rehabilitation

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  1. High Risk Case StudySudbury Regional Hospital Cardiac Rehabilitation

  2. High Risk Case Study • 66 year old male • MI 16 years ago and 2 months ago • CABG 6 years ago • Cardiac Arrest during recent Angiogram

  3. High Risk Case Study • Left Ventricle Ejection Fraction Grade 4 ( less than 20%) • Congestive Heart Failure( NYHA Class II) • TIA • PVD • Osteoarthritis

  4. CORONARY RISK FACTORS • Hypertension • Dyslipidemia • Obesity • Stress • Diabetes • Inactivity • Family History

  5. MEDICATIONS • Digoxin • Coumadin • Aldactone • Enteric Coated ASA • Nitrong • Accupril • Lasix • Carvedilol • Insulin • Ativan • Slow K Mr..H. Nitrong SR 2.6mg

  6. FUNCTIONAL CAPACITY • 3.5 - 4 Mets (metabolic equivalents) • Moderate Dyspnea with ADL • Walked 550 feet on 6 min. walk test

  7. RISK STRATIFICATION SCORE • Total Score from both Risk of Disease Progression and Acute Event = 84.3

  8. HYPERTENSION • Medication • Control weight • Reduce sodium - less than 3 gm/day

  9. DYSLIPIDEMIA • Medication • Low fat diet • Exercise

  10. OBESITY • Exercise to expend 200 cal/session • BMI 20-25/ WHR <1 • 1500-1800 caloric intake daily • Low fat, low sodium diet • Referral to dietician

  11. INACTIVITY • Balance activity with rest • Combination wt./ non-wt.bearing exercise • Must be stable (NYHA I-II) • Exercise capacity of > 3 METS • 500 feet on 6 min. walk test

  12. F.I.T.T. PRINCIPALFREQUENCY • 3-5 Times per week • Can try shorter bouts( 5-10min.) of 2-3 sessions per day

  13. F.I.T.T. PRINCIPALINTENSITY • Based on treadmill test and/or 6 min. walk test • 40-75% Vo2max • Karvonen’s formula • RPE and Dyspnea scale

  14. F.I.T.T. PRINCIPALTYPE • Aerobic activities recommended • Resistance training -high rep, low wt.

  15. F.I.T.T. PRINCIPALTIME • Brief initially: 2-5 min. per session, increasing this by total of 5 min. per week • Rest periods between intervals • Progressively increase time to 20-30 min. total as patient’s tolerance improves

  16. STRESS • Medication to reduce anxiety • Regular exercise • BDI46 • Stress management • Assess social and family support • Quality of Life Assessment tool

  17. DIABETES • Regular exercise • Medication • Diabetes Educator

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