Ischemic heart disease ranks first in the statistics of morbidity and disability. One of the most life-threatening conditions is myocardial infarction, which belongs to the so-called episodes of disasters. Thanks to modern methods of diagnosis and treatment, the number of deaths has significantly decreased, however, full recovery and return to the usual way of life require long and consistent rehabilitation. Recovery methods are chosen depending on the condition and physical capabilities of the patient. A systematic approach to them improves and prolongs life.
Goals of rehabilitation after a heart attack
The coronary arteries supply blood to the heart muscle. A sharp violation of blood flow causes hypoxia (oxygen starvation), and then the death of cells - a heart attack. After scarring, the tissue does not perform the necessary functions, circulatory insufficiency is formed, and the body has to adapt to new conditions. The quality and duration of life of patients after a heart attack and stenting is determined by the development of compensatory mechanisms.
The rehabilitation program for patients after a heart attack or cardiac surgery (bypass, stenting) pursues the following goals:
- prevention of early and late complications: acute and chronic aneurysms (thinning and protrusion of the heart wall), rhythm disturbances, cardiogenic shock with pulmonary edema, heart rupture, myocarditis;
- restoration of physical activity (including professional) to the maximum possible indicators;
- psychological preparation of the patient for life after a heart attack, the mood for long-term rehabilitation;
- reducing the risk of recurrent cardiovascular events, including stroke.
In addition, the program of rehabilitation of patients after myocardial infarction and stenting is aimed at general strengthening of the adaptive capabilities of the body, returning to a full life.
Methods
Physical rehabilitation of postinfarction patients is carried out in stages, with a gradual increase in loads and constant monitoring of functional capabilities. The methods of adaptation of organs and systems (cardiovascular, respiratory, musculoskeletal), as well as psychological support are used in a complex manner.
Rehabilitation means:
- physiotherapy exercises (exercise therapy);
- spa recovery in specialized cardiological boarding houses;
- educational program in organized schools for patients with coronary heart disease (CHD);
- drug treatment depending on the patient's condition, circulatory disorders;
- physiotherapy;
- psychological rehabilitation.
The recovery program is selected based on the patient's diagnosis: the extent of the infarction (transmural or small focal), localization (apex, wall, septum), concomitant diseases are taken into account.
There are three degrees of severity of patients:
| Clinical group | The main signs |
|---|---|
| First (easy) |
|
| Second (moderate) |
|
| Third (heavy) |
|
The patient's clinical group determines the total and stage-by-stage duration of rehabilitation.
Exercise therapy
To select exercises for physical rehabilitation, the functional state of the body's systems is assessed. For this, test loads are carried out:
- 6-minute walk test: the patient needs to walk the longest distance in 6 minutes without jogging;
- veloergometry - on an exercise bike with a given power;
- treadmill test - walking on a treadmill.
Depending on the symptoms that arise, the types of responses presented in the table are distinguished.
| Criterion | Physiological | Intermediate | Pathological |
|---|---|---|---|
| Fatigue | Moderate | Pronounced, disappears in less than 5 minutes | Severe with a long recovery period |
| Dyspnea | Not | Insignificant | Expressed |
| Chest pain | Not | Episodes, self-controlled | Strong, requires nitroglycerin |
| Blood pressure and pulse | Within normal limits for load level | Infrequent disturbances with recovery within 5-10 minutes | Prolonged overstepping requiring more than 10 minutes of rest |
| ECG changes | Not |
|
|
Depending on the patient's response, the stage of rehabilitation and the severity, programs of different levels are selected.
Exercises of the exercise therapy program 1 (the first 2-4 days of rehabilitation with the initial lying position):
- flexion and extension of the fingers and toes (6-8 times);
- while inhaling, bend your forearms, spread your elbows to the sides, while exhaling, straighten your arms along the body (2-3 times);
- alternate bending of the knees, without lifting the feet from the bed (4-6 times);
- turn the brushes with palms down: while inhaling - reach for the knees, straining the muscles of the trunk and legs, while exhaling - relax (2-3 times);
- legs bent at the knees alternately lower to the right and left sides (4-6 times);
- alternately reach out with your hands to the legs bent at the knees (3-5 times).
Between exercises, you need to pause for 10-30 seconds to restore breathing.
An approximate set of exercise therapy 2 (from 4 to 12 days of rehabilitation in a hospital, the initial position is sitting):
- the back is straight, hands on the knees: while inhaling - touch the shoulders with your hands, spread your elbows to the sides, while exhaling - to the starting position (6-8 times);
- on inhalation - arms forward and upward, on exhalation - lower (3-5 times);
- move your feet back and forth without lifting them off the floor (10-15 times);
- on inhalation - spread your arms to the sides, on exhalation - return to the starting position (6-8 times);
- arms bent at the elbows at the waist: turn the head alternately to the left and right sides (5-10 times).
Rehabilitation after myocardial infarction at home (exercise therapy 3) can be carried out using special mobile applications to monitor exercise performance.
Sanatorium recovery
Rehabilitation of patients in sanatoriums after a heart attack is carried out in a stable condition and the expansion of motor activity up to walking 500 meters.
The main goal of spa recovery (up to 2 months after a heart attack) is to stimulate compensatory mechanisms for further transfer of the patient to the polyclinic stage.
Methods and means used:
- physical rehabilitation with the help of massage, remedial gymnastics and exercise therapy (modes expand to programs 4, 5 and 6 with increased intensity of classes);
- use of special simulators - treadmill, bicycle ergometry;
- Scandinavian (with sticks) and metered walking;
- teaching at school for patients with ischemic heart disease: maintaining a healthy lifestyle, giving up alcohol and smoking, rational nutrition, work and rest;
- psychotherapy: group and individual sessions using audio and video materials;
- drug treatment (basic therapy, vitamins, mineral complexes, metabolic agents);
- physiotherapy (courses of at least 10-15): carbon dioxide and radon baths, electrophoresis with No-Shpa, Euphyllin. Sessions associated with the influence on the cerebellum have a positive effect: electrosleep, TES (transcranial electrical stimulation).
National programs allow more than 80% of patients to improve their health and recover in public institutions free of charge (up to 21 days). The referral to the resort is drawn up by the attending doctor together with the medical advisory commission on the basis of the conclusion after the inpatient stage.
Medical supervision
The selection of an effective individual program, the correction of the intensity of loads and doses of drugs is carried out by the doctor. After discharge from the hospital, local doctors and staff of specialized cardiological centers take control of the rehabilitation process.
In a sanatorium, the level of fitness and adaptive capabilities of the patient is assessed by changes in parameters under the influence of dosed physical activity:
- breathing rate;
- the number of heartbeats per minute;
- changes in the electrocardiogram;
- the power of the machine and the duration of the session that causes fatigue.
Patients who have had myocardial infarction are registered with a cardiologist for life.
Outpatient medical supervision includes:
- visits to the cardiologist every 3 months during the first year, every six months - thereafter;
- daily blood pressure measurement;
- control of lipid profile, coagulogram - once every three months (first year), then - once every six months;
- general analysis of blood and urine - every 6 months.
Stages of postinfarction rehabilitation
The effectiveness of restoring the adaptive capabilities of a person depends on the adequacy of the loads in different periods. In general cardiac rehabilitation, there are three main stages:
- early;
- outpatient;
- remote.
The duration of the stages is different for each person, depending on the clinical situation.
Early
The early period implies the rehabilitation of the patient in a hospital in various departments.
- Department of intensive care and resuscitation (no more than 3 days with uncomplicated course). The patient is allowed to make turns of the body in bed, head movements and low-amplitude movements of the limbs. The implementation of the exercise therapy complex 1 is carried out exclusively under the supervision of a therapeutic gymnastics instructor. The greatest attention is paid to the psychological side of recovery: there are talks about the disease, the methods of treatment and rehabilitation used, and further modification of the lifestyle.
- Cardiology department (10-14 days). The patient's motor regime expands to walking in the ward, riding a wheelchair along the corridor. A set of exercises exercise therapy 2 is used, with a positive reaction of the patient, exits to the corridor are allowed.
- Hospital of a specialized sanatorium or resort (up to 1.5-2 months). The main focus is on the patient's return to normal life, participation in an educational program for patients, physiotherapy.
Physical activity is severely limited due to the need to form an adequate scar at the site of the necrotic myocardium, which will be able to maintain hemodynamic parameters at sufficient levels.
Outpatient
In foreign sources, the period of rehabilitation after the hospital is called the recovery phase. The average duration is 6-8 weeks, during which the patient is under the supervision of specialists from a polyclinic or an outpatient center.
The main areas of work with the patient:
- restoration of the patient's physical capabilities;
- preparation for professional activity;
- secondary prevention of cardiovascular accidents and late complications.
In this period, the patient is offered to use rehabilitation methods in a polyclinic (physiotherapy, bicycle ergometry).
Remote (supportive)
The duration of this phase of the patient's rehabilitation implies lifelong adherence to the doctor's recommendations regarding:
- physical activity;
- rational nutrition: such patients are recommended a Mediterranean diet with a low content of animal fats;
- giving up bad habits;
- adequate work activity (return to low-intensity work is possible 2 months after a heart attack).
In Russia, recovery in the outpatient period means regular visits to the local therapist, as well as other doctors. In foreign countries, state programs provide 21-day stay of patients in hospitals of specialized centers once a year.
Life after a heart attack: how to maintain longevity
Myocardial infarction was previously considered a disease of older men, but now the pathology is increasingly being recorded among the working-age population. The impairment of cardiac function significantly impairs the patient's quality of life.
Thanks to new methods of diagnosis, treatment and early rehabilitation, patients who have had myocardial infarction can live to a ripe old age, following easy recommendations:
- systemic drug therapy, most often Aspirin, statins, nitrates;
- regular physical activity: morning exercises, dosed walking 3-4 times a week for 1 hour;
- weight loss (the required level is calculated by the doctor using the Quetelet index);
- Mediterranean diet;
- optimistic attitude towards full recovery.
Recovery after myocardial infarction at home is the most critical stage for the patient, since the quality of life depends on the consistency of classes and adherence to recommendations.
Where to recover: a list of centers and institutions
In Russia, there are many resorts and health resorts specializing in cardiological pathologies. The choice of the necessary institution is carried out depending on the concomitant diseases, geographic location and material capabilities of the patient.
The most popular cardiac rehabilitation centers in the country:
- Kislovodsk (Stavropol Territory) - balneoclimatic resort from the group of Caucasian mineral waters;
- sanatorium them. Kirov (Crimea);
- rehabilitation center them. Herzen (Moscow region);
- sanatorium "Zvezdny" (Krasnodar Territory), which also treats patients with pathologies of the respiratory, digestive, kidney, and skin organs;
- rehabilitation center of the clinic. NI Pirogova deals with seriously ill patients after a heart attack and complex operations on blood vessels and heart;
- sanatorium "Electra" (Irkutsk);
- sanatorium-preventorium "Salyn" (Bryansk region).
It is necessary to select an institution for rehabilitation among proven certified sanatoriums that offer specialized medical services.
Conclusions
Rehabilitating a patient who has had myocardial infarction is a long and difficult job for the patient himself, his relatives and medical staff. However, the commenced restoration of physical activity on time improves the prognosis for labor activity in 15-25% of patients. Compliance with the principles of consistency, staging and an individual approach allows 80% of patients to return to normal life within the first year after a heart attack.
