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High Risk Case Study Sudbury Regional Hospital Cardiac Rehabilitation

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High Risk Case Study Sudbury Regional Hospital Cardiac Rehabilitation – PowerPoint PPT presentation

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Title: High Risk Case Study Sudbury Regional Hospital Cardiac Rehabilitation


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 lt1
  • 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 gt 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
  • Karvonens 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 patients 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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