Wellness Blog

Coronary arteries can become narrowed or blocked by a clot or a build-up of cholesterol. This reduces the amount of blood and oxygen getting to your heart muscle. This may cause angina ( discomfort in your chest, throat, jaw, arms or between the shoulder blades), shortness of breath, nausea and sometimes a heart attack.

The arteries used are the internal thoracic or internal mammary artery located inside of the breast bone. The most commonly used vein is the saphenous vein, located in the leg.

Importance of cardiac rehabilitation program:

Helps in:

1. Reducing and modifying risk factors that may cause further complications for CVD patients.
2. Improving quality of life by increasing physical activities and improving endurance.
3. Increasing patient independency in performing activities of daily living (ADL)
4. Improving self-esteem of patients.
5. Educate patients about their condition.

Who need cardiac rehabilitation?

1. Post MI (myocardial infarction)
2. Post CABG
3. Stable Angina
4. Compensated congestive Heart failure (CHF)
5. Percutaneous transluminal coronary angioplasty (PTCA)
6. Cardiomyopathy
7. Heart or other organ transplantation
8. Other cardiac surgeries including valvular and pacemaker insertion (including implantable cardioverter defibrillator)
9. Peripheral vascular disease
10.  Sudden cardiac death syndrome.
11. Cases at risk for coronary arterial disease (CAD) with diagnoses of diabetes mellitus, hyperlipidemia, hypertension
12.  End-stage of renal disease
13. Other patients who may benefit from structured exercise and patient education.

Cardiac rehabilitation team

The most important member in the cardiac rehabilitation team is the patient and it consists of:

1. Cardiologist
2. Physical therapist (specialized in cardiac rehabilitation)
3. Nurse (specialized in cardiac rehabilitation)
4. Dietitian
5. Social worker

Benefits of regular exercise:

1. Helps in strengthening heart muscle and increasing heart working capacity.
2. Reduce the risk of recurrence heart attack.
3. Reduce blood pressure in those with high blood pressure.
4. Control or prevent the development of diabetes.
5. Helps control weight and prevent obesity.
6. Manage stress and reduce anxiety and depression.
7. Improve physical fitness.

Physiotherapy care for cardiothoracic surgery patients

 Exercise plays a vital role for a normal healthy life and to prevent coronary artery disease. Also those who undergo cardiac surgeries, must have a regular exercise programme.

Exercise reduces stress and improves heart and lung functions better, blood cholesterol and fat decreases to normal levels and severity of blood pressure and diabetic is reduced.

Pre op protocol:

Chest binder:

Uses: To support the breastbone reduce pain and prevent the incision.

-Use it throughout the day for at least 6-8 weeks to heal.

-Don’t make it too tight for breathing

Deep breathing:

Repeat 5 times breathing deeply engages your lungs to cough more readily to help move secretion: take a very deep breath in through your nose and expand your ribs. Hold your breath for three seconds. Breath out through your mouth until all of the air is gone. If you are able to change your position in bed, move from your back onto your side-to-side.

Breathing exercises

Diaphragmatic breathing [belly breathing]

1. Sit in a comfortable position or lie flat on the bed or flat surface and relax your shoulder.

2. Put a hand on your chest and a hand on your stomach.

3. Breathe in through your nose for about two seconds, you should feel your stomach expand and move out.

4. Breath out for two seconds through pursed lips.

Purse lip breathing:

1. Breathe in slowly through your nose for two seconds, keeping your mouth closed.

2. Purse your lips as if you were going to whistle and breathe out.

Incentive spirometer:

Repeat 5 times every hour while awake. An incentive spirometer is a device used to help encourage deep breathing exercises. You will get one when you go to the preoperative Orientation Class.

1. Sit up straight and hold the spirometer in your hands

2. Take a deep breath in and let it out.

3. Place the mouthpiece in your mouth. Make sure your lips completely cover the mouthpiece.

4. Breathe in slowly through the mouthpiece (like sucking through a straw).

5. Hold your breath in for 3 seconds and then let it out.

6. Repeat as prescribed, typically about 10 breaths every hour.

Keep the spirometer in reverse position for exhalation and repeat it for 10 breaths.

Ankle movements:

Helps to maintain good blood circulation, lessen muscle loss and decrease swelling in the legs; pump the feet up and down at the ankles. Make circles with feet in each direction with the legs straight. Pull toes up and press the back of your knees down into the bed. Hold for three seconds and relax.

Breath and cough:

Repeat 2 times coughing may be needed to clear mucus in your lungs; while lying down, bend knees and support your incision firmly with a pillow or your hands. Take 3 deep breaths then breathe in and cough sharply. Clear mucus into a tissue; rest and then repeat as needed. Coughing will not damage your chest incision if you support the sternum when you cough.

Common experiences after heart surgery:

1. Post-operative confusion( delirium)
2. Clicking of the sternum (breast bone)
3. Numbness and tingling
4. Swelling (edema) of the legs and ankles

Post operative treatment In ICU:

DAY 1

1. Deep breathing exercises
2. Ankle toe movements
3. Incentive spirometer
4. Chest physiotherapy

Chest physiotherapy includes techniques and devices used to make it easier to cough up excess, thick or sticky mucus from your lungs. Some of them work to break up the mucus using vibration or by applying percussion (force) to the area of the lungs that has mucus.

1. Bed sitting done ( if patient is stable )

DAY 2:

1. Same as first day exercises as given above,
2. Chair sitting done (if patient is stable)

DAY 3:

1. Incentive physiotherapy
2. Chest physiotherapy
3. Deep breathing exercises
4. Exercises: Thoracic Expansion exercises

The same exercises are to be followed, and I can start walking around the bed. If the patient is stable, can walk up to 100 meters 5 times a day.

 DAY 4:

Follow the exercises as a day 3 given above

Sitting upright, roll your shoulders in a smooth motion up, back and down in a circle.

1. Leg straightening :Keep your thighs on the chair, straighten one leg. Relax that leg and then straighten the other leg. Repeat 10 times, every day.

Same exercises should be carried out regularly with adequate rest periods, can walk upto 100 meters 7 times a day, if a patient is stable is advised to climb one flight of stairs with the therapist.

DAY 5:

  The same exercises should be carried out regularly with adequate rest periods.

The patient advised to continue the same exercises, walking to be progressed upto 100 meters 10 times a day.

DAY 6,7: should be continued as followed

1. Stair climbing should be done before the date of discharge depends upon the patient's condition.
2. Patients will go home with advice to continue walking and exercises. Pamphlet given.
3. Coughing and Breathing Exercises: Remember to use your incentive spirometer 10 times per hour when you are awake. You may use a pillow or blanket to hold over your incision when you cough. This will provide support and decrease pain
4. Marching: Do the marching exercise in standing phase for one min per day.

Getting out from the bed

Advice:

Lie on your back and slowly turn to your left or right side. Carefully push your body up, using the elbow beneath you and the arm on the other side of your body. At the same time, gently swing both legs to the floor.

Walking distance after open heart surgery:

Things to remember before start walking:

1. Start walking after half an hour from taking your meal.
2. Begin with warming up before walking.
3. Wear comfortable, loose clothes.
4. Wear suitable shoes with good support.
5. Do not walk in very hot, humid or cold weather better to walk indoors
6. Do not exercise if you feel unwell, and stop exercising if you get any pain, or feel dizzy or sick.
7. If you are diabetic better to keep a snack with you.

Does and don’ts after surgery:

1. The patient should not drive for 6 weeks.

2. Don’t lift anything heavier than 1 kg

3. Do wear a chest binder and stockings for one month.

4. Advised to continue the exercises and walking.

5. You should stop exercising if you [Are sweating profusely, high temperature, extremely SOB, chest pain/discomfort]

6. Patients should not sleep in a prone position.

7. Climbing stairs is OK, but be careful. Balance may be a problem. Rest halfway up the stairs if you need to.

8. Slowly increase the amount and intensity of your activities over the first 3 months

9. Walking is a good exercise for the lungs and heart after surgery. Do not be concerned about how fast you are walking. Take it slow.

10.  Keep your legs raised when sitting.

11.  Always sit in an upright position, not slumped .

12.  Cough strongly from your tummy not your throat.

13.  Do not exercise on a full stomach.